1 Apr 1998 | BIOETHICS
Date: April 1998
Key Principles in the Use of Assisted Human Reproductive Technologies:
Assisted Human Reproduction concerns the origins of human life, and as such should be subject to moral, ethical, scientific and legal review. This review, which is currently taking place in New Zealand and internationally, is a reflection of the fundamental duty of society to respect and protect life at all stages of the lifespan especially at its most vulnerable stages. It recognises the need for control, accountability and limits in an area that goes to the heart of what it means to be human - themes which we have addressed before in our teaching and now wish to develop further.1
Life as Gift
A remarkable balance of forces and physical constants is needed for the very evolution and survival of life, and even more so for intelligent and self-conscious life. Given the range of possibilities in reproduction the sheer contingency and improbability of any individual's existence illustrates why human life is such a unique gift. Moreover we believe that because human life is a profound gift from God the welfare of a child must always be considered within the context of relationship and community. Life is at the base of all else that is human.
Deep within the heart of every person there is a hidden understanding of what it means to be human. However, that understanding may not be articulated, consciously understood, or have ever been considered within a religious or moral framework. It arises from our own knowledge of our hidden selves, and is nurtured by those precious relationships which open our eyes to love as the fulfillment of life. This understanding of our humanness is indeed a hidden treasure, and reflects our individuality even as it binds us together in the human community.
There are times within our lives when we are faced with making decisions which bring us to the deepest part of ourselves. These decisions centre around the meaning of our existence and the quality of our life. The importance of these decisions leads us to search for stable reference points for guidance. For many, points of reference are provided within a religious or philosophical framework. For others, the knowledge of what it means to be fully human can provide the source of wisdom needed to make decisions in an environment of rapid change.
In these times we are facing major decisions, both individually and as a society, in relation to our own reproduction. While scientific advances have provided hope to couples experiencing difficulty in having children they have simultaneously raised fundamental personal and communal questions about what it means to be human. The issues raised by these questions highlight the fact that, embedded within our shared humanity lie certain principles which cannot be ignored in ethical decision-making. The growth of assisted reproductive technologies tends to outstrip our ability to fully appreciate the ethical and moral implications of their use. We believe that an understanding of moral and ethical principles will allow us individually and collectively to make informed judgements about the use of assisted human reproductive technologies. These principles are derived from our understanding of what it means to be fully human and to live in community.
To assist in this understanding we outline principles which require consideration in any use of assisted reproductive technologies: respect for the dignity of human life; protection of the vulnerable; respect for autonomy; informed consent; the balancing of individual and collective interests; the right to genetic information and knowledge of origins. It is our belief that these principles provide a framework through which the stability and integrity of society can be promoted as we move towards a fuller appreciation of the implications of the use of these technologies.
Key Principles in the Use of Assisted Human Reproductive Technologies
Respect for the Dignity of Human Life
The human foetus is a human being from conception, when ovum and sperm unite to form a unique individual. From this moment the foetus is already the human being that it will always be and will only grow in size and complexity. Human life and dignity must be protected and respected from this very beginning. We instinctively know within our hearts when the actions of others demean our dignity, assault our self esteem, or adversely impact upon our rights as human beings. In acknowledging that a new human life begins at conception we are also committing ourselves to providing for that unique individual the same safeguards and rights that we now enjoy, and which furnish a necessary shelter within which we can develop our full human potential.
Protection of the Vulnerable
Protection of the welfare and dignity of vulnerable persons includes not only those groups whose rights are recognised in law. By implication vulnerable groups also include persons whose rights may be infringed by certain actions, those who cannot defend or speak for themselves, and those who may be exploited in any way. The welfare and interests of the child, who is the most vulnerable in the use of assisted reproductive technology, must always be protected. "A society lacks solid foundations when on the one hand, it asserts values such as the dignity of the person, justice and peace, but then, on the other hand, radically acts to the contrary by allowing or tolerating a variety of ways in which life is devalued and violated, especially where it is weak or marginalised.2
Respect for Autonomy
The history of medical research in New Zealand underlines the need to respect the autonomy and innate dignity of the individual. Respect for autonomy is reflected in legislation through the principle of equality, as for example expressed in Human Rights legislation. This principle of equality is accepted as covering all groups within our society. By extension such respect and equality extend to the human person from conception, and exist no matter what the circumstances of an individual's conception and birth.
