Fertility in Women’s Health: Catholic Moral TeachingIntegritas Institute Bioethics Symposium

April 5, 2014Rebecca Davis Mathias, PhD

Great burden for couples to bear Especially when they so deeply desire

to have a child and live out their vocation to be open to life and welcome the gift of children from God

Infertility treatment must respect God’s design for married love

The Church, with sincere compassion and empathy . . . offers guidance and hope through her teachings

Infertility Challenges

On how to understand and approach infertility in a way that reverences and protects the dignity of the human person and respects God’s divine plan for married

love. The challenge is to diagnose and address

problems so these bodies can function as they should – and there is no moral problem in doing this, any more than there is in other medical treatments to restore health. (Life Giving Love in an Age

of Technology)

Infertility Challenges

Moral teachings flow principally from the natural law, lex natualis, understood in the light of the revelation Christ has entrusted to his Church

Natural law is a law written in the human heart, recognized by

reason, a law distinct from the positive law of any State

Natural Law

From this source, the Church has derived its understanding of the nature of:

1. The human person2. Human acts3. The goals that shape human

activity

Ethical and Religious Directives for Catholic Health Care Services - Preamble

When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the

marital act itself, may be used to help married couples conceive.

Ethical and ReligiousDirectives - 38

Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos, or their deliberate generation in such numbers that it is clearly envisaged that all cannot implant and

some are simply being used to maximize the chances of others implanting, may be used as therapies for infertility.

Ethical and ReligiousDirectives - 39

Heterologous fertilization (that is, any technique used to achieve

conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the

spouses, and the dignity proper to parents and the child.

Ethical and ReligiousDirectives - 40

Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extracorporeal conception).

Ethical and ReligiousDirectives - 41

A Catholic health care institution that provides treatment for infertility

should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).

Ethical and ReligiousDirectives - 43

3 Moral Considerations

1. There is a moral order2. This moral order can be

known3. What it means to be

human is the basis of this

moral order

Three Fonts of Morality

1. Act2. Intention3. Circumstances or

Consequences

Questions for Moral Decision-Making

1. ActWhat?

2. IntentionWhy?

3. CircumstancesWho & to Whom? When? Where? How?

Foreseeable Consequences? Viable Alternatives?

Humanae Vitae

Pope Paul VI’s July 25, 1968 Official, magisterial teaching of the Catholic Church

On the regulation of birth Issue ignited controversy Prior to Vatican II (1962 – 1965)

Prominent Catholic theologians

raised questions

Humanae Vitae

Pope John XXII appointed a commission to study the subject

It started with 6 men, mostly scientists

Grew to over 60 members Including 4 women Dialogic for 3 years

Humanae Vitae At end of commission’s 3rd meeting in 1964, Pope Paul

VI urged group to:

Continue its deliberations, listen to the anxiety of so

many souls, and work diligently without worrying

about criticism or difficulties.

Humanae Vitae Prophesies that contraception would lead to:

1. Promiscuity2. Sexual diseases [STIs]3. Abortion4. Divorce 5. Increasing anti-life mentality and culture

Humanae Vitae § 7The question of humanprocreation cannot be limited to mere scientificanalysis

The Church demonstrates a commitment to monitor and critique due respect for human dignity and human flourishing as technology progresses

For example, in Caritas in Veritate Pope Benedict XVI advocates that the

Church’s mission is primarily a moral and evangelical one and not a technical one of medicine or economics

Caritas in Veritate (2009)

Blessed Pope John Paul II

Great defender of HV Provides a personalist

understanding of sexuality

Theology of the Body (1997) Familiaris Consortio (1981)

Promotes Natural Family Planning (NFP)

Blessed Pope John Paul II - NFP

Fertility is offered to one’s partner and lovingly received

Fully human - it allows for transcendence of desire through self-control in the service of a higher good

Fully giving and open to acceptance of children

Science Betrayed If Not in the Service of Humans

Blessed John Paul II claims that . . .

Science and faith are not foreign to one another, but on the contrary,

both need and reciprocally complement each other. . .

Blessed John Paul II

We are now touching upon the autonomy of the sciences.

Today the postulate of unlimited freedom in

scientific research is often defended. In this regard, if

on one hand [sic] it is necessary to recognize the

right of the sciences to apply the methods of research that

are proper to them;

Blessed John Paul II

on the other, one cannot agree with the affirmation that the field of research itself is not subject to any limitations. The boundary is, precisely, the fundamental distinction between good and evil. This distinction takes place in [the

person’s] conscience.

Conscience

Deep within the conscience men and women discover a law which they have not laid upon themselves but

which they must obey.Its voice, ever calling them to love

and to do what is good and to avoid what is evil, tells them

inwardly at the right moment: do this,

shun that.

Conscience

For people have in theirhearts a law inscribed by God.

Their dignity lies inobserving this law,

and by it they will be judged.

Vatican Council II,Pastoral Constitution on the Church in the Modern World

Conscience

The ability to reason or discern well the moral decisions we face in our every day living

Practical wisdom – well-informed

Process of determining right from wrong

Not a magic voice in our heads

Humanae Vitae § 12

This doctrine, often set forth by the teaching authority, is founded upon the inseparable connection, willed by God, and which man cannot break on his own initiative, between the two meanings of the conjugal act:

union and procreation.

