Moral theology, along with bioethics and moral philosophy, focuses on the principles, reasoning, and practice of good behavior. When taking or integrating a Christian theological approach, as in this article, such goodness includes the obligations, virtues, and realization of a human teleology that reflect the truth of the revelation of Christ. In order to identify good behavior, however, there must be some insight into evil; acts that are evil are possible and opposed to goodness, particularly as they inhibit or undermine the pursuit of grace and everlasting life in the vision of God. A full moral theology and integrated bioethics will therefore prohibit evil acts just as it encourages good acts. It all seems rather simple.
What do we do, however, when certain characteristics of an act seem, perhaps erroneously or injudiciously, to be evil and therefore cause us to question what is good? Not only might confusion reign, but our enthusiasm for what is, in its essence, a good act will be suppressed. Some ardent moralists might even judge those who practice the good act to be committing a grievous sin. This kind of situation can have tragic consequences, for suppression of positive moral behavior can be in itself one of the worst kinds of evil.
This dilemma is one that Christians must wrestle with periodically in the field of bioethics. This essay will consider a bioethical topic where an essentially good act appears to be actively suppressed by some moral theologians:[1] the practice of embryo adoption, in which a previously frozen (cryopreserved) human embryo is transferred into a woman’s uterus, and the woman and her spouse gestate, nurture, give birth to, and raise the child as their own.[2] These adopted embryonic persons were conceived when another couple engaged in vitro fertilization (IVF), causing the merger of sperm and egg in a laboratory for the sake of producing multiple embryos for transfer into the IVF-engaged woman’s uterus and possible pregnancy. Because most IVF clinics will test the produced embryos and select only those that are considered healthy, likely to survive, and desirable according to varying physical, cognitive, gender, and aesthetic characteristics, and because some embryos may not implant or survive to birth, the IVF process typically includes the production of many such embryos (a target rate for retrieval of a woman’s eggs is around 12–18, not all of which will be successfully fertilized).[3] Those that are not implanted will often be frozen through a cryopreservation process and stored for potential future use by the IVF-engaged couple. Nearly all of those frozen embryos are destined for years or even decades in that state, released only by their eventual death through natural expiration or active destruction. While embryos cannot suffer nerve-based pain, they do suffer—to an extent rarely experienced by any human being—indignity and severe harm to their health, peace, security, freedom, growth, spiritual destiny, and eventually their lives.
There are, at the least, hundreds of thousands of such embryonic persons frozen in the United States; such data is difficult to ascertain.[4] We can arrive at a good estimate, however, from data reported by the US Centers for Disease Control and Prevention in 2018 that over one-third of attempts at assisted reproduction technology (ART) involved the intention of freezing the embryos.[5] There are more than 300,000 attempts at ART each year in the United States and 1.5 million worldwide,[6] with many embryos conceived per attempt. Such data suggests that there are several hundred thousand frozen embryos added to storage every year in the United States alone.
For the Christian, Jesus’ unambiguous command to love one’s neighbor and his consistent teaching about the goodness of and responsibility for extending mercy to the most needy, suffering, and downtrodden members of society seem to favor consideration of embryo adoption as a loving and sacrificial act of mercy. On the other hand, there are aspects of embryo adoption that may give at least some moralists pause, and at times spark outright condemnation of the act. Does participation in embryo adoption involve real or implied complicity in the prior act of IVF, which is in itself considered a grievous sin by Catholics and many other Christians? Is embryo adoption too similar to surrogate motherhood, also considered by many to be sinful? Is the act of transferring a genetically unrelated embryo to the uterus of the adoptive mother an unacceptable indignity to the sanctity of the womb and of motherhood, or a matter of technological domination over the dignity of the nascent embryonic person? In this article, I argue that, despite such considerations, embryo adoption is not only morally permissible but laudatory.
