Some Thoughts on Hormonal Contraceptives

The issue of birth control came to the foreground for me when I was diagnosed with Polycystic Ovarian Syndrome. Basically my ovaries were maturing oocytes but often were unable to release these eggs, resulting in cysts. In response to the first grouping of ova sacks not rupturing my body would mature subsequent groupings that were unsuccessful, utilizing more of the unregenerative number of immature gametes. Following this revelation my prior doctor gave me a limited time to have children and informed me that I would have to rely on fertility medications and possible artificial interventions like IVF and ICSI. That doctor's advisement was to begin taking an oral hormonal contraceptive for 3 months followed by a cycle of Clomid, an ovulation inducing medication.

That doctor's suggestion became an immediate subject with our Priest, who graciously made it known that even though it is an abortifacient there would not be any moral dilemma with using the contraceptives as long as we were abstaining during the interval I was taking the medication. Abstinence would be a necessary precaution do to the contraceptive's abortive properties. If we were not to abstain while I was ingesting the medication and a child was conceived, the baby would not be received in to the naturally hospitable environment of the uterus, but rather into a hostile, chemically transformed habitat incapable of fostering implantation.

Our priest also warned us that he did not think abstaining for that duration would be conducive to the beginning of a healthy marriage. Even the abstinence required for accurate Natural Family Planning practices is only a few days a month. After the discussion with our Priest I switched from my pro-life doctor to a Catholic ob/gyn and midwife that were family centered, NFP oriented, and did not provide contraception. We felt very strongly that the professionals that would be aiding our family needed to be in complete conformity with church teachings.

For most gynecologists and obstetricians their first course of action for fertility concerns is to prescribe the regiment of hormonal birth control for 3 months to restart the reproductive system, essentially by stopping its function, and follow that time period with a prescription for an ovulation inducing medication like Clomid. This instant response is a result of connections with major pharmaceutical companies and not the need of the misinformed patients who are unaware of there options. Often times, on the occasion that the ovulation inducer does provoke ovulation, a large number of oocytes are expelled producing multiple babies, therefore greater health risks for all parties involved.

In addition to putting yourself and children in danger, there are all the side effects from the contraceptives themselves. These adverse effects, include increased heart disease, breast and ovarian cancer ovarian cysts, and uterine fibroids, are why we will not be using the recommended hormone regiment and now use a Catholic obstetrician/gynecologists and midwife. On a side note, the use of hormonal contraceptives as an aid for PMS or to regulate cycles still hold the same long term side effects. And further women are given this endowment of pain each month as an opportunity for penance as with child birth. Clomid has side effects of its own, like hot flashes and ovarian hyperstimulation. Another draw back to using Clomid is that the drug inhibits the production of the viable cervical mucus crucial to the survival of sperm within the female reproductive tract. A possible solution to this side effect may be the use of Preseed, the only nonspermicidal personal moisturizer, with a make up similar to that of fertile cervical mucus. There are also many natural and licit measures for PMS, cycle regulation, and conception assistance through the help of the Creighton Method and Dr. Hildgers at the Pope Paul VI Institute.

I have been charting for fertility awareness for a few years now, and that was also the counsel given by my ob/gyn and midwife, to determine when ovulation occurs and at what frequency. It may take longer for us to conceive than those using artificial conception methods but most importantly we will not unknowingly be killing our children, moreover it will serve as a reminder to us that a child is not a right, but in fact gift that deserves to be conceived, as Pope John Paul II expressed, though a natural and marital act of love.

British Fertility Clinics Plan to Grow Human Ova

Sadly there is another tragedy on the ART front. Two British fertility clinics are beginning the harvest and storage of immature gametes to mature in the lab for career women in the future. The poor egg is not even allowed to mature in the woman's body rather all the "work" is done in a lab and a newly created embryo is just implanted when the parties deem it the right time. What is the next step, no gestation or labor at all, just pick up the fully developed baby nine months later?

You can read the article from The Telegraph here.

Ethical Answers to Infertility 5

The Gift of Infertility, Part 4

Dr. Jameson and Jennifer Taylor

Catholic Exchange
August 19, 2007

Part one of this series discussed natural family planning (NFP) as a means of treating infertility and introduced readers to the basics of artificial reproductive technologies (ART). Parts two and three explained the Church's teaching on human sexuality, with special attention paid to the link between infertility treatments and the contraceptive mentality. A Response to Readers clarified the Church's teaching on the use of Intrauterine Insemination (IUI). Here, we enter into the heart of the mystery of infertility. If, as the Church teaches, children are the "supreme gift" of marriage, how are couples (like us) to understand their infertility as a gift?

Infertility: A Gift?
Tears were streaming down my face and they were not tears of joy. Clutching the freezer door with my left hand, I stood holding a tiny test tube in my right. With each attempt to spit, I struggled to see if my tears or my saliva were filling the vial. At any minute, I was sure I was going to fall beneath the weight of the pain. Only the cold of the door handle between my fingers kept me focused on the task. "They want a stress test as part of my infertility workup," I thought to myself. "Well, they're sure going to get it!" It was the week of my 30th birthday, and I'd never been more miserable.

The first year of our marriage seemed like an extension of our honeymoon. Jameson had a good job, and I was working part-time from home in expectation of soon becoming a mom. When we hadn't conceived after six months, we suspected something was wrong. Yet, we continued to hope that "things just hadn't come together yet" and "it wasn't the right time." Still not pregnant and nearing a year of marriage, I called one of the NFP organizations. "Give it a little more time," they said, "and if, after a year you're still not pregnant, go and see an NFP specialist."

Traditionally, primary infertility is defined as the inability to conceive after 12 months of noncontraceptive, targeted intercourse. We've come to learn, however, that for couples who are charting (or women over 35) the time frame is 6 months. If you have concerns about your ability to conceive, it's never too early to make an appointment with an NFP doctor.

Several months later, we finally met with one of the best NFP doctors in the country. Just like that, we were caught up in a whirlwind of testing — the spit test I mentioned above, as well as semen analyses and blood tests — and a strict schedule of targeted conjugal relations.

By now, we'd been married almost two years, and Jameson had been laid off. Then, I lost my part-time job; a publisher pulled out of a book contract we were counting on; and my parents lost the family farm. In the meantime, we switched doctors and started learning about the Creighton Model System. While we remain among the small percentage of couples who haven't conceived through Creighton's "NaProTechnology," thanks to our Creighton doctor we discovered that I have hyperprolactemia (elevated levels of prolactin). This condition, however, is also associated with brain tumors. Thus in addition to my already scheduled tests and surgeries — hysterosalpingogram, laparoscopy, transvaginal songrams, to name a few — I also had to have an MRI.

"It's no wonder you don't have kids," people would tell us. "Look at the stress you're under." As if having a good job or a book deal would result in having a baby. Sure, stress is a key factor related to infertility, but other people under stress seem to get pregnant easily. Besides, we'd enjoyed a time in our marriage when our stress levels were low. We'd also given up caffeine and alcohol; lost weight; taken Clomid; taken progesterone shots; targeted our intercourse — the list goes on and on. And still no baby.

Do we feel as if we've been handed a gift, or that any of this makes sense? Often, no. Our infertility makes no sense outside of God's plan for our lives — for us as an infertile couple. For all of us as infertile couples.

Part of the pain of being infertile lies in the struggle to understand how God can give us the desire to have children, and then prevent us from realizing this desire. Or, for those of you suffering from secondary infertility, how God can give you a baby only to take it away again. It's no wonder that, as we wrote in part one of our series, "infertile couples report equivalent levels of anxiety and depression as women with cancer, HIV status or heart disease" and that "the majority of infertile women report that infertility is the most upsetting experience of their lives."

The Gift of Faith
As if to add insult to injury, some time later we discovered that my prolactin levels had receded back to a "healthy level." Still, we were not conceiving. Just in case, our doctor ordered another semen analysis. While previous tests had come back as "essentially normal," the new specimens showed a defect with Jameson's sperm. At least three sperm tests are necessary to get an accurate picture of the health of a man's sperm. Even then, men produce new sperm every three months, so trouble can arise at any time. For us, this time came just as my own problems had apparently disappeared.

Soon after, the day came — a little more than a year ago — when our doctor told us he couldn't do anymore for us. "I have no other means of helping you. I've consulted all the experts. I don't know what to tell you," he whispered. The finality of it all was numbing. After a moment, our doctor continued, "I'm praying through this book. It's changed my life. It's called The Gift of Faith, by Father Tadeusz Dajczer. This is not a book you read. It's a book you pray — one you have to go over little by little because it's so tough."

We didn't read the book right away (as if a book could console our pain). For his part, Jameson felt as if God had tricked him. "God's a jokester," he protested. "Before we got married, I saw my children in my prayers. God's message to me was very clear: He told me I was called to the vocation of marriage and that I'd have kids. He duped me!"

What's God Doing to Us?
Once we finally did read The Gift of Faith, we were inspired by what we found. According to Fr. Dajczer, God often "does just the opposite of what we would expect." In our case, we expected God to give us children because we were being faithful. The fact that God wasn't living up to His part of the bargain proved He couldn't be trusted. Our experience of infertility had thus distorted our image of God, which, as Fr. Dajczer explained, had been preventing our abandonment to Him. How could we abandon ourselves to a God who seemed so unfair? Fr. Dajczer helped us see that what we were most afraid of — was not what God was doing to us — but what he was trying to do with us. What we feared, in other words, was that our infertility might actually be part of God's plan for our lives, a gift from God necessary to the working out of our salvation.

Book in hand, Jameson rounded the corner into our office and declared, "Infertility is a gift." "I thought God was a jokester," I responded. "I do feel that way sometimes," he said, "but let's be serious for a moment. We know we're infertile. That's a fact. So, let's talk about what we're going to do about it now that we've been told there's nothing we can do about it."

Our choice was to give up hope or abandon ourselves to God, trusting Him completely. Sadly, many couples reject God's gift of infertility and turn instead to the world of artificial reproductive technologies. Others abandon themselves to their own suffering, becoming enmeshed in their pain. We wanted neither, so we decided to write, with the hope of understanding what God wanted from us. "You need to give God everything," counsels Fr. Dajczer. "You need to know how to give Him, that which is His; that is the program of our conversion." So it was. We had to give God ourselves — and our infertility.

Not long after, we had coffee with Fr. Mitch Pacwa of EWTN. While discussing our infertility, he told us that it seems as if God is asking infertile couples to do penance for the sins against life committed by others. "It's a sort of divine fasting," he said. "Would I fast if God asked me to?" I wondered. "God isn't a God of imposition — He created us with free will — so why didn't He ask me?" Without realizing it, I answered out loud, "He's trusting you." The choice comes in how we respond to God's offer.

The Gift of Infertility
As the mystery of the gift of our infertility has begun to unfold before us, we have come to see that children are not the only gift of marriage. Infertility, too, is a great and mysterious blessing. Just as much as fertility, infertility is a gift husband and wife can give one another. It is an affirmation that: "I still love you. I love all of you. And I refuse to allow anything to come between this love, whether it be fertility or infertility." Infertility is also a gift couples can give to God and to the world. Like Christ's crucifixion, infertility is a sign of contradiction in a culture in which human life has lost its value.

Instead of giving children to God, infertile families can give their suffering to Him, their unfulfilled longing to conceive a baby. God will use this suffering to glorify His name and bring about the salvation of souls (cf. Jn. 9:1-3). Likewise, infertility is the gift God gives couples for the salvation of their own souls, as well as the souls of any children they might eventually adopt. To reject this gift is to reject the specific means by which God wills to lead us to Heaven.