Humanae Vitae § 12

For, by its intimate structure, the conjugal act, while most closely uniting the spouses, enables them to procreate

new lives according to laws inscribed in the very being

of man and woman.

Humanae Vitae § 12

It is by safeguarding these two essential aspects, union and procreation,

that the conjugal act preserves in its fullness the sense of true mutual love and its ordination towards man’s most high calling to parenthood.

Donum Vitae (1987)Evangelium Vitae (1995)Dignitas Personae (2008)

From the moment of fertilization, the new life is a human being with unconditional respect and moral rights

Because the embryo must be treated as a person, it

needs to be cared for as any other human being

Donum Vitae (1987)Evangelium Vitae (1995)Dignitas Personae (2008)

Teachings allow for fertility medication to encourage ovulation (a source of many higher-order multiple births)

Surgery to correct conditions like varicoceles and endometriosis

Forbids procedures that substitute medical techniques for human intercourse

Certainly, techniques aimed at removing obstacles to natural fertilization, as for

example, hormonal treatments for infertility, surgery for endometriosis, unblocking of

fallopian tubes or their surgical repair, are licit. All these techniques may be considered

authentic treatments because, once the problem causing the infertility has been resolved, the married couple is able to engage in conjugal

acts resulting in procreation, without thephysician’s action directly interfering in that act

itself. None of these treatments replacesthe conjugal act, which alone is worthy of truly

responsible procreation.

Donum Vitae (no. 13)

No biologist or doctor can reasonably claim, by

virtue of his scientific competence, to be able to decide on people's origin and

destiny.This norm must be applied in a

particular way in the field of sexuality and procreation, in

which man and woman actualize the fundamental values of love and life.

Donum Vitae (Introduction)

Best Options? Pope Paul VI Institute - Omaha, NE

Founded by Thomas W. Hilgers in 1985

Trains physicians to treat infertility in harmony with church teachings

Adoption ? Infertility is not a problem to

overcome, but can be an opportunity

Best Options? Embryonic stem cell research

opposition is clearly prohibited

Often relies on “left over” embryos from IVF

Hormonal treatment with certain drugs have side-effects

http://www.ivpcare.com/patient/Pharmacy/products/prod_inf.asp?gclid=CLetqoWk3J0CFRYhDQodXDqeMQ

Best Options? Use of perforated condom to

circumvent hypospadias LTOT – Low Tubal Ovum Transfer

Moving sperm deposited in the vagina, uterus, fallopian tube

Temporary removal of sperm or ova to “wash” or “capacitate” for relocation in the fallopian tube

Best Options? Accumulating sperm from a series of marital acts and introducing them into the wife’s vagina

Sperm is conserved, concentrated and placed in wife’s generative tract in association with marital act

SIFT (Sperm Intrafallopian Tube Transfer

GIFT (Gamete Intrafallopian Tube Transfer)

Best Options? Some Catholic moral theologians like McCarthy, Griese, Cataldo, and Carlson defend GIFT

Other Catholic moral theologians like Doerfler, Seifert, Demarco, Tonti-Filipini, Griesz, May and Ashley-O’Rourke are against it

TOTS (Tubal Ovum Transfer with Sperm)

Reproductive Technologies

Eventual success rate is roughly 50 – 70 % for all women

Up to 86% for women under 35 Church documents highlight GIFT or ZIFT (Zygote Intrafallopian Transfer)

Rarely used due to medical inferiority

Reproductive Cycle can be $12,400

Protection of Couple’s Health and Safety

People who seek fertility treatment often feel vulnerable

Goal = protect health and safety of individuals

Ensuring reproductive techniques are safe and affordable

Able to make informed decisions

Science Empoweredby Love?

Morality - challenge about what is most deeply human and

choices which are either life- enhancing or life-diminishing

Dignitatis Personae offers reasoned argument in support for the culture of modern science as “an invaluable service to the integral good of life and dignity of every human

being.” (nos. 3 & 37)

8. Implement the Plan

9. Follow Up

Resources: Natural Family Planning

http://www.irh.org/nfp.htm http://nfpandmore.org/nfphowto.shtml

http://www.billings-centre.ab.ca/general/index.html

http://familydoctor.org/online/famdocen/home/women/contraceptive/126.html

US Conference of Catholic Bishops, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/resources/infertility.cfm

Paul VI, Humanae Vitae, no. 8, http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html

Congregation for the Doctrine of the Faith, Dignitas Personae, nos. 6 and 9, http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html

US Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 5th Ed., http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf

Resources

Congregation for the Doctrine of the Faith, Donum Vitae, (February 22, 1987), http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html.

“Reproductive Technologies,” Natural Family Planning Program, United Stated Conference of Catholic Bishops, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/catholic-teaching/upload/Reproductive-technologies.pdf.

Resources

Benedict XV1, Caritas in Veritate, http://www.vatican.va/holy_father/benedict_xvi/encyclicals/documents/hf_ben-xvi_enc_20090629_caritas-in-veritate_en.html

Health Ethics Guide, (Ottawa, ON: Catholic Health Association), 2000, 81.

John Paul II, Evangelium Vitae (March 25, 1995), http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae_en.html, nos. 18-20, 44-45.

Resources