Whether embryo adoption is cooperation with a prior sinful act depends, of course, on whether one considers IVF to be sinful. There is debate on this topic among Christians. The production of multiple embryonic persons in the process and the freezing or destruction of many of them is a strong reason to consider IVF to be a moral evil; it is a brutal and callous way to treat multitudes of early-stage human beings that are produced, stored, and packaged as if they were mere consumer goods. IVF also involves producing a human being in the technologically dominated environment of the laboratory and clinic, followed by a technician’s insertion of the chosen embryos into the uterus of the intended mother. This is a matter of asserting significant human control over an otherwise intensely meaningful, interpersonal, and natural act of procreation between a married couple who are naturally open to the providential involvement of God in the possible creation of a new person. One might consider such human arrogance in the very creation of a new person to be an affront to God and a considerable indignity to the person formed. Even for those who have trouble accepting that a human embryo is a morally dignified person with basic rights, the highly technical production of new human beings in laboratories, the consumer-like acquisition of a family member by IVF-engaged couples, the profit-driven hunger of IVF clinics for more clients and more efficient processes, and the widespread freezing, storing, and destruction of human embryos might all encourage a morally relevant feeling of disgust or disillusion.[7]
Embryo adoption is not, however, morally illicit cooperation with the evils of IVF, because the object and effect of the adoption is, primarily, rescuing the frozen embryo.[8] The adoption thereby resolves one aspect of the physical and moral evil produced by IVF, which is sequentially prior to the adoption. The adoptive couple does not, by their action, encourage IVF or its participants, for their act is an extraordinary and visibly pro-life one that highlights the terrible plight of frozen human embryos.[9] In fact, it is a radically countercultural, loving, and generous demonstration that challenges others to recognize the human embryo as a dignified child of God. There may be some similarity in the desires of both the adoptive couple and the IVF-engaged couple to acquire a new child for their family, but the adoptive couple’s object is fundamentally different in its focus on improving the welfare of an already living human being.
Embryo adoption also does not bear the same moral flaws as does the practice of surrogate birth and motherhood. In the practice of surrogacy, a couple solicits and usually pays for the conception of the child outside the marriage, and the gestational mother is a contractual agent in a willful transaction among all parties. The couple willfully uses the creation of a child and the gestational “services” of the birth mother selfishly and with highly meaningful disrespect for the child and the birth mother. In embryo adoption, there is no encouragement of, or cooperation with, IVF; no cooperation or solicitation of third parties to engage in a sinful act; and no focus on creation of a new child at all—only the rescue of an already conceived, dignified child.[10]
While a woman’s uterus has a central role in a marriage as the site of implantation, pregnancy, gestation, and nurturing of a new child, some moralists go too far in arguing that the uterus is sacrosanct and therefore its use to nurture a non-genetically related child is a grievous violation of the natural law.[11] Such logic is too similar to animism or idolatry, for it attributes to an organic substance an uncompromising and inherently divine status. Because humans are created in the image of God, every part of the human body is oriented to that person’s true, final good; that which adheres to the vision of God and the life lived in imitation of Christ. This includes the call to mercy and sacrifice for the sake of the other. Consider that very few moralists would argue that it is fundamentally unacceptable for a person to put their very life in danger to save the life of someone else. If risking one’s life can be acceptable to save another, why should we consider it a sin for a mother to offer her womb to save an embryonic person?
Adoption has traditionally been considered by the Christian community to be a loving fulfillment of a mother’s natural and marital role.[12] The presence of a genetically unrelated child in the adoptive mother’s uterus does not undermine the marital covenant, for the husband is a consenting, co-adoptive parent, and he is no more relationally excluded from the gestation of the new family member than he is from the mother’s independent breastfeeding, cuddling, or otherwise nurturing a child. There is a special intimacy involved in the joint decision to adopt and the care given by the father to the adoptive mother as she experiences pregnancy. Most importantly, embryo adoption does not substitute in any way for natural procreation, for it is not creation of a child, and even conjugal relations can continue for much of the pregnancy.
Although there is an important technical aspect to the procedure of transferring a frozen and thawed embryo to the adoptive mother’s uterus, this is not a matter of undignified technological domination over the creation of human life.[13] In fact, there is no life created, but only a life saved. It is a medical procedure that removes a critically harmed human being from peril, and is therefore a caring, life-fulfilling act that not only respects but actively supports the dignified integrity of the patient.
In evaluating the goodness of embryo adoption, we might apply the principle of double effect, which is a means to evaluate the morality of an act when there is a mix of good and bad circumstances and consequences of the act.[14] Therefore, in the case of frozen embryo adoption, the object of the act, which is clearly to rescue the frozen embryo, is good. There is no intention to obtain anything other than the good effect if the adopting parents are seeking the welfare of the child (as opposed to merely seeking acquisition of a new child). The good effects of embryo adoption are not caused by the bad, and the rescue of a dignified human life overwhelms proportionally any potential bad effect. The good effects proceed at least as immediately as any bad ones, and the good effects are related certainly to the act of embryo adoption, while any bad effects are merely possible or unlikely.
