“Be Fruitful and Multiply?” Ethical Takes on ART

News of a California woman giving birth to octuplets raises a pressing problem: the development and use of assisted reproductive technologies has outstripped our ethical and regulatory response.

Questions about assisted reproductive
technologies (ARTs) have been making major headlines with the California
octuplets.  Without sifting through the particularities of this
woman’s family story, a pressing problem surfaces:  the development
and use of these technologies has outstripped our ethical and regulatory
response.  As the Religious Institute’s just-released Open
Letter to Religious Leaders on Assisted Reproductive
states, "The use of ARTs is always a serious moral
and medical decision."   Ethical deliberation is desperately

Since the advent of these technologies
30 years ago, millions of women and men have used ARTs to try to have
children.  It is not a new story (although eight at once is
a rare occasion).  Yet the use of ARTs is a largely unregulated
practice in the United States.  Are they safe enough, effective
enough, affordable enough?  What are the ethical considerations
that should govern their use?  Moral judgments that take into consideration
medical, economic, and religious concerns will come to different conclusions
about artificial insemination than they might about in-vitro fertilization.  There is no easy answer, nor a single answer. 

We urgently need a public dialogue
– involving physicians, theologians, ethicists, clergy, health advocates
and the scientific community – that responds to the social, religious
and medical issues raised by the use of ARTs.  We need to assess
individual choice within a larger social context, so that we do not
divorce moral choices from moral responsibilities to one’s self, family
or the larger community.   In other words, the moral questions
not only involve the individual — health risk to self and potential
child(ren), ability to care for child(ren), religious belief/teaching,
partner’s desires, and personal motive.  But there are social
justice issues we as a community must weigh — medical effectiveness,
cost, and equal access.  We also must consider how ARTs reinforce
biological children as superior and women as valued only for childbearing.  

Medical Effectiveness and Economic

Not all ARTs are the same; they vary
in their cost and medical risk.  Some procedures have unknown long-term
health implications, not to mention high financial cost and limited
success.  There is a need for increased regulation to safeguard
health, additional research to determine the risks, and caution on the
use of high-risk, low-success technologies.  Medically effective
practices must be part of what determines the use of available technologies. 
With regard to in-vitro fertilization (IVF), for example, it is not
statistically effective to implant an excess of embryos
– and it could
increase health risks for the mother and children if multiple births
occur.  The high-financial cost also creates a class system of
those with access and those without. 

Equal Access and Non-Discriminatory Practices.

While religious and other cultural
beliefs will affect individual decisions about ARTs, no single religious
viewpoint should determine public policy or medical practice. 
We know from history that, when moral agency over reproductive choice
has been denied, marginalized persons and communities have been harmed
by forced sterilization, eugenics and medical experimentation in the
name of progress.  The right to make personal decisions about reproduction
should not be limited on the basis of marital status, sexual orientation,
gender identity, disability, class or race.   

‘Fruitfulness’ and Personal

I do not deny that many women and men
experience a yearning for biological children, or that women in particular
suffer in cultural and religious contexts that value them primarily
for childbearing.  Religious traditions have contributed to this
suffering.  From Jewish and Christian traditions, the Open Letter
calls for broader interpretations of texts such as "be fruitful and
multiply" and those that present infertility as a penalty for sin
or unfaithfulness.  Simultaneously, we must mine our religious
traditions’ rich sources of spiritual and moral support for various
understandings of creativity, generativity and family formation.    

As a society, and as faith communities,
we must commit to an ongoing conversation that respects an individual’s
desire to have biological children, holds medical professionals accountable
to nondiscriminatory and medically effective practices, and supports
reproductive justice for generations to come.    

The Religious Institute convened a
group of clergy, theologians, ethicists and health professionals to
create the Open Letter to Religious Leaders on Assisted Reproductive
Our intent was to help prepare religious leaders
to assist women and men seeking to become parents and to counsel individuals
and couples considering ARTs. I invite you into a discussion of the
moral and religious implications of these technologies.  The Open
Letter is available on our web site.  An accompanying guidebook, A Time
to Be Born
, will be published in May.