The principle of respect for the autonomy and dignity of the person finds practical expression in the obtaining by the healthcare professional of informed consent from couples using assisted human reproductive technologies. Informed consent cannot occur without a comprehensive explanation of all risks and benefits associated with the use of these procedures. We question whether knowledge of the long term effects of many of these technologies is as yet sufficient for couples to make truly informed decisions. Experience is so limited that the future impact upon children conceived through the use of assisted reproduction technologies is not yet known.
Balancing of Individual and Collective Interests
As individuals we have the right to autonomy in making decisions about our moral well-being, but in doing so we must recognise that we are part of a larger society and that our individual actions can impact adversely upon society. While individual and collective interests are worthy of protection, individual autonomy can never be divorced from respect for persons and the protection of human life. "It is impossible to further the common good without acknowledging and defending the right to life, upon which all the other inalienable rights of individuals are founded and from which they develop."3 All persons are to be treated with dignity and respect and not viewed as objects or as a means to an end for others.
Right to Genetic Information and Knowledge of Origins
Growth in understanding of the adoption process has illustrated the need to understand our origins and to be able to place ourselves genetically and emotionally within a family. Wider awareness of the principles enshrined in the Treaty of Waitangi has also highlighted the importance of the concepts of whanau and family and emphasised the necessity of belonging for all people.
The Principles Applied
Respect for the dignity of human life is the foundational principle from which other principles flow. In Catholic teaching life is a sacred gift from God, to be protected and nurtured at every stage from conception to natural death. In nurturing life we are called to care not only for those individuals currently alive, but also for generations as yet unborn. In this respect there is a universal aspect to individual and group decisions made in the area of our own reproduction. As Pope John Paul II observes, "Only respect for life can be the foundation and guarantee of the most precious and essential goods of society, such as democracy and peace."4
These fundamental principles provide us with a framework for evaluating the rapid developments in the field of assisted reproduction technologies. Internationally and locally legislation is being developed in this field. The decision to move in this respect is to be applauded, as it is consistent with the principles of protecting the vulnerable and balancing individual and collective interests.
A regulatory body involving medical, scientific, religious and philosophical expertise is needed to establish fundamental ethical standards grounded in respect for human life and dignity. In an area of such profound importance it is essential that there be a balance of community representation in the membership of this regulatory body.
The right to know our lineage or genetic heritage requires that any legislation provide for the sharing of information between all those involved in any form of assisted reproduction. The provision of this information is a form of accountability in the use of these technologies.
Commercialisation of aspects of assisted reproduction commodify the child and raise the possibility of exploitation, both of which offend against the innate dignity of human life. Consequently payments for embryos, gametes, fetal tissue or babies are not in accordance with the fundamental respect for the dignity of human life, and the protection of the vulnerable. To prohibit this commercialisation of reproduction would also be an expression of the fundamental respect for the sacredness of the human body which is so pivotal in Maori culture.
Surrogacy is an arrangement made before conception in which the child to be produced is to be transferred from the birth mother to another person or persons. Surrogacy offends against the dignity of the child and the uniqueness of the mother-child relationship. This indignity is compounded by payments for these arrangements, which turn children and the reproductive capacity of women into commodities. Further, women bearing children for others are often vulnerable due to disparities of power and resources between themselves and those seeking their help.
The placing of a human embryo in an animal or the creation of human-animal hybrids should always be prohibited because they deny the embryo's connections to the human community, the dignity of human life, and the right to genetic information.
The cloning of human beings would create genetically identical individuals. The uniqueness of personal identity is a gift to each person from God. While our individuality cannot be exclusively reduced to genetic make-up, the possibility of cloning humans is incompatible with the dignity of the person. Every person is called into existence by a unique creative act of God through the union of two parents. As human beings it is our fundamental right to be born in a way that is consistent with our human nature.5 This is the foundation of all human dignity. Cloning of humans also subverts and confuses basic parent-child, sibling and family relationships. "Children have the right to be born in a human way and not in a laboratory. Going against these principles should be interpreted not as opposition to science or as a brake on progress, but as safeguarding those values which constitute the human being and its existence."6
"Genetic testing can assist sound decision-making in a wide range of situations...To the extent that genetic testing sets the stage for a cure or effective therapy it is a blessing."7 The use of genetic testing as a prelude to abortion, to discriminate against a group of people such as those with genetic disorders, for sex selection, or for eugenic purposes highlights the potential for abuse of this procedure.
