Monday, August 06, 2007

Ethical Answers to Infertility 3

The Gift of Infertility … A Response to Readers

Dr. Jameson Taylor and Jennifer Taylor

Catholic Exchange
August 5, 2007

Before we turn to part three of our series, we want to respond to readers' questions concerning whether the Church has formally condemned the use of intrauterine insemination (IUI). In addition to asking about the Church's teaching on IUI, several people have wondered how we can possibly refer to infertility as a gift. Part four will discuss this issue in more detail. In the meantime, we speak to this question in the comments sections of part one and part two.

As pointed out by one reader, Dr. Peter Cataldo has claimed that Catholics are permitted to use IUI or GIFT in cases where a perforated condom has been employed to collect semen from a previous act of conjugal intercourse. Cataldo's opinion derives support from a document that appears on the U.S. bishop's (USCCB) website. This document was written, not by the bishops, but by Dr. Hanna Klaus. Klaus asserts that the following two procedures are "neither approved nor disapproved":

1) Gamete intra-fallopian transfer (GIFT). (The Sacred Congregation for the Doctrine of the Faith has not yet pronounced on the subject.)

2) Intrauterine insemination (IUI) of "licitly obtained" (normal intercourse) but technologically prepared semen sample (washed, etc.).

In light of the historical instruction of the Church that artificial insemination is always wrong, it is difficult to make sense of Dr. Cataldo and Dr. Klaus' interpretations of Church doctrine. What, then, does the Church teach? The U.S. bishops address this question in the fourth edition of the USCCB text Ethical and Religious Directives for Catholic Health Care Services:

[Directive 38]: 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.

[Directive 41]: 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 extra-corporeal conception).

These two directives clearly indicate that — at least under the usual conditions — homologous artificial fertilization is prohibited by the Church. Granted, the directives do not specify what other techniques may be used to assist conception. The bishops, though, provide an indication of what they mean in the footnotes that accompany these passages. The first footnote, which cites Donum Vitae, states:

Homologous artificial insemination within marriage cannot be admitted except for those cases in which the technical means is not a substitute for the conjugal act but serves to facilitate and to help so that the act attains its natural purpose (Donum Vitae, Part II, B, no. 6; cf. also Part I, nos. 1, 6).

Likewise, the footnote to Directive 41 states:

Artificial insemination as a substitute for the conjugal act is prohibited by reason of the voluntarily achieved dissociation of the two meanings of the conjugal act. Masturbation, through which the sperm is normally obtained, is another sign of this dissociation: even when it is done for the purpose of procreation, the act remains deprived of its unitive meaning: "It lacks the sexual relationship called for by the moral order, namely, the relationship which realizes 'the full sense of mutual self-giving and human procreation in the context of true love'" (Donum Vitae, Part II, B, no. 6, emphasis added).

To begin with, let us grant that heterologous artificial insemination (AID) — or artificial insemination by donor, instead of husband — is always wrong. The question, then, remains whether IUI, when practiced as a form of homologous artificial insemination (AIH), "separates procreation from the marital act in its unitive significance." If it does, then it is illicit.

In order to answer this question, we need to clarify what Donum Vitae means when it grants that certain "technical means" that do not substitute for the conjugal act may be used to "facilitate" and "help" the sexual act attain its "natural purpose." Instead of delineating here what technical means are licit, however, we will limit our discussion to the question at hand — whether IUI, and related procedures, is permissible.

While Dr. Klaus is correct to emphasize that semen used in IUI cannot be acquired through masturbation, she obscures the real meaning of the Church's teaching by focusing on whether the semen sample has been "licitly obtained" or not. Donum Vitae, though, does not say that masturbation is the only indicator that artificial insemination causes a dissociation of the natural and personal ends of the conjugal act. Masturbation is only "another sign of this dissociation," which is to suggest that the dissociation is not essentially caused by the manner in which the sperm is collected — e.g., through a perforated condom or through masturbation. Rather, the dissociation of which Donum Vitae speaks is a result of the artificial insemination process itself, which (as explained in parts one and two of our article) disrupts the unitive aspect of the conjugal act.

Thus whether or not IUI, GIFT and TOTS (tubal ovum transfer with sperm) are licit depends, not only on how the sperm is collected, but on whether these techniques disrupt or facilitate the unitive aspect of the conjugal act. As we explain in part four of this series, GIFT is a procedure in which multiple eggs and processed semen are placed into a catheter and then injected into the fallopian tubes so that fertilization may occur. Similarly, TOTS is a procedure in which semen is collected from a perforated condom (rather than masturbation) and placed with one or more eggs into a tube where they are kept separate from one another by an air bubble. The semen and eggs are then injected into the fallopian tubes. Technically speaking, GIFT and TOTS are not the same as IUI. This is because neither GIFT nor TOTS entail intrauterine insemination, but rather, intrafallopian insemination. Our article did not specifically address whether GIFT and TOTS are permissible techniques. That being said, Donum Vitae defines artificial insemination as the "transfer into the woman's genital tracts of previously collected sperm" (DV, Part II). According to this definition, IUI, GIFT and TOTS are all forms of artificial insemination.