Of course, this is not to say that infertile couples shouldn't use every licit means they can to conceive a child or bring a baby to term. We also do not mean to imply that every infertile couple is called to adopt. Adoption is not a "cure" for infertility because even after you adopt you remain infertile. Each of us, however, is called to "give everything to God," and to serve Him, even in the weakness of infertility.

Given that children are the "supreme gift of marriage," it might seem strange to think of infertility as a blessing. No doubt, infertility contradicts nature's intention. The gift of infertility, however, is one that transcends the natural order. It is a sign of divinity, of God's power to bring life out of a situation where nature is powerless. In this way, infertile spouses are like empty vessels, vessels that can be filled only by the intangible gift of grace. Even more so than those who can have biological children, the infertile couple is called by God to be a channel of spiritual fecundity (CCC 2379). As such, these couples are a sign to the world that the fullness of life is found in the gift of love, rather than mere physical existence.

This is not to demean in any way the generosity of large families. Although their sacrifices generally go unappreciated, these families are nonetheless a tangible manifestation of love. Part of the pain of infertility, however, is that it is an invisible sign. In our culture, most people assume that if you don't have kids you're contracepting. If you're infertile, they suppose you can easily correct the problem through artificial means. The physical and spiritual suffering caused by infertility is usually hidden. To use an analogy, the generosity of the couple who chooses to have a large family is like a brightly burning sun whose beams produce beautiful flowers that everyone can see and admire. While their love might shine just as brightly, the infertile family has no flowers of its own. Yet, as Fulton Sheen perceives: "There is no sign unless something happens contrary to nature. The brightness of the sun is no sign, but an eclipse is."

Like an eclipse, the sign of infertility is incomprehensible without the gift of faith. It is a sign that is usually missed because it is veiled by disappointment and failure. God, however, is the master of bringing success out of failure and life out of death. If we allow God to reveal Himself in the poverty of our infertility, He will give us a harvest of flowers more beautiful than we could sow on our own. Oftentimes these flowers are not meant for us to keep, but to give to others. For the unwed mother, infertile couples impart the gift of hope. For the couple delaying childbirth, infertile families provide motivation. For the orphan, infertile couples present the chance of new life. Recommends the Church: "Spouses who still suffer from infertility after exhausting legitimate medical procedures should unite themselves with the Lord's Cross, the source of all spiritual fecundity. They can give expression to their generosity by adopting abandoned children or performing demanding services for others" (CCC 2379).

Just as with physical fertility, spiritual fecundity requires the elimination of any barriers of bitterness, resentment and discouragement that might be obstructing your relationship with God. Although it's okay to be angry with God, at some point it's necessary to "forgive" Him. Ultimately this "forgiveness" rests in realizing that God has not committed an offense against us in allowing us to be infertile. The fruit of such forgiveness is trust.

God will forgive you, too, for not trusting Him — whether by using contraception, or in vitro fertilization, or, as is easy to do, letting the desire to have a child become a god in itself.

Forgiveness is the fruit of prayer, which is also a gift of infertility. Without prayer, the heart will never be able to discover, as one anonymous infertile woman puts it, that God is enough to love. Because we can't understand why God doesn't give us what we want, we often go in search of it on our own. By doing so, we risk overlooking the shocking truth that the gift of infertility is God Himself.

Infertility Terms You Need to Know

(Primary) Infertility: The standard medical definition of infertility is the inability to conceive after 12 months of noncontraceptive, targeted intercourse, but for couples who are charting (or women over 35) the time frame is 6 months. The definition should also include mothers unable to carry any pregnancy to term.

Secondary Infertility: The inability to conceive and/or carry a baby to term after doing so at least once before.

Sterility: A permanent condition inhibiting conception.

Zygote: A fertilized egg in the single-cell phase — i.e., an undivided fertilized egg.

Embryo: A fertilized egg that has begun the division process that will result in a fully formed person; used by scientists to refer to a baby until it reaches the fetal stage.

Fetus: Term used by the scientific community to refer to a preborn child 8 weeks or older.

ART (Assisted Reproductive Technologies): Any procedure in which both eggs and semen are extracted from a woman and a man and manipulated with the intention of producing a baby.

IVF (In Vitro Fertilization): From the Latin, "in glass," the fertilization of an egg with a sperm in an artificial environment, namely a petri dish, and the subsequent implantation of the embryo in the uterus.

AIH (Homologous Artificial Insemination): Injection of a husband's processed semen into his wife's genital tract.

AID (Heterologous Artificial Insemination): Injection of a donor's (not the husband) processed semen into a married woman's genital tract.

IUI (Intrauterine Insemination): Technique by which processed sperm are injected into the uterus with a catheter.

Multifetal Pregnancy Reduction: A euphemism used to describe the abortion of one or more children (at 8 to 12 weeks) sharing the same womb. Unlike most abortions, the dead baby's body is resorbed by the mother's body.

Embryo Cryopreservation: The freezing of leftover embryos produced via IVF.

Assisted Hatching: An IVF technique of micromanipulation that uses an acidic solution to dissolve the shell around a 2- to 3-day-old embryo to improve chances of implantation.

ICSI (Intracytoplasmic Sperm Injection): A technique by which a single sperm is injected in vitro into an extracted egg; used in cases of acute male infertility.

GIFT (Gamete Intrafallopian Transfer): An ART 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.

ZIFT (Zygote Intrafallopian Transfer): An ART procedure in which multiple eggs are actually fertilized in the laboratory with processed semen; the resulting zygotes are then injected into the fallopian tubes. Also known as PROST, pronuclear stage transfer.

TOTS (Tubal Ovum Transfer with Sperm): An ART 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. This technique is rarely performed anymore.

Where to Turn for Help

Natural Family Planning Techniques

The Creighton Model System (NaProTechnology)

Pope Paul VI Institute for the Study of Human Reproduction

Phone: (402) 390-6600

Email: popepaul@popepaulvi.com

Web: http://www.naprotechnology.com/; http://www.popepaulvi.com/

The Couple to Couple League International, Inc. (Sympto-Thermal Method)

Phone: (513) 471-2000 or (800) 745-8252

Web: http://www.ccli.org/

Billings Ovulation Method Association (BOMA-USA)

Phone: (651) 699-8139

Email: info@boma-usa.org

Web: http://www.boma-usa.org/

Locate an NFP Center or Teacher Near You

One More Soul

Phone: (800) 307-7685

Email: omsoul@omsoul.com

Web: http://www.omsoul.com/

Further Reading

The Bible and Birth Control, Charles D. Provan

Donum Vitae, Congregation for the Doctrine of the Faith

Empty Womb, Aching Heart, Marlo Schalesky (While some couples profiled in this book have used artificial technologies, reading their personal struggles with infertility might prove helpful.)

Fertility Cycles and Nutrition, Marilyn M. Shannon

Full of Grace: Women and the Abundant Life, Johnnette S. Benkovic

Humanae Vitae, Pope Paul VI

Ethical Answers to Infertility 4

The Gift of Infertility Part 3

Dr. Jameson and Jennifer Taylor

Catholic Exchange
August 12, 2007

While natural family planning (NFP) is not always effective for couples (like us) who are trying to conceive naturally (see part one of this series), the Church has good reasons for its teaching on human sexuality (see part two and our "Response to Readers"). Nevertheless, many couples believe they can use intrauterine insemination (IUI) and in vitro fertilization (IVF) without violating their consciences or their faith, because, after all, such techniques create life, not destroy it.

Flirting with Danger
Proponents of artificial reproductive technologies (ART) often argue that IUI and IVF are actually "pro-life." The thinking behind this assertion is that every endeavor aimed at bringing forth new life promotes the dignity of life. Of course, all orthodox Christians, both Catholic and Protestant, agree life begins at conception. For this reason, Dr. Dobson recommends that couples using IVF fertilize and insert only as many eggs as they are willing to keep, and no more than three. "To fertilize and implant more than three," reckons Dobson, "would unacceptably increase the risk of pregnancies of quadruplets or more, pregnancies which carry high risk for both mother and babies."

These dangers are significant. According to the CDC, even twins, who comprise 30 percent of ART births, "are still at substantially greater risk for illness and death than singletons." Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology, cautions: "Twin pregnancies are at a three- to five-fold greater risk for pregnancy complications and perinatal mortality compared to carrying one fetus. With triplets, there is at least a seven-fold greater risk." Low-birth weights and neurological diseases, such as cerebral palsy, are also far more common in twins and other multiple-infant births. In addition, women using ART, especially when combined with drugs that cause ovarian hyperstimulation, are putting their "health and lives in jeopardy," warn Drs. Marie Anderson and John Bruchalski. "Since there is no regulatory agency to oversee the industry, women are treated as research subjects, given drugs that pose an unknown risk."

While pro-life Christians who resort to IUI or IVF would never consider having an abortion, they should keep in mind that the reproductive technology industry is institutionally dependent upon the destruction of human life. On average, women 35 and younger are impregnated with three to five embryos per cycle. Most IVF specialists discourage couples from transferring just one embryo, but approximately 66 percent of all ART births are singletons. At the same time, the overall live-birth success rate for ART is 29 percent. Hence, well over 70 percent of all embryos created through ART do not survive. Thousands more children that reach the fetal stage are killed via selective or "multifetal pregnancy" reduction, a euphemism used to refer to a first trimester abortion. Although the CDC does not disclose the exact number of multifetal reductions each year, the number of multifetal pregnancies accounting for miscarriages and induced abortions exceeds the number of multiple births by approximately 10 percent. A 1993 study found that 31 percent of multifetal pregnancies ended with miscarriage while 27 percent ended with selective reduction.

With experts complaining about an "epidemic of multiple births," physicians feel pressure to keep their multibirth rate low. As reported by the San Francisco Chronicle, "The creation and destruction of human embryos is part and parcel of modern infertility treatments, reflecting both the inherent inefficiency of human reproduction and efforts by fertility clinics to keep costs down and success rates as high as possible" (Aug. 20, 2001, A-1).

It is estimated that as many as one million embryos have been destroyed since IVF was introduced in the United States in 1981. Over 500 embryos alone lost their lives to produce the first "test tube baby," Louise Brown, in 1978. Currently, more than 400,000 embryos are frozen.

Even if a couple follows Dr. Dobson's advice and transfers only as many embryos as they are willing to carry to term, they are still unintentionally cooperating with the murder of nascent human life. To begin with, these couples are benefiting from technologies that would not exist without embryonic research, research many of these same couples oppose. Additionally, they are lending financial and social support to a system that dishonors life by encouraging such practices as selective reduction (i.e., abortion), cryopreservation and genetic selection. Finally, couples who use ART tacitly buy into the abortion-driven myth that life begins upon implantation, rather than conception. After all, no one sends out pregnancy announcements when their baby is still "in vitro." Yet the debate over when life begins — at conception or implantation — is one of the great divides that separate the culture of life from the culture of death.

I've Got the Power
Ironically, many of the couples using IUI and IVF in their late twenties and mid-thirties were contracepting earlier in their marriage. This is because IUI and IVF are the logical counterparts of the contraceptive mentality, whose fundamental tenet is that women enjoy total control over their fertility. The following comment from one infertile woman perfectly epitomizes this view: "I'm not a control freak, but it's one area of my life that I thought I'd always have control over. You know, I was on the pill for five years before we started trying to have a baby. ... Five years I thought I was in control of my fertility. When I didn't get pregnant, it came as quite a shock" (Handbook of Families & Health, SAGE Publications, 103).