Germ-line modification has the potential to permanently alter the human genetic heritage by changing the genetic structure of individuals in ways which can be inherited. Its safety cannot be guaranteed without putting future generations at risk, and thus it contravenes the principles of respect for the dignity of human life and protection of the vulnerable (unborn generations).
In-vitro fertilisation often produces a greater number of embryos than that needed for implantation. While we do not wish to endorse in-vitro fertilisation we wish to "Limit the harm"8 of its use. Consequently, the storage of embryos by cryopreservation or other means and the creation or use of "surplus" human embryos for research must be viewed as an assault on a vulnerable and powerless group. The lack of legislative control over commercial activities involving in-vitro fertilisation in New Zealand remains a major concern.
Infertility – A Catholic Perspective
Infertility can cause great pain for couples who desire children. Some of that pain and anguish is caused by societal pressure. The Catholic Church believes that life comes from God, in whose image each person is created. It teaches that assisted conception is only acceptable between a husband and wife in very specific circumstances which assist the natural processes of generation and do not pose undue risks for parent or child.
The suffering of those who desire a child can be deep and overwhelming, and those who seek to alleviate that suffering through technological intervention may do so with good intention. However, this cannot be done at the expense of human dignity or of life itself. Whether our understanding of what it means to be human flows from a religious context or a secular context, it binds us together in the human community and transcends the boundaries of generations.
The use of new reproductive technologies requires well defined boundaries and systems of accountability. It also provides society with a significant challenge. Existence is the first gift of God to us, and each person is a unique gift to the community of all human beings. As we deepen our appreciation of this gift of life we discover a connectedness with those around us, those who have gone before us, and those who will come after us. To reflect upon this is to be drawn into the deepest part of ourselves where there is a hidden understanding of what it means to be human. Inevitably this leads to an awareness of our Creator and a realisation that human life is sacred in both its origins and its destiny. This consecration of life is the context for evaluating all human activity, lifting our vision beyond that of our lifespan into eternity:
... human life and its transmission are realities whose meaning is not limited by the horizons of this life only: their true evaluation and full meaning can only be understood in reference to our eternal destiny. 9
In this context we see new reproductive technologies offering many possibilities; equally we see the need for defined boundaries and systems of accountability to protect the gift which is life. How this is done will be a collective statement about who we are as a people and what we value as a society.
God, the Lord of life, has entrusted to us the whole mission of safeguarding life, and we must carry it out in a manner worthy of ourselves.10
+ P J Cullinane
Bishop of Palmerston North,
President, NZ Catholic Bishops Conference
+ D G Browne
Bishop of Hamilton
Vice President, NZ Catholic Bishops Conference
+ J A Dew
Auxiliary Bishop of Wellington
Secretary, NZ Catholic Bishops Conference
+ L A Boyle
Bishop of Dunedin
+ J J Cunneen
Bishop of Christchurch
+ O J Dolan
Coadjutor Bishop of Palmerston North
+ P J Dunn
Bishop of Auckland
+ R W Leamy SM
Emeritus Bishop of Rarotonga
+ M T Mariu SM
Auxiliary Bishop of Hamilton
+ Cardinal Thomas Williams
Archbishop of Wellington
1. See, for example The Morality of In-vitro Fertilisation. New Zealand Catholic Bishops Conference, 1984. "Catholic Bishops Submission to Ministerial Committee on Assisted Reproductive Technologies", March 1994.
2. John Paul II, Evangelium Vitae, 1995, No 101.
5. Congregation for the Doctrine of the Faith, Donum Vitae, 1987.
6. Fr Gino Concetti, Editorial, L'Osservatore Romano 26 February 1997.
7. United States of America National Conference of Catholic Bishops: Committee on Science and Human Values, Critical Decisions: Genetic Testing and its Implications, 1996.
8. John Paul II, Evangelium Vitae, 1995, No 73.
9. The Second Vatican Council, Gaudium et Spes, 1965, No 51.