Following the release of Donum Vitae, then-cardinal Joseph Ratzinger seemed to leave open the possibility that GIFT and TOTS might be licit. Commented Ratzinger: "When the discussion is still open and there is not yet a decision by the magisterium, the doctor is required to stay informed, according to classic theological principles and concrete circumstances."

Understandably, Ratzinger's response led some ethicists to conclude that GIFT and TOTS — but not other forms of artificial insemination — might be permissible. This conclusion requires one to presume that "classic theological principles" allow some forms of artificial insemination. In fact, they do not.

Here, we should recall that artificial insemination is not a new process, but was being used on humans at least as early as the 1930s. Accordingly, Donum Vitae — precisely in the section quoted above that deals with artificial homologous insemination — cites two documents (notes 51-53) issued by Pope Pius XII that explicitly condemn artificial insemination of any kind. The second of these documents, the 1951 Discourse to the Italian Catholic Union of Midwives, is worth quoting at length:

To reduce the common life of husband and wife and the conjugal act to a mere organic function for the transmission of seed would be but to convert the domestic hearth, the family sanctuary, into a biological laboratory. Therefore, in Our allocution of September 29, 1949, to the International Congress of Catholic Doctors, We expressly excluded artificial insemination in marriage. The conjugal act, in its natural structure, is a personal action, a simultaneous and immediate cooperation of husband and wife, which by the very nature of the agents and the propriety of the act, is the expression of the reciprocal gift, which, according to Holy Writ, effects the union 'in one flesh.'

That is much more than the union of two genes, which can be effected even by artificial means, that is, without the natural action of husband and wife. The conjugal act, ordained and desired by nature, is a personal cooperation, to which husband and wife, when contracting marriage, exchange the right.

Pope Pius XII repeated this prohibition in even more forceful terms in a 1960 address to the Seventh Annual Hematological Congress:

The first case mentioned above envisages, as a solution to the husband's sterility, artificial insemination, which evidently presumes a donor, unknown to the couple. We have already had an opportunity to take a stand against this practice in the address delivered to the Fourth International Congress of Catholic Doctors on September 9, 1949. We absolutely condemned insemination between people who are not married to one another, and even between spouses.

We returned to this question on May 19, 1956, in Our address to the World Congress on Fertility and Sterility; We condemned once again all types of artificial insemination, on the ground that this practice is not included among the rights of married couples and because it is contrary to the natural law and Catholic morals. As for artificial insemination between unmarried persons, We declared in 1949 that this practice violates the principle of the natural law that new life may be procreated only in a valid marriage.

Given Pope Pius XII's clear censure of "all types of artificial insemination," Donum Vitae reminds us that "the teaching of the Magisterium on this point has already been stated" (II, 6). Adds the instruction, "This teaching is not just an expression of particular historical circumstances but is based on the Church's doctrine concerning the connection between the conjugal union and procreation and on a consideration of the personal nature of the conjugal act and of human procreation" (II, 6).

The Church's prohibition of "all types of artificial insemination," in other words, is based on "classic theological principles." As if to reinforce this fact, the Catechism's teaching on artificial insemination, published seven years later, is free of the apparent ambiguities arising from Donum Vitae's reference to techniques that might facilitate the conjugal act. States the Catechism:

Techniques involving only the married couple (homologous artificial insemination and fertilization) are perhaps less reprehensible, yet remain morally unacceptable. They dissociate the sexual act from the procreative act: the act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that "entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children." "Under the moral aspect procreation is deprived of its proper perfection when it is not willed as the fruit of the conjugal act, that is to say, of the specific act of the spouses' union. ...Only respect for the link between the meanings of the conjugal act and respect for the unity of the human being make possible procreation in conformity with the dignity of the person" (2377).

Moreover, several pronouncements by John Paul II explicitly condemn artificial insemination as "morally unacceptable." These include the 1993 encyclical Veritatis splendor and the 2002 address to the bishops of Brazil. Likewise, the Pontifical Council for the Family interprets Donum Vitae as denouncing artificial insemination. Finally, a document written by Dr. Jerôme Lejeune for the Pontifical Academy of Sciences refers to the Church's prohibition of "artificial insemination by syringe."

In light of the Church's past and present statements regarding artificial insemination, it is clear that Donum Vitae does not permit IUI — the most widely practiced form of artificial insemination. Indeed, following the 1987 release of the instruction, numerous ethicists and journalists (and even a cardinal or two) bemoaned the fact that the Church had upheld its condemnation of artificial insemination — even when performed using the husband's sperm.

Thus while it may remain an open question among some Catholic ethicists as to whether procedures like IUI, GIFT and TOTS are morally permissible, the Church's constant teaching on this matter is and has been that all forms of artificial insemination, including IUI, are illicit.

For some couples, the Church's teaching on IUI seems to be insensitive, with the result that it is often said that the Church lacks compassion for infertile couples. As we explain in parts three and four (forthcoming) of this series, however, it is precisely out of Her deep love and respect for the human person — including the infertile couple and the unborn child — that the Church does not permit the use of such techniques.

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