Predictably, the Catholic Church is criticized from both sides: When it's convenient, couples tell the Church that they should be allowed to contracept; when they change their mind, they tell the Church that she should permit them to use IUI and IVF. Either way, the Church is accused of being archaic and narrow. Rather, it is the view that separates the procreative and unitive aspects of marital intercourse that is truly "narrow." Such a view reduces the sexual act to being either primarily for the sake of unity or primarily for the sake of reproduction. The Church alone, in her wisdom, refuses to divide the two.

The Church refuses to divide what God has joined because she does not have the power to do so (cf. Mt. 19:6). The possession of such power would enable man to become like God (cf. Gn. 3:5). In fact, this premise underlies the scientific revolution, which promises man total control over nature, even human nature and human sexuality. Some might argue that the power science gives man comes from God, but not every thing invented by man is for his own good. This does not mean that technology cannot be used to assist the reproductive process, but that such assistance must never be divorced from the recognition that all life is a gift.

In accepting the gift of life, man agrees to respect the means by which life should be transmitted. A man who gave his wife a diamond ring, for instance, would be horrified if she used it as a drill bit. Likewise, a gift should not be opened before its time; rather the gift-giver chooses when and how to give the gift. As Donum Vitae reminds us: "The child is not an object to which one has a right, nor can he be considered as an object of ownership: rather, a child is a gift, 'the supreme gift' and the most gratuitous gift of marriage" (II, 8).

If children are "the supreme gift of marriage," how are couples to understand their infertility as a gift? The fourth and final part of this series will discuss the heart of the mystery of infertility and provide additional resources for those who want more information.

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.

"Multiple Births Bring Dangers"

Multiple Births Bring Dangers; Church Teaching Urges Caution

Maria Wiering

Tidings.com July 27, 2007

When Brianna Morrison gave birth to sextuplets at Abbot Northwestern Hospital in Minneapolis June 10, only 22 weeks into her pregnancy, the children weighed between 11 ounces and 1.3 pounds and were considered to be at the extreme limit of viability.

Within two weeks, three boys and one girl had died. In mid-July, a boy and a girl --- Sylas and Lucia --- remained in neonatal intensive care at Children's Hospital of Minneapolis.

Pregnancies resulting in multiple babies are increasing as more couples, like Brianna and Ryan Morrison of St. Louis Park, turn to fertility treatments or in vitro fertilization to conceive. However, such methods often lead to complications, as the Morrisons have experienced.

The Morrisons, both 24, said their Christian faith is sustaining them through their grief. The couple rejected "selective reduction" --- aborting some of the fetuses so that the remaining have a better chance at healthy growth and survival. On their Web site, Ryan Morrison said aborting fetuses was never an option for them, as they consider each baby a "miracle given to us by God."

Ten hours after the Morrison sextuplets were born, Jenny Masche gave birth to another set of sextuplets in Phoenix. Jenny Masche suffered acute heart failure several hours after the birth, but is recovering and all six of the infants survived.

The Morrisons used fertility drugs to achieve pregnancy; Masche and her husband, Bryan, used artificial insemination. The health complications associated with multiple births have resurfaced difficult questions regarding how to treat infertility.

The most common methods to assist couples trying to conceive are assisted reproductive technology and controlled ovarian hyperstimulation, according to the March of Dimes.

The first of the two methods involves procedures, such as in vitro fertilization, in which sperm and eggs are united in a laboratory and then implanted in the uterus.

Controlled ovarian hyperstimulation treatments include injectable medications that stimulate a woman's ovaries to accelerate egg growth and maturity. It often is combined with artificial insemination, in which sperm is placed directly into the uterus by a doctor.

The Catechism of the Catholic Church teaches that reproductive techniques that disassociate sex from reproduction --- such as artificial insemination --- are morally unacceptable, even if the sperm and eggs are from the husband and wife, because they disrespect the gift of sex and the dignity of the child to be conceived.

However, controlled ovarian hyperstimulation can be used alone, without combining it with reproductive techniques that disassociate sex from reproduction. This use has not attracted the attention of church documents or moral theologians, said Paul Wojda, a bioethicist and theologian at the University of St. Thomas in St. Paul.

"The general rule here is that as long as technologies don't replace the natural function but help it to achieve its intended function, it's morally permissible," he said in an interview with The Catholic Spirit, newspaper of the Archdiocese of St. Paul-Minneapolis.

Hyperovulation medication attempts to assist a natural process to do what it naturally does, he said.

It's important to remember that couples do not have a right to a child, said Father Peter Laird, a moral theologian who teaches at St. Paul Seminary. "Children are gifts," he said. "Couples that suffer infertility suffer a great cross. That's no easy reality."

Although not morally problematic in themselves, controlled ovarian hyperstimulation treatment methods may not be prudent for a variety of reasons, including the health of the mother or the babies. "Catholic principles tend to argue for a more conservative approach," Father Laird said.

While greater care has been taken in the United States in recent years to avoid pregnancies involving multiple fetuses, such cases mostly involve in vitro fertilization, which is morally impermissible, Wojda said.

Not only does in vitro fertilization disassociate sex from reproduction, it is also often complicated by "excess" embryos that are never implanted in the womb. Embryos deserve the full respect of human dignity, and the church teaches that to discard them or use them for research violates that right.

"Catholic couples who are having infertility problems really need to do their homework," Wojda said. "They really need to find the right fertility doctor and make sure that they're getting the best information possible on their infertility, its causes and the risks involved in using hyperovulant drugs.

"They can't simply assume that any old fertility doctor is going to be on the same page as they are as far as what's acceptable and unacceptable" from the perspective of church teaching, he said.

Couples struggling to conceive should learn natural family planning, which teaches couples their bodies' natural fertility cycles and maximizes the possibility to achieve pregnancy, Father Laird said.

"God has, by design, allowed for a proper way of spacing or planning births," he said, in that a woman is fertile during only a portion of her natural cycle, while men are always fertile.

"The more that a couple learns about these truths," he said, "the more a husband will be able to respect his wife and respect her body and (the) uniqueness of his body." ----CNS

More Reasons to Decline IVF.

The following article exposes more of the repercussions and evils that are IVF, and ART as a whole.

IVF Turns Families Topsy-Turvy
Troubling Consequences of Artificial Reproduction

Zenit.org
Rome, July 23, 2007

- As demand for in vitro fertilization continues to rise, so too are concerns over the clinics and consequences for families. A leading British expert recently had harsh words for the industry, whose methods have long been criticized by the Church.

Robert Winston, professor of fertility studies at Imperial College London, said clinics had been corrupted by money and that doctors were exploiting women desperate to get pregnant, reported the Guardian on May 31. "It's very easy to exploit people by the fact that they're desperate and you've got the technology, which they want, which may not work," he said.

When it comes to the impact on family life, one of the changes introduced is the trend toward older mothers, reported the London-based Times newspaper June 6. The proportion of in vitro fertilization (IVF) patients aged between 40 and 45 has risen from 10% in the 1990s to 15% in 2006, the article noted. Last year a total of 6,174 women in this age group had fertility treatment, compared with just 596 in 1991.

The average age of all fertility patients has also increased by a full year since 1996, from 33.8 to 34.8. The information comes from data published by the Human Fertilization and Embryology Authority.

The Times commented that the success rate of treatments at an older age is much lower. For women aged between 40 and 42, the live birthrate for a first treatment cycle is 9%. Once they are 44 or above it is 1%. Moreover, at 40, the risk of miscarriage is twice what it is at 20, and there is an increased likelihood of ectopic pregnancy, premature birth, stillbirth, neonatal death and birth defects.

Twins at 60
Shortly before the publication of this data, news came from the United States of a 60-year-old woman who gave birth to twin boys, reported the Associated Press, May 23. Frieda Birnbaum gave birth to the boys at Hackensack University Medical Center, New Jersey.

Another case that received attention was that of Spanish mother Carmela Bousada, who gave birth at 67 to twins, reported the Times on Jan. 29. She underwent IVF treatment at the Pacific Fertility Center in Los Angeles.

Meanwhile, the Canadian newspaper the Ottawa Citizen reported April 18 the case of Melanie Boivin, who donated some of her ova to her daughter, Flavie. The daughter, aged 7, is sterile due to a genetic condition. The article commented that if Flavie eventually decides to use the ova and becomes pregnant, she will be give birth to her genetic sister and Melanie Boivin will simultaneously become mother and grandmother. The mother's actions were criticized by ethicist Margaret Somerville, the paper reported. "We have to think about what we are doing when we are running around nature," she said, noting that such a procedure completely overturns the normal transition of life.

Another practice that raises ethical doubts is the increasing use of surrogate mothers from developing nations to bear children for families from richer nations. One of the countries where this is taking place is India, explained an article published by Reuters on Feb. 4. A surrogate mother in the United States would cost a couple anything up to $50,000, Gautam Allahbadia, a fertility specialist, told Reuters. In India, however, it can be done for $10,000-$12,000. The Indian clinics usually charge $2,000-$3,000 for the procedure while the surrogate mother is paid $3,000-$6,000. The article observed that there are no official figures, but it is possible that 100-150 surrogate babies are born each year in India.

Motherless
Clinics are also starting to offer treatments aimed at the homosexual community. The Los Angeles-based The Fertility Institutes has launched a program for homosexual men who want to become parents, Reuters reported March 14. According to clinic director Jeffrey Steinberg they have already treated about 70 gay male couples while preparing the new service. He also noted that around three-quarters of the homosexual couples pay extra to choose the sex of their baby.

The convoluted parental structures created by IVF techniques also give rise to complex legal problems. A surrogate mother who has no genetic connection to the baby she is carrying does not have to be listed as the mother on a birth certificate, ruled the Maryland Court of Appeals, according to a report by the Associated Press on May 16. The case involved twins born in 2001. The woman carried the twins for a father who used an egg donor, and the surrogate mother had no genetic relationship to the twins.

Another case, still to be decided, involves the fate of a couple's frozen embryos. Augusta and Randy Roman decided to go ahead with treatment to produce the embryos, but just hours before they were due to be implanted in the wife's womb, her husband decided he did not want to go ahead with the procedure, reported the Los Angeles Times on May 30. This took place in 2002 and the following year the couple divorced. Since then they have disagreed over the fate of the frozen embryos and the matter has now reached the Supreme Court of Texas. Randy wants the embryos destroyed or to remain frozen.

The Los Angeles Times noted that so far the top courts of six states have ruled in such cases. In general they have decided that the right of one ex-spouse to not procreate trumps that of the other to procreate.

Not morally neutral
Church has long warned of the problems associated with IVF. In 1987 the Congregation for the Doctrine of the Faith published the "Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation," ("Donum Vitae").

Since 1987, the technologies involved in IVF have changed greatly, but many of the underlying ethical problems are the same. Science and technology are valuable resources, the instruction readily acknowledged. Nevertheless, it is a mistake to consider that scientific research and its applications are morally neutral. Moreover, the Congregation for the Doctrine of the Faith explained, they must be put at the service of the human person and should follow the criteria of the moral law. It is a mistake to consider the human body as merely made up of biological elements, the instruction argued. The human person has both a bodily and a spiritual nature.

As well, when it comes to the question of transmitting human life, it is not permissible to ignore the special nature of the human person. From the moment of conception, the instruction insisted, the life of every human person must be respected. In addition, the gift of human life should be carried out in the context of acts by a husband and wife.

The congregation admitted that the desire for children and the love between spouses who wish to overcome problems of sterility "constitute understandable motivations," behind the use of IVF methods. Nevertheless, the instruction continued, the existence of good intentions needs to be placed alongside the nature of marriage and the need to respect the rights of the child.