In the Roman Catholic Church’s document Dignitas personae, authored by the Congregation for the Doctrine of the Faith (CDF) in 2008, the CDF recognized the good intentions behind rescuing frozen human embryos but cited some important concerns.[16] The document did not declare embryo adoption to be morally illicit as it clearly indicated for a number of other acts. In fact, according to its 1987 document Donum vitae, which must be recognized as the continued authoritative teaching of the Catholic Church, the embryonic person must be “defended in its integrity, tended and cared for, to the extent possible, in the same way as any other human being as far as medical assistance is concerned,” and Catholics cannot deliberately “expose to death human embryos obtained ‘in vitro.’”[17] The CDF declared that “courageous opposition to all those practices which result in grave and unjust discrimination against unborn human beings” is a duty for all.[18] Pope Benedict XVI stated that “life is the first good received from God and is fundamental to all others; to guarantee the right to life for all and in an equal manner for all is the duty upon which the future of humanity depends.”[19] Pope John Paul II wrote that concern for the child at any stage of development “is the primary and fundamental test of the relationship of one human being to another.”[20]
Understanding the CDF’s concerns about embryo adoption requires paying close attention to the significant difference in object between “treatment for infertility” and rescuing the frozen embryo “solely in order to allow human beings to be born who are otherwise condemned to destruction.”[21] By “treatment for infertility,” the CDF was referring to the possibility that a couple might engage in embryo adoption primarily for the purpose of adding a new member of their family, rather than as a merciful sacrifice for the sake of the embryo’s welfare. The CDF counseled that “treatment for infertility is not ethically acceptable for the same reasons which make artificial heterologous procreation illicit as well as any form of surrogate motherhood; this practice would also lead to other problems of a medical, psychological and legal nature.”[22] In short, merely using embryo adoption to acquire a new child involves cooperation with the immoral act of IVF by carrying forward the original object of acquisition of a child and selfishly using the morally prohibited act of IVF as well as the IVF-engaged couple’s participation to achieve a personal objective. To be clear, such an object is much different than the object of rescuing the child, which is not at all maligned by the CDF in this document.[23]
The CDF also expressed its worry that Catholics might inappropriately view the practice of embryo adoption as an adequate resolution of the moral and other problems associated with the widespread practice of IVF. Dignitas personae indicates that “the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved”—the Italian meaning is closer to irreparable—and the document quotes Pope St. John Paul II’s prior statement that “there seems to be no morally licit solution” to such a problem.[24] It is therefore clear that the evils of IVF extend beyond the plight of frozen embryos, and that even adoption of every single frozen embryo would not “resolve” the injustice and immorality that characterize participation in IVF by couples, technicians, and corporations. While embryo adoptions will virtuously save the lives of embryonic human beings, the scourge of IVF can only be resolved when the practice of IVF is ended entirely.
The Positive Obligation and Opportunity for Mercy
Jesus taught that we have an obligation of mercy toward our neighbor in need: “[The king] will answer them, ‘Amen, I say to you, what you did not do for one of these least ones, you did not do for me’” (Matt 25:45–46, NABRE).[25] The parable of the Good Samaritan in the Gospel of Luke dramatically contrasts the merciful works of the Samaritan, who will be rewarded with eternal life, with the inaction of the priest and Levite, who resorted to excuses drawn from otherwise holy law and tradition. This parable is not merely an example of good action, but a strong warning to all of us who look to moral law as a means of apparently reducing the primacy of loving mercy. Jesus was consistent in his harsh condemnation of the obedient scribes and the Pharisees who “neglected the weightier things of the law: judgment and mercy and fidelity” (Matt 23:23).
Even more than an obligation, our merciful behavior toward others is a matter of deepening our relationship with Christ himself. “For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you made me welcome” (Matt. 25:35). This teaching is embedded in Jesus’ warning of the final judgment (Matt. 25:31-46) and is repeated elsewhere in the New Testament, for “If someone who has the riches of this world sees his brother in need and closes his heart to him, how does the love of God abide in him?” (1 Jn. 3:17). It is important to note that such teachings are presented without qualification by the ethical tenets of the Law or any other consideration.
