Christians who are infertile face a tangle of ethical questions.

By Deonna Neal

How should Christians evaluate assisted reproductive technologies (ARTs) that treat infertility? The most traditional ethicists reject ARTs outright. They teach that the biological integrity of marital sexual love is the moral standard: the natural link between sexual union and reproduction should remain indivisible.

This means that if sex without the potential for conception is wrong, then so is conception without sex. This understanding draws heavily on the doctrine of creation, Christology, and theology about the covenant of marriage, which includes beliefs about the moral duties of parenthood.

The most secular and permissive end of the spectrum teaches that any person — regardless of marital status or sexuality — who wishes to become a parent may make any private arrangement and use any legal method to achieve this end. This understanding is most significantly influenced by its emphases on personal autonomy, individual rights, and the rules of contract.

One of the realities of formation today is that Christians have been more influenced by the moral norms of secular society than by the moral norms of distinctively Christian theological commitments. This can be particularly difficult when such theological commitments not only challenge our claims to personal autonomy and the exercise of individual rights, but also teach that certain relationships should not be entered. Situations that arise with the use of ARTs illustrate these tensions well.

Consider this imaginary scenario of Pat and Jordan Smith, an infertile heterosexual couple who serve as a composite of options associated with ARTs.

The Smiths cannot conceive through any natural form of sexual intercourse and they have no available gametes. Pat required a hysterectomy years earlier. They do not want to adopt because they have heard horror stories about the difficulties that adopted children often experience. They want to have two children.

They consider it important to give their children some sense of connection to their genetic heritage. Pat asks her sister, Deborah, who is 30, married, and has one child, for her help.

Deborah agrees to undergo IVF and become a traditional surrogate for both pregnancies as a gift to her sister. Jordan enlists James, his only brother, who is 25 and single, as a sperm donor. Contracts explain the rights and roles of all participants.

The IVF procedure creates five embryos. The Smiths rely on Preimplantation Genetic Diagnosis (PGD) to assure that their children are free of any serious genetic defects. They learn that the embryos are three girls and two boys. Genetic screening determines that one of the girls has Down syndrome. Pat and Jordan, as the “intended parents” — in the language of the contracts — exercise their right to destroy that embryo, but Deborah and James object.

To secure the best chance of having a healthy baby, they choose an elective Single Embryo Transfer of a male embryo. Deborah has a very difficult pregnancy, but delivers a healthy baby boy. She experiences severe post-partum depression and decides not to be a surrogate for a second baby.

The Smiths then decide to find a young healthy college student, Susan, age 18 — who needs money to pay for her tuition — as a surrogate. Pat and Jordan agree to pay her the average base fee of $25,000 and to cover medical expenses. This time they transfer two female embryos, hoping that only one will implant.

When Susan’s health exam reveals that both embryos implanted, Pat and Jordan choose a “selective reduction” of one embryo, as stipulated in the surrogate’s contract, because they do not want twins. When the baby girl is born, they discover that she has a genetic disease that should have been detected by PGD. The Smiths file a “wrongful birth” lawsuit against the fertility clinic.

The Smiths divorce each other 15 years later. A custody battle ensues for the remaining frozen male embryo.

To what extent are these kinds of decisions related to ARTs consistent with the Christian requirement to pattern one’s life and household after the teaching of Christ? From the normative requirements of a secular framework — autonomy, individual rights, and the rules of contract — nothing in this scenario would pose moral problems. Within Christian ethics, couples would likely make different judgments.

To what extent should understanding marriage as a covenant and the natural link between sexual intercourse and procreation shape our thinking? What about the doctrine of Creation? Eschatology? What duties do parents have toward their children? Should Deborah and Jordan have agreed to be donors for their siblings? Is paid surrogacy similar to prostitution? What is the difference between begetting and “making” children? Does that moral distinction matter? As adopted sons and daughters of Christ, how might that shape our views on adoption versus wanting “our own” children?

These are but a few questions to consider. Perhaps one of the most important questions is how the Church forms Christians who can make theologically informed decisions that relate to their marriage, family, and reproductive lives. How do we address our greater disagreement about the normative role Christian theological commitments should play in our lives?

The Rev. Dr. Deonna D. Neal is an associate rector of St. John’s Episcopal Church in Montgomery, Alabama, and former chair of the Department of Leadership, Ethics, and the Profession of Arms at Air University, Maxwell Air Force Base, Alabama. Her research interests include the ethics of emerging technologies, moral injury, and issues that reside at the intersection of church, state, and military service.