The document also commented on how only too often IVF techniques involve the destruction of human embryos. By acting in this manner we place ourselves in the position of imposing "death by decree," the text warned. The regular practice of such acts carries with it the risk of creating a mentality that leads us to a domination over the life and death of fellow human beings, the congregation adverted. A domination that with the passing of time is creating a seemingly unstoppable slide into practices that bring about serious moral and social dilemmas.

Ethical Answers to Infertility 2

The Gift of Infertility Part 2

Dr. Jameson and Jennifer Taylor

Catholic Exchange
July 22, 2007

As we saw in part one of this series, couples who have learned to chart effectively have a 76 percent chance of conceiving during their first cycle of use and a 98 percent pregnancy rate by their sixth cycle. Still, even if natural family planning (NFP) does not work for everyone (us included), artificial reproductive technologies (ART), such as intrauterine insemination (IUI) and in vitro fertilization (IVF), are contrary to the Church's teaching on human sexuality. Not only do IUI and IVF frustrate the unitive aspect of lovemaking, they violate the baby's right to be conceived through a person-to-person, body-to-body communion of husband and wife.

Person to (Doctor to) Person
Just as the person is an integration of the physical and the spiritual, every act of lovemaking should be ordered to the physical and spiritual good of each spouse. The physical goods of intercourse — pleasure and reproduction — need little explanation. The spiritual goods — primarily joy and gratitude — are derived from knowing that your spouse accepts and embraces all that you are. In this acceptance, the person is treated as an end in himself rather than a means to an end.

Couples struggling with infertility often experience an intense bond that comes from enduring the crisis of infertility together. Such intimacy, however, is distinct from the personal communion that only occurs in the conjugal act. Perhaps more than others, infertile couples can appreciate the spiritual benefits of lovemaking. When you are infertile, every act of intercourse is pregnant with the hope that God will work a miracle.

By contrast, techniques such as IUI and IVF entail an intentional decision to bypass the unitive aspect of the marital act. The use of these procedures transforms what is supposed to be a spiritual union between two persons into a merely biological process. Unlike intercourse between animals, though, the marital act requires that husband and wife surrender their entire selves to each other and to God.

This total gift of self, from which the spiritual goods of the conjugal act are derived, is inseparable from the act itself. For this reason, techniques such as IUI and IVF cannot bring about the spiritual goods unique to marital intercourse. Donum Vitae (The Gift of Life) explains: "The origin of the human being thus follows from a procreation that is 'linked to the union, not only biological but also spiritual, of the parents, made one by the bond of marriage.' Fertilization achieved outside of the bodies of the couple remains by this very fact deprived of the meanings and the values which are expressed in the language of the body and in the union of human persons" (II, 4).

The "meanings and values" inherent to the conjugal act are uniquely personal. That is to say, man and wife can only give themselves person to person, not person to catheter to person, or person to petri dish to person. By definition, this union is exclusive. Hence, nothing should come between the person-to-person, body-to-body communion of husband and wife. IUI and IVF are not conjugal acts because they are not extrinsically exclusive. The very possibility that these procedures can produce a baby between two people who have never even met one another indicates that IUI and IVF are not exclusive, and hence, not personal. To claim that they are is to redefine the conjugal act, much as homosexuals want to redefine marriage as a union between any two people who subjectively love one another. The wisdom of the Church's instruction is derived from the recognition that the marital act is designed by God to adhere to certain objective standards.

What About the Baby?
Most people believe that intercourse should be something more than a physical process aimed at making a baby — that the baby himself has a right to be created through the loving union of two persons. This intuition, at least, helps to explain why couples who use IUI and other reproductive technologies continue making love even after the procedure in the hope that their child might be the result of a natural conception — a conception achieved without the intervention of a third party. It also permits the couple to believe that their baby is the product of their conjugal love for one another in spite of their use of a procedure aimed at conceiving a child outside of a specific conjugal act. In effect, these couples presume IUI and IVF are personal acts because they occur within the context of ongoing marital relations. But not every sexual act that may occur within marriage — sodomy, for example — is a personal act.

As suggested above, a personal act harmonizes the spiritual and physical welfare of each spouse. This integration is what distinguishes mere reproduction from procreation — creation that seeks to imitate God in his own generosity and fecundity (cf. CCC 2335). In doing so, the couple extends God an invitation to enter into and bless their sexual union in whatever way He desires. This idea, that a child has the right to be created by God through a specific personal act, is especially stressed in Donum Vitae: "Conception in vitro is the result of the technical action which presides over fertilization. ... In homologous IVF and ET [embryo transfer], therefore, even if it is considered in the context of 'de facto' existing sexual relations, the generation of the human person is objectively deprived of its proper perfection: namely, that of being the result and fruit of a conjugal act in which the spouses can become 'cooperators with God for giving life to a new person.' These reasons enable us to understand why the act of conjugal love is ... the only setting worthy of human procreation" (II, 5).

To conceive a child through a technological process that replaces the conjugal act is to subject him to the "standards of control and dominion" inherent to the scientific method (II, 4). As such, the baby becomes an object of micromanipulation, rather than the fruit of a personal union sanctified by God.

Christians who approve of IUI and IVF maintain that these "artificial means merely assist the natural process." The Church, however, teaches that these procedures replace the conjugal act. Clarifies Donum Vitae: "A medical intervention respects the dignity of persons when it seeks to assist the conjugal act either in order to facilitate its performance or in order to enable it to achieve its objective once it has been normally performed" (II, 7). In the case of IUI, IVF, and other techniques, "The medical act is not, as it should be, at the service of conjugal union but rather appropriates to itself the procreative function and thus contradicts the dignity and the inalienable rights of the spouses and of the child to be born" (II, 7).

Divine Grace and Human Nature
What is primarily at issue here are the differing views of human nature held by Catholics and Protestants. Catholic doctrine maintains that grace builds on nature. God — and man's — action in the world must thus respect the natural order, which itself is part of the eternal order. Protestant theology believes nature is something low, something to be overcome by grace. For the Catholic, IUI and IVF are immoral because they replace the natural means by which a child should be conceived and, in so doing, subvert the natural ends of marital sexuality. For the Protestant, these natural means (and ends) are much less important than the good intentions and faithful heart that accompany the use of these techniques. As the authors of Empty Arms put it, "One can use 'unnatural' treatments and still demonstrate trust in God." What is important for the Protestant is the belief that God is working through these procedures, apart from whether or not the procedures are performed according to nature.

United in prayer and hope in God's generosity, couples who use IUI and IVF naturally feel as if their struggle with infertility has brought them closer to each other and to God. Yet these couples, albeit inadvertently, are impeding their union as man and wife by enabling a third party to intervene. The Catechism counsels: "These techniques ... betray the spouses' 'right to become a father and mother only through each other'" (CCC 2376). Some couples intuit this fact by acknowledging that masturbation is embarrassing or that choosing IVF was an extremely difficult decision. Nevertheless, these same people will maintain that they don't feel alienated from each other or God. The case is similar to those who justify their use of contraception by saying: "If God wants us to have a baby, we'll still have one." Yet, as the author of life, God "fearfully and wonderfully" begets each one of us "in secret" (Ps. 139:13-16). According to Scripture, this is His right alone (cf. Eccl. 11:5). Sure, God is acting when a man and a woman conceive a child outside of the natural order, but His hand is being forced. In such cases, God is present only permissively, rather than actively. Every baby, however, has the right to be given as a gift, a blessing bestowed according to the natural means established by God in accord with His perfect timing.

This is not to deny that babies produced through IUI and IVF are just as cute, wonderful and loved as any other children. The joy they bring to their parents is also just as real, if not more intense. This happiness, though, comes at the expense of the babies who have been denied the right to be conceived through a personal act. Needless to say, children created through artificial techniques are persons; they have immortal souls. Once conceived they also have a right to be loved and protected by their parents and society. Still, no one would admit that every act that results in the conception of a child is morally licit. Rape, for instance, may also result in the conception of a child.

Likewise, as we will see in part three of this series, not every act that creates life is "pro-life" — or even promotes the dignity of life.

Dr. Jameson Taylor is the author of America's Drug Deal: Vaccines, Abortion, Corruption (www.americasdrugdeal.com); Jennifer Taylor is a homemaker and a marriage and family therapist. Jameson and Jennifer are in the process of adopting their first baby and are currently writing The Gift of Infertility: A Guide for Catholic Couples Struggling with Infertility.

Ethical Answers to Infertility

Here is the first in the series of articles to come on the issue of Catholic infertility. You can see previous notes on the subject here.

The Gift of Infertility, Part 1

Dr. Jameson and Jenifer Taylor

Catholic Exchange
July 15, 2007

Having struggled with infertility for nearly six years, we know the pain of not being able to have a baby. We're also familiar with the awkward silences — and tears — that often accompany conversations with those who have never experienced infertility. On the one hand, people tend to believe fertility is something we have perfect control over. "Just relax," we've been told. "When you settle down, I'm sure it will happen." Or, "Maybe you're just not ready yet," as if "buying a house" or "getting a better job" would make us pregnant. On the other hand, it's a mystery why so many couples like us aren't blessed with biological children. If, as Scripture tells us, "children are a gift from the Lord" (Ps. 127:3), how should couples understand their infertility? What hope is there for couples who desperately desire children, but also want to remain faithful to the Church's guidance regarding artificial reproductive technologies?

According to the Centers for Disease Control, infertility is a condition that affects 2.1 million married couples (1 in 8 of childbearing age) and 6.1 million women, aged 15 to 44. Male factor infertility accounts for 30 percent to 40 percent of all cases. These rates are increasing as more couples delay marriage and childbirth to pursue careers and educational opportunities.

But did you know that according to Harvard researcher Alice Domar, "Infertile women report equivalent levels of anxiety and depression as women with cancer, HIV status or heart disease"? Adds Domar: "The majority of infertile women report that infertility is the most upsetting experience of their lives." Such heartbreak might help explain why so many hurting couples are tempted to pursue morally questionable remedies for infertility.

Fortunately, though, most couples can conceive using natural techniques that accord with the Church's wisdom on marital sexuality. Counsels Dr. Domar: "Very few people have physical conditions that make it impossible to have a child, and in many cases simple lifestyle changes and low-tech strategies can make a decisive difference. ... Many couples can be helped by our greater knowledge of how lifestyle factors like stress, exercise, and nutrition affect conception, of better ways to regulate and target ovulation cycles, and of common medicines to avoid that can inhibit sperm and egg production." Dr. Paul Dmowski, a leading infertility specialist, estimates that "only 8-10 percent of couples in treatment need high-tech ... procedures," such as in vitro fertilization (IVF). Concludes Domar: "So much attention in the media is focused on the latest high-tech intervention that many people forget to give nature enough of a chance."

Domar's observations allude to a popular prejudice in our culture that nature and science are at odds with one another. Natural, scientifically based alternatives are thus thought to be inferior to their high-tech counterparts. In reality, scientific technologies that work in accord with nature have proven very effective in treating infertility. The Creighton System's NaProTechnology program, for instance, boasts an overall pregnancy rate of up to 50 percent for patients of all ages and diagnoses — with rates as high as 80 percent for many couples. These figures are nearly two to three times higher than results from the leading artificial technologies.

Techniques like those taught by the Pope Paul VI Institute, Couple to Couple League, and the Billings Ovulation Method Association differ from artificial technologies in that they cooperate with nature by equipping couples to listen to what their bodies are saying. For a woman, these messages can usually be discerned by charting monthly cycles and mucus patterns. According to the Pope Paul VI Institute, couples who have learned to chart effectively have a 76 percent chance of conceiving during their first cycle of use and a 98 percent pregnancy rate by their sixth cycle. Yet, because many couples assume they'll get pregnant right away, they rarely take time to explore how their fertility works. "Even sophisticated couples," relates Dr. Domar, "may not be clear about when ovulation occurs or how long sperm live."