In regard to embryo adoption, it should be seen as a grace-filled opportunity to extend mercy and love to a neighbor in dire need. It is not only a fulfillment but an enhancement of the marital covenant, for it is a consensual and highly intimate act – emotionally, relationally, and biologically – of entering into parenthood. Importantly, those who wonder about the intricacies of moral law and its application to embryo adoption should at least be particularly careful not to enter into a pharisaical condemnation of what is, in its essence, a powerfully good act. The “Good Samaritans” of our world need all the encouragement they can get.
References
[1] Nicanor Austriaco, “Embryo Transfer and the Extended Inseparability Argument,” National Catholic Bioethics Quarterly 21, no. 1 (2021): 29-35; Tadeusz Pacholczyk, “On the Moral Objectionability of Human Embryo Adoption,” in The Ethics of Embryo Adoption and the Catholic Tradition: Moral Arguments, Economic Reality and Social Analysis, ed. Sarah-Vaughan Brakman and Darlene Fozard Weaver (Berlin: Springer, 2007), 71; Charles Robertson, “A Thomistic Analysis of Embryo Adoption,” National Catholic Bioethics Quarterly 14, no. 4 (2014): 673–97, https://doi.org/10.5840/ncbq201414470; Elio Sgreccia, Personalist Bioethics: Foundations and Applications, trans. John A. DiCamillo and Michael J. Miller (Philadelphia, PA: National Catholic Bioethics Center, 2012), 526–27; Thomas K. Nelson, “Personhood and Embryo Adoption,” Linacre Quarterly 79, no. 3 (2021): 261–74, https://doi.org/10.1179/002436312804872767; and Mary Geach, “Are There Any Circumstances in Which It Would Be Morally Admirable for a Woman to Seek to Have an Orphan Embryo Implanted in Her Womb?” in Issues for a Catholic Bioethic: Proceedings of the International Conference to Celebrate the Twentieth Anniversary of the Linacre Center, ed. Luke Gormally (London: Linacre Center, 1999), 341–46.
[2] Although embryo adoption can certainly be enacted by a single mother or unmarried couple, there are more complex moral considerations for such circumstances. In order to keep the focus on moral objections to embryo transfer in itself, this article’s consideration is restricted to embryo adoption by married couples.
[3] Yin Jun Law et al., “Is There an Optimal Number of Oocytes Retrieved at which Live Birth Rates or Cumulative Live Birth Rates per Aspiration Are Maximized after ART? A Systematic Review,” Reproductive BioMedicine Online 42, no. 1 (2021): https://doi.org/10.1016/j.rbmo.2020.10.008.
[4] David I. Hoffman et al., “Cryopreserved Embryos in the United States and Their Availability for Research,” Fertility and Sterility 79, no. 5 (2003):1063–69, https://doi.org/10.1016/S0015-0282(03)00172-9.
[5] Centers for Disease Control and Prevention (CDC), “Assisted Reproductive Technology,” CDC.gov, April 20, 2021, https://www.cdc.gov/art/artdata/index.html.
[6] CDC, “Assisted Reproductive Technology;” European Society of Human Reproduction and Embryology, “ART Fact Sheet,” ESHRE.eu, accessed July 14, 2021, https://www.eshre.eu/Press-Room/Resources.
[7] Rachel Strodel, “Fertility Clinics Are Being Taken Over by For-Profit Companies Selling False Hope,” Think, March 1, 2020, https://www.nbcnews.com/think/opinion/fertility-clinics-are-being-taken-over-profit-companies-selling-false-ncna1145671; Rebecca Robbins, “Investors See Big Money in Infertility. And They’re Transforming the Industry,” STAT News, December 4, 2017, https://www.statnews.com/2017/12/04/infertility-industry-investment/; ReportBuyer, “The Global IVF Services Revenue Market Generated $12,505 Million in 2018 and Is Projected to Reach $26,376 Million by 2026, Growing at a CAGR of 9.8% from 2019 to 2026,” PR Newswire, July 19, 2019, https://www.prnewswire.com/news-releases/the-global-ivf-services-revenue-market-generated-12-505-million-in-2018-and-is-projected-to-reach-26-376-million-by-2026--growing-at-a-cagr-of-9-8-from-2019-to-2026--300881817.html.