Diet and nutrition are also crucial to achieving pregnancy. According to John Kippley, cofounder of The Couple to Couple League, "In many cases, cycle irregularities can be either eliminated or alleviated simply by better nutrition or body balance." Many other seemingly insignificant modifications — wearing boxers instead of briefs, eliminating nightlights, taking 500 mg of extended release B6, using iodized salt — can likewise aid in conception.

Shifting Trends
Despite high success rates, some couples (like us) might not be able to have a baby using natural family planning. Lured by promises frequently backed up by a "100 percent money back guarantee," more and more couples, including many Catholic couples, are resorting to artificial insemination (AI) and assisted reproductive technologies (ART) to conceive a baby. The majority of people who employ high-tech treatments turn first to intrauterine insemination (IUI), the most popular form of artificial insemination (a technique by which processed sperm are injected into the uterus with a catheter). If that fails, many couples move on to in vitro fertilization (IVF), by far the most widely used form of ART. In recent years, however, IVF has become so popular that some physicians no longer consider IUI a first-line approach.

Given that very few Christian ethicists approve of donor insemination, or heterologous artificial insemination (AID), we will limit our remarks to the homologous forms of IUI and IVF. By and large, Protestant theologians agree that infertility procedures that are homologous or exclusive, in that they use only the husband's sperm and/or his wife's eggs, are Biblically defensible. Out of her deep respect for the human person, however, the Catholic Church holds that no form of artificial insemination or ART is permissible.

The primary reason the Church opposes IUI and IVF is that these techniques frustrate the unitive aspect of the marital act. As discussed below, the unitive end of marriage encompasses the personal and spiritual good of the spouses themselves. One indication of this breach in unity is that artificial interventions (excepting a tubal ovum transfer with sperm) always require masturbation.

Until quite recently nearly all Protestant theologians disapproved of masturbation. Genesis 38:8-10, in which Onan is struck dead by God for repeatedly practicing coitus interruptus, is the locus classicus for the traditional teaching on masturbation. Commenting on this passage, Luther argued that God punished Onan because he "preferred polluting himself with a most disgraceful sin to raising up offspring for his brother." Continues Luther: "It is far more atrocious than incest or adultery. We call it unchastity, yes a Sodomitic sin." Calvin likewise declared: "The voluntary spilling of semen outside of intercourse between man and woman is a monstrous thing."

Yet most Protestant authorities no longer agree with the traditional elucidation of Genesis 38 and so do not consider masturbation a sin. James Dobson, for one, posits that Onan was killed for failing to do his "duty" to produce offspring for his brother, rather than for spilling his seed. In a similar vein, When Empty Arms Become a Heavy Burden, a "Christian guide to the practical, moral, marital, and spiritual challenges of infertility," acknowledges that while masturbation "can prove disruptive to a relationship with God as well as others, particularly in marriage," providing a semen specimen "on demand" can be a gesture of "respect for God" and love of one's spouse.

Protestant scripture scholar Charles Provan, however, demonstrates in The Bible and Birth Control that Onan was not killed for disobeying his father, Judah, or because he did not honor his brother's memory, or for anything other than spilling his seed. Citing Genesis 2:24, Provan shows that Judah's authority over his son ended when Onan got married. Provan also recalls that the punishment prescribed for failure to "raise up seed for a dead brother" is not death, but merely to have the widow publicly remove her brother-in-law's sandal and spit in his face (Dt. 25:5-10). Additionally, Provan leads us to ask why Onan — and not Adam, Eve, Cain, Jonah and countless others — merited such harsh punishment for his disobedience? Provan's conclusion, based upon a close analysis of Leviticus 20, is that God forbids all forms of intentionally sterile intercourse.

The Narrow Way

Apologists for IUI and IVF often call the Church's view on masturbation narrow, just as they call the Church's definition of conjugal love constrictive. Empty Arms offers this partially misleading analysis of Catholic teaching: "The Vatican, which interprets Scripture for members of the Roman Catholic Church, holds that sex (the unitive) must not be separated from the opportunity to reproduce (the procreative) nor vice versa. ... As a result, the Vatican prohibits birth control, D.I. [donor insemination], and even insemination using the husband's sperm. ... While we agree on the importance of Scripture, we question the specific interpretation that leads to the Vatican's viewpoint. If carried to its extreme conclusion, this view would suggest that no sterile man or woman may have sexual intercourse. It would also prohibit postmenopausal women from sexual relations. For this reason, some have suggested that the Vatican redefine conjugal love in such a way that it encompasses all forms of physical expression in marital love, rather than limiting it to sexual intercourse" (167-168).

Similarly, John and Sylvia Van Regenmorter, authors of a popular text on infertility published by Focus on the Family, contend that "numerous Roman Catholic theologians" disagree with the Church regarding infertility treatments. "Following this reasoning many Roman Catholic couples are convinced they may pursue AIH [homologous artificial insemination] without violating their consciences or their faith."

Granted, some Protestants don't approve of any form of artificial insemination or ART. But lacking doctrinal authority, most discussions about these matters are vague and unsystematic; equivocation is also common. Frequently, couples looking for specific advice are told there is no simple right or wrong answer. That's why it's so great to be Catholic. Regardless of what dissident Catholic theologians claim, the Church offers concrete guidance for couples struggling with infertility. This guidance is grounded in the Church's longstanding teaching on human sexuality. As reaffirmed in Humanae Vitae (Of Human Life): "There is an unbreakable connection between the unitive meaning and the procreative meaning [of the conjugal act], and both are inherent in the conjugal act. This connection was established by God, and man is not permitted to break it through his own volition (12)." These last four words — "through his own volition" — are essential to understanding the Church's position. Contrary to what the authors of Empty Arms say, the Church does not prohibit sterile (impotency is another matter, cf. Can. 1084) or postmenopausal couples from having intercourse. These couples are not choosing to disconnect the procreative and unitive aspects of their lovemaking; rather, they are letting nature take its course while continuing to come together as man and wife in the way nature ordains.

But the main point here is that the unitive aspect of the marital act does not consist merely of sex, as asserted above. Rather, as the Catechism teaches, its end is the "good of the spouses themselves" (CCC 2363). This good is such that it can only come about through the mutual surrender of one spouse to another: a self-donation that must be both personal and exclusive.

Contrary to what many couples may believe, IUI and IVF are neither exclusive nor personal acts. As we shall see in part two of this series, IUI and IVF thus violate both the baby's right to be created through a specific personal act and the mother and father's right to become parents only through each other (CCC 2376).

Dr. Jameson Taylor is the author of America's Drug Deal: Vaccines, Abortion, Corruption (http://www.americasdrugdeal.com/); Jennifer Taylor is a homemaker and a marriage and family therapist. Jameson and Jennifer are in the process of adopting their first baby and are currently writing The Gift of Infertility: a guide for Catholic couples struggling with infertility.

The Morality of ART and Stem Cells: All You Ever Needed to Know.

CONGREGATION FOR THE DOCTRINE OF THE FAITH

INSTRUCTION ON RESPECT FOR HUMAN LIFE IN ITS ORIGIN
AND ON THE DIGNITY OF PROCREATION
REPLIES TO CERTAIN QUESTIONS OF THE DAY

FOREWORD

The Congregation for the Doctrine of the Faith has been approached by various Episcopal Conferences or individual Bishops, by theologians, doctors and scientists, concerning biomedical techniques which make it possible to intervene in the initial phase of the life of a human being and in the very processes of procreation and their conformity with the principles of Catholic morality. The present Instruction, which is the result of wide consultation and in particular of a careful evaluation of the declarations made by Episcopates, does not intend to repeat all the Church's teaching on the dignity of human life as it originates and on procreation, but to offer, in the light of the previous teaching of the Magisterium, some specific replies to the main questions being asked in this regard. The exposition is arranged as follows: an introduction will recall the fundamental principles, of an anthropological and moral character, which are necessary for a proper evaluation of the problems and for working out replies to those questions; the first part will have as its subject respect for the human being from the first moment of his or her existence; the second part will deal with the moral questions raised by technical interventions on human procreation; the third part will offer some orientations on the relationships between moral law and civil law in terms of the respect due to human embryos and foetuses* and as regards the legitimacy of techniques of artificial procreation.

* The terms "zygote", "pre-embryo", "embryo" and "foetus" can indicate in the vocabulary of biology successive stages of the development of a human being. The present Instruction makes free use of these terms, attributing to them an identical ethical relevance, in order to designate the result (whether visible or not) of human generation, from the first moment of its existence until birth. The reason for this usage is clarified by the text (cf I, 1).

INTRODUCTION

1. BIOMEDICAL RESEARCH AND THE TEACHING
OF THE CHURCH

The gift of life which God the Creator and Father has entrusted to man calls him to appreciate the inestimable value of what he has been given and to take responsibility for it: this fundamental principle must be placed at the centre of one's reflection in order to clarify and solve the moral problems raised by artificial interventions on life as it originates and on the processes of procreation. Thanks to the progress of the biological and medical sciences, man has at his disposal ever more effective therapeutic resources; but he can also acquire new powers, with unforeseeable consequences, over human life at its very beginning and in its first stages. Various procedures now make it possible to intervene not only in order to assist but also to dominate the processes of procreation. These techniques can enable man to "take in hand his own destiny", but they also expose him "to the temptation to go beyond the limits of a reasonable dominion over nature".(1) They might constitute progress in the service of man, but they also involve serious risks. Many people are therefore expressing an urgent appeal that in interventions on procreation the values and rights of the human person be safeguarded. Requests for clarification and guidance are coming not only from the faithful but also from those who recognize the Church as "an expert in humanity " (2) with a mission to serve the "civilization of love" (3) and of life.

The Church's Magisterium does not intervene on the basis of a particular competence in the area of the experimental sciences; but having taken account of the data of research and technology, it intends to put forward, by virtue of its evangelical mission and apostolic duty, the moral teaching corresponding to the dignity of the person and to his or her integral vocation. It intends to do so by expounding the criteria of moral judgment as regards the applications of scientific research and technology, especially in relation to human life and its beginnings. These criteria are the respect, defence and promotion of man, his "primary and fundamental right" to life,(4) his dignity as a person who is endowed with a spiritual soul and with moral responsibility (5) and who is called to beatific communion with God. The Church's intervention in this field is inspired also by the Love which she owes to man, helping him to recognize and respect his rights and duties. This love draws from the fount of Christ's love: as she contemplates the mystery of the Incarnate Word, the Church also comes to understand the "mystery of man"; (6) by proclaiming the Gospel of salvation, she reveals to man his dignity and invites him to discover fully the truth of his own being. Thus the Church once more puts forward the divine law in order to accomplish the work of truth and liberation. For it is out of goodness - in order to indicate the path of life - that God gives human beings his commandments and the grace to observe them: and it is likewise out of goodness - in order to help them persevere along the same path - that God always offers to everyone his forgiveness. Christ has compassion on our weaknesses: he is our Creator and Redeemer. May his spirit open men's hearts to the gift of God's peace and to an understanding of his precepts.

2. SCIENCE AND TECHNOLOGY
AT THE SERVICE OF THE HUMAN PERSON

God created man in his own image and likeness: "male and female he created them" (Gen 1: 27 ), entrusting to them the task of "having dominion over the earth" (Gen 1:28). Basic scientific research and applied research constitute a significant expression of this dominion of man over creation. Science and technology are valuable resources for man when placed at his service and when they promote his integral development for the benefit of all; but they cannot of themselves show the meaning of existence and of human progress. Being ordered to man, who initiates and develops them, they draw from the person and his moral values the indication of their purpose and the awareness of their limits.

It would on the one hand be illusory to claim that scientific research and its applications are morally neutral; on the other hand one cannot derive criteria for guidance from mere technical efficiency, from research's possible usefulness to some at the expense of others, or, worse still, from prevailing ideologies. Thus science and technology require, for their own intrinsic meaning, an unconditional respect for the fundamental criteria of the moral law: that is to say, they must be at the service of the human person, of his inalienable rights and his true and integral good according to the design and will of God.(7) The rapid development of technological discoveries gives greater urgency to this need to respect the criteria just mentioned: science without conscience can only lead to man's ruin. "Our era needs such wisdom more than bygone ages if the discoveries made by man are to be further humanized. For the future of the world stands in peril unless wiser people are forthcoming".(8)

3. ANTHROPOLOGY AND PROCEDURES
IN THE BIOMEDICAL FIELD

Which moral criteria must be applied in order to clarify the problems posed today in the field of biomedicine? The answer to this question presupposes a proper idea of the nature of the human person in his bodily dimension.

For it is only in keeping with his true nature that the human person can achieve self-realization as a "unified totality":(9) and this nature is at the same time corporal and spiritual. By virtue of its substantial union with a spiritual soul, the human body cannot be considered as a mere complex of tissues, organs and functions, nor can it be evaluated in the same way as the body of animals; rather it is a constitutive part of the person who manifests and expresses himself through it. The natural moral law expresses and lays down the purposes, rights and duties which are based upon the bodily and spiritual nature of the human person. Therefore this law cannot be thought of as simply a set of norms on the biological level; rather it must be defined as the rational order whereby man is called by the Creator to direct and regulate his life and actions and in particular to make use of his own body.(10) A first consequence can be deduced from these principles: an intervention on the human body affects not only the tissues, the organs and their functions but also involves the person himself on different levels. It involves, therefore, perhaps in an implicit but nonetheless real way, a moral significance and responsibility. Pope John Paul II forcefully reaffirmed this to the World Medical Association when he said: "Each human person, in his absolutely unique singularity, is constituted not only by his spirit, but by his body as well. Thus, in the body and through the body, one touches the person himself in his concrete reality. To respect the dignity of man consequently amounts to safeguarding this identity of the man 'corpore et anima unus', as the Second Vatican Council says (Gaudium et Spes, 14, par.1). It is on the basis of this anthropological vision that one is to find the fundamental criteria for decision-making in the case of procedures which are not strictly therapeutic, as, for example, those aimed at the improvement of the human biological condition".(11)

Applied biology and medicine work together for the integral good of human life when they come to the aid of a person stricken by illness and infirmity and when they respect his or her dignity as a creature of God. 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. God, who is love and life, has inscribed in man and woman the vocation to share in a special way in his mystery of personal communion and in his work as Creator and Father.(12) For this reason marriage possesses specific goods and values in its union and in procreation which cannot be likened to those existing in lower forms of life. Such values and meanings are of the personal order and determine from the moral point of view the meaning and limits of artificial interventions on procreation and on the origin of human life. These interventions are not to be rejected on the grounds that they are artificial. As such, they bear witness to the possibilities of the art of medicine. But they must be given a moral evaluation in reference to the dignity of the human person, who is called to realize his vocation from God to the gift of love and the gift of life.

4. FUNDAMENTAL CRITERIA FOR A MORAL JUDGMENT

The fundamental values connected with the techniques of artificial human procreation are two: the life of the human being called into existence and the special nature of the transmission of human life in marriage. The moral judgment on such methods of artificial procreation must therefore be formulated in reference to these values.

Physical life, with which the course of human life in the world begins, certainly does not itself contain the whole of a person's value, nor does it represent the supreme good of man who is called to eternal life. However it does constitute in a certain way the "fundamental " value of life, precisely because upon this physical life all the other values of the person are based and developed.(13) The inviolability of the innocent human being's right to life "from the moment of conception until death" (14) is a sign and requirement of the very inviolability of the person to whom the Creator has given the gift of life. By comparison with the transmission of other forms of life in the universe, the transmission of human life has a special character of its own, which derives from the special nature of the human person. "The transmission of human life is entrusted by nature to a personal and conscious act and as such is subject to the all-holy laws of God: immutable and inviolable laws which must be recognized and observed. For this reason one cannot use means and follow methods which could be licit in the transmission of the life of plants and animals" (15)

Advances in technology have now made it possible to procreate apart from sexual relations through the meeting in vitro of the germ-cells previously taken from the man and the woman. But what is technically possible is not for that very reason morally admissible. Rational reflection on the fundamental values of life and of human procreation is therefore indispensable for formulating a moral evaluation of such technological interventions on a human being from the first stages of his development.

5. TEACHINGS OF THE MAGISTERIUM

On its part, the Magisterium of the Church offers to human reason in this field too the light of Revelation: the doctrine concerning man taught by the Magisterium contains many elements which throw light on the problems being faced here. From the moment of conception, the life of every human being is to be respected in an absolute way because man is the only creature on earth that God has "wished for himself " (16) and the spiritual soul of each man is "immediately created" by God; (17) his whole being bears the image of the Creator. Human life is sacred because from its beginning it involves "the creative action of God" (18) and it remains forever in a special relationship with she Creator, who is its sole end.(19) God alone is the Lord of life from its beginning until its end: no one can, in any circumstance, claim for himself the right to destroy directly an innocent human being. (20) Human procreation requires on the part of the spouses responsible collaboration with the fruitful love of God; (21) the gift of human life must be actualized in marriage through the specific and exclusive acts of husband and wife, in accordance with the laws inscribed in their persons and in their union.(22)

I RESPECT FOR HUMAN EMBRYOS

Careful reflection on this teaching of the Magisterium and on the evidence of reason, as mentioned above, enables us to respond to the numerous moral problems posed by technical interventions upon the human being in the first phases of his life and upon the processes of his conception.

1. WHAT RESPECT IS DUE TO THE HUMAN EMBRYO, TAKING INTO ACCOUNT HIS NATURE AND IDENTITY?

The human being must be respected - as a person - from the very first instant of his existence. The implementation of procedures of artificial fertilization has made possible various interventions upon embryos and human foetuses. The aims pursued are of various kinds: diagnostic and therapeutic, scientific and commercial. From all of this, serious problems arise. Can one speak of a right to experimentation upon human embryos for the purpose of scientific research? What norms or laws should be worked out with regard to this matter? The response to these problems presupposes a detailed reflection on the nature and specific identity - the word "status" is used - of the human embryo itself .

At the Second Vatican Council, the Church for her part presented once again to modern man her constant and certain doctrine according to which: "Life once conceived, must be protected with the utmost care; abortion and infanticide are abominable crimes". (23) More recently, the Charter of the Rights of the Family, published by the Holy See, confirmed that "Human life must be absolutely respected and protected from the moment of conception".(24)

This Congregation is aware of the current debates concerning the beginning of human life, concerning the individuality of the human being and concerning the identity of the human person. The Congregation recalls the teachings found in the Declaration on Procured Abortion: "From the time that the ovum is fertilized, a new life is begun which is neither that of the father nor of the mother; it is rather the life of a new human being with his own growth. It would never be made human if it were not human already. To this perpetual evidence ... modern genetic science brings valuable confirmation. It has demonstrated that, from the first instant, the programme is fixed as to what this living being will be: a man, this individual-man with his characteristic aspects already well determined. Right from fertilization is begun the adventure of a human life, and each of its great capacities requires time ... to find its place and to be in a position to act". (25) This teaching remains valid and is further confirmed, if confirmation were needed, by recent findings of human biological science which recognize that in the zygote* resulting from fertilization the biological identity of a new human individual is already constituted. Certainly no experimental datum can be in itself sufficient to bring us to the recognition of a spiritual soul; nevertheless, the conclusions of science regarding the human embryo provide a valuable indication for discerning by the use of reason a personal presence at the moment of this first appearance of a human life: how could a human individual not be a human person? The Magisterium has not expressly committed itself to an affirmation of a philosophical nature, but it constantly reaffirms the moral condemnation of any kind of procured abortion. This teaching has not been changed and is unchangeable.(26)

Thus the fruit of human generation, from the first moment of its existence, that is to say from the moment the zygote has formed, demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality. The human being is to be respected and treated as a person from the moment of conception; and therefore from that same moment his rights as a person must be recognized, among which in the first place is the inviolable right of every innocent human being to life. This doctrinal reminder provides the fundamental criterion for the solution of the various problems posed by the development of the biomedical sciences in this field: since the embryo must be treated as a person, it must also 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.

* The zygote is the cell produced when the nuclei of the two gametes have fused.

2. IS PRENATAL DIAGNOSIS MORALLY LICIT?

If prenatal diagnosis respects the life and integrity of the embryo and the human foetus and is directed towards its safeguarding or healing as an individual, then the answer is affirmative.

For prenatal diagnosis makes it possible to know the condition of the embryo and of the foetus when still in the mother's womb. It permits, or makes it possible to anticipate earlier and more effectively, certain therapeutic, medical or surgical procedures. Such diagnosis is permissible, with the consent of the parents after they have been adequately informed, if the methods employed safeguard the life and integrity of the embryo and the mother, without subjecting them to disproportionate risks.(27) But this diagnosis is gravely opposed to the moral law when it is done with the thought of possibly inducing an abortion depending upon the results: a diagnosis which shows the existence of a malformation or a hereditary illness must not be the equivalent of a death-sentence. Thus a woman would be committing a gravely illicit act if she were to request such a diagnosis with the deliberate intention of having an abortion should the results conf rm the existence of a malformation or abnormality. The spouse or relatives or anyone else would similarly be acting in a manner contrary to the moral law if they were to counsel or impose such a diagnostic procedure on the expectant mother with the same intention of possibly proceeding to an abortion. So too the specialist would be guilty of illicit collaboration if, in conducting the diagnosis and in communicating its results, he were deliberately to contribute to establishing or favouring a link between prenatal diagnosis and abortion. In conclusion, any directive or programme of the civil and health authorities or of scientific organizations which in any way were to favour a link between prenatal diagnosis and abortion, or which were to go as far as directly to induce expectant mothers to submit to prenatal diagnosis planned for the purpose of eliminating foetuses which are affected by malformations or which are carriers of hereditary illness, is to be condemned as a violation of the unborn child's right to life and as an abuse of the prior rights and duties of the spouses,

3. ARE THERAPEUTIC PROCEDURES CARRIED OUT ON THE HUMAN EMBRYO LICIT?

As with all medical interventions on patients, one must uphold as licit procedures carried out on the human embryo which respect the life and integrity of the embryo and do not involve disproportionate risks for it but are directed towards its healing, the improvement of its condition of health, or its individual survival. Whatever the type of medical, surgical or other therapy, the free and informed consent of the parents is required, according to the deontological rules followed in the case of children. The application of this moral principle may call for delicate and particular precautions in the case of embryonic or foetal life. The legitimacy and criteria of such procedures have been clearly stated by Pope John Paul II: "A strictly therapeutic intervention whose explicit objective is the healing of various maladies such as those stemming from chromosomal defects will, in principle, be considered desirable, provided it is directed to the true promotion of the personal well-being of the individual without doing harm to his integrity or worsening his conditions of life. Such an intervention would indeed fall within the logic of the Christian moral tradition" (28)

4. HOW IS ONE TO EVALUATE MORALLY RESEARCH AND EXPERIMENTATION* ON HUMAN EMBRYOS AND FOETUSES?

Medical research must refrain from operations on live embryos, unless there is a moral certainty of not causing harm to the life or integrity of the unborn child and the mother, and on condition that the parents have givers their free and in formed consent to the procedure. It follows that all research, even when limited to the simple observation of the embryo, would become illicit were it to involve risk to the embryo's physical integrity or life by reason of the methods used or the effects induced. As regards experimentation, and presupposing the general distinction between experi;'nentation for purposes which are not directly therapeutic and experimentation which is clearly therapeutic for the subject himself, in the case in point one must also distinguish between experimentation carried out on embryos which are still alive and experimentation carried out on embryos which are dead. If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit.(29) No objective, even though noble in itself, such as a foreseeable advantage to science, to other human beings or to society, can in any way justify experimentation on living human embryos or foetuses, whether viable or not, either inside or outside the mother's womb. The informed consent ordinarily required for clinical experimentation on adults cannot be granted by the parents, who may not freely dispose of the physical integrity or life of the unborn child. Moreover, experimentation on embryos and foetuses always involves risk, and indeed in most cases it involves the certain expectation of harm to their physical integrity or even their death. To use human embryos or foetuses as the object or instrument of experimentation constitutes a crime against their dignity as human beings having a right to the same respect that is due to the child already born and to every human person.