[8] It is crucial here to distinguish between the object, or moral purpose, and the circumstances. If the object is to save the embryo, the circumstances will most certainly include the joy of adding a new member to the family and raising the child, and those are good circumstances. If the object, however, is primarily to add a child to the family rather than to save a distressed person, this is a more narrowly self-interested purpose that cooperates with the purpose of the IVF, which is to obtain a child; mercy and charity in such an object are minimized or may not be considerations at all.
[9] We might even consider the embryo adoption to be a redemptive act that counters the social sin of the prior IVF. I do not make this argument here, but it seems to be worth consideration and further discussion.
[10] Steven A. Long, “An Argument for the Embryonic Intactness of Marriage,” The Thomist 70, no. 2 (2006): 267–88, https://doi.org/10.1353/tho.2006.0019.
[11] For such an argument against embryo adoption, see Tadeusz Pacholczyk, “On the Moral Objectionability of Human Embryo Adoption,” 78.
[12] Levi Bareither, “Orphan Care and the Early Church,” Story International, January 31, 2019, https://www.storyintl.org/blog/orphan-care-and-the-early-church; “The Theology and Practice of Adoption,” FBC Durham, accessed August 13, 2021, https://www.fbcdurham.org/wp-content/uploads/2015/08/Theology-Practice-of-Adoption-1-Biblical-Theology-of-Adoption.pdf.
[13] For such an argument, see Mary Geach, “Are There Any Circumstances in Which It Would Be Morally Admirable for a Woman to Seek to Have an Orphan Embryo Implanted in Her Womb?”
[14] See Joseph T. Mangan, “An Historical Analysis of the Principle of Double Effect,” Theological Studies 10, no. 1 (1949): 41–61, https://doi.org/10.1177/004056394901000102; Edward J. Furton and Albert S. Moraczewski, “Double Effect,” in Catholic Health Care Ethics, 3rd ed., ed. Edward J. Furton (Philadelphia, PA: National Catholic Bioethics Center, 2020), 3.18–3.23. On dual benefits and intentions, see E. Christian Brugger, “In Defense of Transferring Heterologous Embryos,” National Catholic Bioethics Quarterly 5, no. 1 (2005): 112, https://doi.org/10.5840/ncbq20055170.
[15] For a much longer analysis of the Catholic debate over embryo adoption, see Christopher M. Reilly, “Rescuing the Good Samaritan in Embryo Adoption and Beyond, National Catholic Bioethics Quarterly 20, no. 3 (2020): 487–98.
[16] Congregation for the Doctrine of the Faith (CDF), Dignitas personae (Rome: CDF, September 8, 2008), https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html.
[17] CDF, Donum vitae (Rome: CDF, February 22, 1987), I.1, I.5, https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html.
[18] CDF, Dignitas personae, n. 37.
[19] Benedict XVI, “Address of His Holiness Benedict XVI to the Participants in the General Assembly of the Pontifical Academy for Life,” Vatican.va, February 24, 2007, https://www.vatican.va/content/benedict-xvi/en/speeches/2007/february/documents/hf_ben-xvi_spe_20070224_academy-life.html.
[20] John Paul II, Familiaris consortio (Rome: November 22, 1981), n. 26, https://www.vatican.va/content/john-paul-ii/en/apost_exhortations/documents/hf_jp-ii_exh_19811122_familiaris-consortio.html.
[21] CDF, Dignitas personae, n. 19.
[22] CDF, Dignitas personae, n. 19.
[23] For an extended discussion, see William E. May, “The Object of the Acting Woman in Embryo Rescue,” in Thomas V. Berg and Edward J. Furton, eds., Human Embryo Adoption: Biotechnology, Marriage, and the Right to Life (Philadelphia, PA: National Catholic Bioethics Center, 2009), 145.
[24] CDF, Dignitas personae, n. 19, emphasis original, citing John Paul II, Address to the Participants in the Symposium on “Evngelium vitae and Law” and the Eleventh International Colloquium on Roman and Canon Law (May 24 1996), in Acta Apostolicae Sedis 88 (1996): 943–44; and Edward J. Furton, “Embryo Adoption Reconsidered,” in “Responses to Dignitas personae: Part II of II,” ed. Edward J. Furton, National Catholic Bioethics Quarterly 10, no. 2 (2010): 333.
[25] Also see John 13:14; Matt. 22:36–40.
Christopher M. Reilly, “Ambryo Adoption: A Radically Counter-Cultural Act of Mercy,” Dignitas 27, no. 1–4 (2020): 28–32.