The Charter of the Rights of the Family published by the Holy See affirms: "Respect for the dignity of the human being excludes all experimental manipulation or exploitation of the human embryo".(30) The practice of keeping alive human embryos in vivo or in vitro for experimental or commercial purposes is totally opposed to human dignity. In the case of experimentation that is clearly therapeutic, namely, when it is a matter of experimental forms of therapy used for the benefit of the embryo itself in a final attempt to save its life, and in the absence of other reliable forms of therapy, recourse to drugs or procedures not yet fully tested can be licit (31)

The corpses of human embryos and foetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings. In particular, they cannot be subjected to mutilation or to autopsies if their death has not yet been verified and without the consent of the parents or of the mother. Furthermore, the moral requirements must be safeguarded that there be no complicity in deliberate abortion and that the risk of scandal be avoided. Also, in the case of dead foetuses, as for the corpses of adult persons, all commercial trafficking must be considered illicit and should be prohibited.

* Since the terms "research" and "experimentation" are often used equivalently and ambiguously, it is deemed necessary to specify the exact meaning given them in this document.

1) By research is meant any inductive-deductive process which aims at promoting the systematic observation of a given phenomenon in the human field or at verifying a hypothesis arising from previous observations.

2) By experimentation is meant any research in which the human being (in the various stages of his existence: embryo, foetus, child or adult) represents the object through which or upon which one intends to verify the effect, at present unknown or not sufficiently known, of a given treatment (e.g. pharmacological, teratogenic, surgical, etc.).

5. HOW IS ONE TO EVALUATE MORALLY THE USE FOR RESEARCH PURPOSES OF EMBRYOS OBTAINED BY FERTILIZATION 'IN VITRO'?

Human embryos obtained in vitro are human beings and subjects with rights: their dignity and right to life must be respected from the first moment of their existence. It is immoral to produce human embryos destined to be exploited as disposable "biological material". In the usual practice of in vitro fertilization, not all of the embryos are transferred to the woman's body; some are destroyed. Just as the Church condemns induced abortion, so she also forbids acts against the life of these human beings. It is a duty to condemn the particular gravity of the voluntary destruction of human embryos obtained 'in vitro' for the sole purpose of research, either by means of artificial insemination of by means of "twin fission". By acting in this way the researcher usurps the place of God; and, even though he may be unaware of this, he sets himself up as the master of the destiny of others inasmuch as he arbitrarily chooses whom he will allow to live and whom he will send to death and kills defenceless human beings.

Methods of observation or experimentation which damage or impose grave and disproportionate risks upon embryos obtained in vitro are morally illicit for the same reasons. every human being is to be respected for himself, and cannot be reduced in worth to a pure and simple instrument for the advantage of others. It is therefore not in conformity with the moral law deliberately to expose to death human embryos obtained 'in vitro'. In consequence of the fact that they have been produced in vitro, those embryos which art not transferred into the body of the mother and are called "spare" are exposed to an absurd fate, with no possibility of their being offered safe means of survival which can be licitly pursued.

6. WHAT JUDGMENT SHOULD BE MADE ON OTHER PROCEDURES OF MANIPULATING EMBRYOS CONNECTED WITH THE "TECHNIQUES OF HUMAN REPRODUCTION"?

Techniques of fertilization in vitro can open the way to other forms of biological and genetic manipulation of human embryos, such as attempts or plans for fertilization between human and animal gametes and the gestation of human embryos in the uterus of animals, or the hypothesis or project of constructing artificial uteruses for the human embryo. These procedures are contrary to the human dignity proper to the embryo, and at the same time they are contrary to the right of every person to be conceived and to be born within marriage and from marriage.(32) Also, attempts or hypotheses for obtaining a human being without any connection with sexuality through "twin fission", cloning or parthenogenesis are to be considered contrary to the moral law, since they are in opposition to the dignity both of human procreation and of the conjugal union.

The freezing of embryos, even when carried out in order to preserve the life of an embryo - cryopreservation - constitutes an offence against the respect due to human beings by exposing them to grave risks of death or harm to their physical integrity and depriving them, at least temporarily, of maternal shelter and gestation, thus placing them in a situation in which further offences and manipulation are possible.

Certain attempts to influence chromosomic or genetic inheritance are not therapeutic but are aimed at producing human beings selected according to sex or other predetermined qualities. These manipulations are contrary to the personal dignity of the human being and his or her integrity and identity. Therefore in no way can they be justified on the grounds of possible beneficial consequences for future humanity. (33) Every person must be respected for himself: in this consists the dignity and right of every human being from his or her beginning.

II INTERVENTIONS UPON HUMAN PROCREATION

By "artificial procreation" or " artificial fertilization" are understood here the different technical procedures directed towards obtaining a human conception in a manner other than the sexual union of man and woman. This Instruction deals with fertilization of an ovum in a test-tube (in vitro fertilization) and artificial insemination through transfer into the woman's genital tracts of previously collected sperm.

A preliminary point for the moral evaluation of such technical procedures is constituted by the consideration of the circumstances and consequences which those procedures involve in relation to the respect due the human embryo. Development of the practice of in vitro fertilization has required innumerable fertilizations and destructions of human embryos. Even today, the usual practice presupposes a hyperovulation on the part of the woman: a number of ova are withdrawn, fertilized and then cultivated in vitro for some days. Usually not all are transferred into the genital tracts of the woman; some embryos, generally called "spare ", are destroyed or frozen. On occasion, some of the implanted embryos are sacrificed for various eugenic, economic or psychological reasons. Such deliberate destruction of human beings or their utilization for different purposes to the detriment of their integrity and life is contrary to the doctrine on procured abortion already recalled. The connection between in vitro fertilization and the voluntary destruction of human embryos occurs too often. This is significant: through these procedures, with apparently contrary purposes, life and death are subjected to the decision of man, who thus sets himself up as the giver of life and death by decree. This dynamic of violence and domination may remain unnoticed by those very individuals who, in wishing to utilize this procedure, become subject to it themselves. The facts recorded and the cold logic which links them must be taken into consideration for a moral judgment on IVF and ET (in vitro fertilization and embryo transfer): the abortion-mentality which has made this procedure possible thus leads, whether one wants it or not, to man's domination over the life and death of his fellow human beings and can lead to a system of radical eugenics.

Nevertheless, such abuses do not exempt one from a further and thorough ethical study of the techniques of artificial procreation considered in themselves, abstracting as far as possible from the destruction of embryos produced in vitro. The present Instruction will therefore take into consideration in the first place the problems posed by heterologous artificial fertilization (II, 1-3), * and subsequently those linked with homologous artificial fertilization (II, 4-6 ) .** Before formulating an ethical judgment on each of these procedures, the principles and values which determine the moral evaluation of each of them will be considered.

* By the term heterologous artificial fertilization or procreation, the Instruction means techniques used to obtain a human conception artificially by the use of gametes coming from at least one donor other than the spouses who are joined in marriage. Such techniques can be of two types

a) Heterologous IVF and ET: the technique used to obtain a human conception through the meeting in vitro of gametes taken from at least one donor other than the two spouses joined in marriage.

b) Heterologous artifical insemination: the technique used to obtain a human conception through the transfer into the genital tracts of the woman of the sperm previously collected from a donor other than the husband.

** By artificial homologous fertilization or procreation, the Instruction means the technique used to obtain a human conception using the gametes of the two spouses joined in marriage. Homologous artificial fertilization can be carried out by two different methods:

a) Homologous IVF and ET: the technique used to obtain a human conception through the meeting in vitro of the gametes of the spouses joined in marriage.

b) Homologous artificial insemination: the technique used to obtain a human conception through the transfer into the genital tracts of a married woman of the sperm previously collected from her husband.

A. HETEROLOGOUS ARTIFICIAL FERTILIZATION

1. WHY MUST HUMAN PROCREATION TAKE PLACE IN MARRIAGE?

Every human being is always to be accepted as a gift and blessing of God. However, from the moral point of view a truly responsible procreation vis-à-vis the unborn child must be the fruit of marriage.

For human procreation has specific characteristics by virtue of the personal dignity of the parents and of the children: the procreation of a new person, whereby the man and the woman collaborate with the power of the Creator, must be the fruit and the sign of the mutual self-giving of the spouses, of their love and of their fidelity.(34) The fidelity of the spouses in the unity of marriage involves reciprocal respect of their right to become a father and a mother only through each other. The child has the right to be conceived, carried in the womb, brought into the world and brought up within marriage: it is through the secure and recognized relationship to his own parents that the child can discover his own identity and achieve his own proper human development. The parents find in their child a confirmation and completion of their reciprocal self-giving: the child is the living image of their love, the permanent sign of their conjugal union, the living and indissoluble concrete expression of their paternity and maternity, (35) By reason of the vocation and social responsibilities of the person, the good of the children and of the parents contributes to the good of civil society; the vitality and stability of society require that children come into the world within a family and that the family be firmly based on marriage. The tradition of the Church and anthropological reflection recognize in marriage and in its indissoluble unity the only setting worthy of truly responsible procreation.

2. DOES HETEROLOGOUS ARTIFICIAL FERTILIZATION CONFORM TO THE DIGNITY OF THE COUPLE AND TO THE TRUTH OF MARRIAGE?

Through IVF and ET and heterologous artificial insemination, human conception is achieved through the fusion of gametes of at least one donor other than the spouses who are united in marriage. Heterologous artificial fertilization is contrary to the unity of marriage, to the dignity of the spouses, to the vocation proper to parents, and to the child's right to be conceived and brought into the world in marriage and from marriage.(36) Respect for the unity of marriage and for conjugal fidelity demands that the child be conceived in marriage; the bond existing between husband and wife accords the spouses, in an objective and inalienable manner, the exclusive right to become father and mother solely through each other.(37) Recourse to the gametes of a third person, in order to have sperm or ovum available, constitutes a violation of the reciprocal commitment of the spouses and a grave lack in regard to that essential property of marriage which is its unity. Heterologous artificial fertilization violates the rights of the child; it deprives him of his filial relationship with his parental origins and can hinder the maturing of his personal identity. Furthermore, it offends the common vocation of the spouses who are called to fatherhood and motherhood: it objectively deprives conjugal fruitfulness of its unity and integrity; it brings about and manifests a rupture between genetic parenthood, gestational parenthood and responsibility for upbringing. Such damage to the personal relationships within the family has repercussions on civil society: what threatens the unity and stability of the family is a source of dissension, disorder and injustice in the whole of social life. These reasons lead to a negative moral judgment concerning heterologous artificial fertilization: consequently fertilization of a married woman with the sperm of a donor different from her husband and fertilization with the husband's sperm of an ovum not coming from his wife are morally illicit. Furthermore, the artificial fertilization of a woman who is unmarried or a widow, whoever the donor may be, cannot be morally justified.

The desire to have a child and the love between spouses who long to obviate a sterility which cannot be overcome in any other way constitute understandable motivations; but subjectively good intentions do not render heterologous artificial fertilization conformable to the objective and inalienable properties of marriage or respectful of the rights of the child and of the spouses.

3. IS "SURROGATE"* MOTHERHOOD MORALLY LICIT?

No, for the same reasons which lead one to reject heterologous artificial fertilization: for it is contrary to the unity of marriage and to the dignity of the procreation of the human person. Surrogate motherhood represents an objective failure to meet the obligations of maternal love, of conjugal fidelity and of responsible motherhood; it offends the dignity and the right of the child to be conceived, carried in the womb, brought into the world and brought up by his own parents; it sets up, to the detriment of families, a division between the physical, psychological and moral elements which constitute those families.

* By "surrogate mother" the Instruction means:

a) the woman who carries in pregnancy an embryo implanted in her uterus and who is genetically a stranger to the embryo because it has been obtained through the union of the gametes of "donors". She carries the pregnancy with a pledge to surrender the baby once it is born to the party who commissioned or made the agreement for the pregnancy.

b) the woman who carries in pregnancy an embryo to whose procreation she has contributed the donation of her own ovum, fertilized through insemination with the sperm of a man other than her husband. She carries the pregnancy with a pledge to surrender the child once it is born to the party who commissioned or made the agreement for the pregnancy.

B HOMOLOGOUS ARTIFICIAL FERTILIZATION

Since heterologous artificial fertilization has been declared unacceptable, the question arises of how to evaluate morally the process of homologous artificial fertilization: IVF and ET and artificial insemination between husband and wife. First a question of principle must be clarified.

4. WHAT CONNECTION IS REQUIRED FROM THE MORAL POINT OF VIEW BETWEEN PROCREATION AND THE CONJUGAL ACT?

a) The Church's teaching on marriage and human procreation affirms the "inseparable connection, willed by God and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning. Indeed, by its intimate structure, the conjugal act, while most closely uniting husband and wife, capacitates them for the generation of new lives, according to laws inscribed in the very being of man and of woman".(38) This principle, which is based upon the nature of marriage and the intimate connection of the goods of marriage, has well-known consequences on the level of responsible fatherhood and motherhood. "By safeguarding both these essential aspects, the unitive and the procreative, the conjugal act preserves in its fullness the sense of true mutual love and its ordination towards man's exalted vocation to parenthood".(39) The same doctrine concerning the link between the meanings of the conjugal act and between the goods of marriage throws light on the moral problem of homologous artificial fertilization, since "it is never permitted to separate these different aspects to such a degree as positively to exclude either the procreative intention or the conjugal relation" (40) Contraception deliberately deprives the conjugal act of its openness to procreation and in this way brings about a voluntary dissociation of the ends of marriage. Homologous artificial fertilization, in seeking a procreation which is not the fruit of a specific act of conjugal union, objectively effects an analogous separation between the goods and the meanings of marriage. Thus, fertilization is licitly sought when it is the result of a "conjugal act which is per se suitable for the generation of children to which marriage is ordered by its nature and by which the spouses become one flesh".(41) But from the moral point of view procreation is deprived of its proper perfection when it is not desired as the fruit of the conjugal act, that is to say of the specific act of the spouses' union.

b ) The moral value of the intimate link between the goods of marriage and between the meanings of the conjugal act is based upon the unity of the human being, a unity involving body and spiritual soul. (42) Spouses mutually express their personal love in the "language of the body ", which clearly involves both "sponsal meanings" and parental ones.(43) The conjugal act by which the couple mutually express their self-gift at the same time expresses openness to the gift of life. It is an act that is inseparably corporal and spiritual. It is in their bodies and through their bodies that the spouses consummate their marriage and are able to become father and mother. In order to respect the language of their bodies and their natural generosity, the conjugal union must take place with respect for its openness to procreation; and the procreation of a person must be the fruit and the result of married love. The origin of the human being thus follows from a procreation that is "linked to the union, not only biological but also spiritual, of the parents, made one by the bond of marriage".(44) Fertilization achieved outside the bodies of the couple remains by this very fact deprived of the meanings and the values which are expressed in the language of the body and in the union of human persons.

c) 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. In his unique and irrepeatable origin, the child must be respected and recognized as equal in personal dignity to those who give him life. The human person must be accepted in his parents' act of union and love; the generation of a child must therefore be the fruit of that mutual giving (45) which is realized in the conjugal act wherein the spouses cooperate as servants and not as masters in the work of the Creator who is Love. In reality, the origin of a human person is the result of an act of giving. The one conceived must be the fruit of his parents' love. He cannot be desired or conceived as the product of an intervention of medical or biological techniques; that would be equivalent to reducing him to an object of scientific technology. No one may subject the coming of a child into the world to conditions of technical efficiency which are to be evaluated according to standards of control and dominion. The moral relevance of the link between the meanings of the conjugal act and between the goods of marriage, as well as the unity of the human being and the dignity of his origin, demand that the procreation of a human person be brought about as the fruit of the conjugal act specific to the love between spouses. The link between procreation and the conjugal act is thus shown to be of great importance on the anthropological and moral planes, and it throws light on the positions of the Magisterium with regard to homologous artificial fertilization.

5. IS HOMOLOGOUS 'IN VITRO' FERTILIZATION MORALLY LICIT?

The answer to this question is strictly dependent on the principles just mentioned. Certainly one cannot ignore the legitimate aspirations of sterile couples. For some, recourse to homologous IVF and ET appears to be the only way of fulfilling their sincere desire for a child. The question is asked whether the totality of conjugal life in such situations is not sufficient to ensure the dignity proper to human procreation. It is acknowledged that IVF and ET certainly cannot supply for the absence of sexual relations (47) and cannot be preferred to the specific acts of conjugal union, given the risks involved for the child and the difficulties of the procedure. But it is asked whether, when there is no other way of overcoming the sterility which is a source of suffering, homologous in vitro fertilization may not constitute an aid, if not a form of therapy, whereby its moral licitness could be admitted. The desire for a child - or at the very least an openness to the transmission of life - is a necessary prerequisite from the moral point of view for responsible human procreation. But this good intention is not sufficient for making a positive moral evaluation of in vitro fertilization between spouses. The process of IVF and ET must be judged in itself and cannot borrow its definitive moral quality from the totality of conjugal life of which it becomes part nor from the conjugal acts which may precede or follow it.(48)

It has already been recalled that, in the circumstances in which it is regularly practised, IVF and ET involves the destruction of human beings, which is something contrary to the doctrine on the illicitness of abortion previously mentioned.(49) But even in a situation in which every precaution were taken to avoid the death of human embryos, homologous IVF and ET dissociates from the conjugal act the actions which are directed to human fertilization. For this reason the very nature of homologous IVF and ET also must be taken into account, even abstracting from the link with procured abortion. Homologous IVF and ET is brought about outside the bodies of the couple through actions of third parties whose competence and technical activity determine the success of the procedure. Such fertilization 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.

Conception in vitro is the result of the technical action which presides over fertilization. Such fertilization is neither in fact achieved nor positively willed as the expression and fruit of a specific act of the conjugal union. In homologous IVF and ET, therefore, even if it is considered in the context of 'de facto' existing sexual relations, the generation of the human person is objectively deprived of its proper perfection: namely, that of being the result and fruit of a conjugal act in which the spouses can become "cooperators with God for giving life to a new person".(50) These reasons enable us to understand why the act of conjugal love is considered in the teaching of the Church as the only setting worthy of human procreation. For the same reasons the so-called "simple case", i.e. a homologous IVF and ET procedure that is free of any compromise with the abortive practice of destroying embryos and with masturbation, remains a technique which is morally illicit because it deprives human procreation of the dignity which is proper and connatural to it. Certainly, homologous IVF and ET fertilization is not marked by all that ethical negativity found in extra-conjugal procreation; the family and marriage continue to constitute the setting for the birth and upbringing of the children. Nevertheless, in conformity with the traditional doctrine relating to the goods of marriage and the dignity of the person, the Church remain opposed from the moral point of view to homologous 'in vitro' fertilization. Such fertilization is in itself illicit and in opposition to the dignity of procreation and of the conjugal union, even when everything is done to avoid the death of the human embryo. Although the manner in which human conception is achieved with IVF and ET cannot be approved, every child which comes into the world must in any case be accepted as a living gift of the divine Goodness and must be brought up with love.

6. HOW IS HOMOLOGOUS ARTIFICIAL INSEMINATION TO BE EVALUATED FROM THE MORAL POINT OF VIEW?

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.

The teaching of the Magisterium on this point has already been stated.(51) 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. "In its natural structure, the conjugal act is a personal action, a simultaneous and immediate cooperation on the part of the husband and wife, which by the very nature of the agents and the proper nature of the act is the expression of the mutual gift which, according to the words of Scripture, brings about union 'in one flesh' ".(52) Thus moral conscience "does not necessarily proscribe the use of certain artificial means destined solely either to the facilitating of the natural act or to ensuring that the natural act normally performed achieves its proper end".(53) If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit. 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' ".(54)

7. WHAT MORAL CRITERION CAN BE PROPOSED WITH REGARD TO MEDICAL INTERVENTION IN HUMAN PROCREATION?

The medical act must be evaluated not only with reference to its technical dimension but also and above all in relation to its goal which is the good of persons and their bodily and psychological health. The moral criteria for medical intervention in procreation are deduced from the dignity of human persons, of their sexuality and of their origin. Medicine which seeks to be ordered to the integral good of the person must respect the specifically human values of sexuality.(55) The doctor is at the service of persons and of human procreation. He does not have the authority to dispose of them or to decide their fate.

A medical intervention respects the dignity of persons when it seeks to assist the conjugal act either in order to facilitate its performance or in order to enable it to achieve its objective once it has been normally performed",(56) On the other hand, it sometimes happens that a medical procedure technologically replaces the conjugal act in order to obtain a procreation which is neither its result nor its fruit. In this case the medical act is not, as it should be, at the service of conjugal union but rather appropriates to itself the procreative function and thus contradicts the dignity and the inalienable rights of the spouses and of the child to be born. The humanization of medicine, which is insisted upon today by everyone, requires respect for the integral dignity of the human person first of all in the act and at the moment in which the spouses transmit life to a new person. It is only logical therefore to address an urgent appeal to Catholic doctors and scientists that they bear exemplary witness to the respect due to the human embryo and to the dignity of procreation. The medical and nursing staff of Catholic hospitals and clinics are in a special way urged to do justice to the moral obligations which they have assumed, frequently also, as part of their contract. Those who are in charge of Catholic hospitals and clinics and who are often Religious will take special care to safeguard and promote a diligent observance of the moral norms recalled in the present Instruction.

8. THE SUFFERING CAUSED BY INFERTILITY IN MARRIAGE

The suffering of spouses who cannot have children or who are afraid of bringing a handicapped child into the world is a suffering that everyone must understand and properly evaluate.

On the part of the spouses, the desire for a child is natural: it expresses the vocation to fatherhood and motherhood inscribed in conjugal love. This desire can be even stronger if the couple is affected by sterility which appears incurable. Nevertheless, marriage does not confer upon the spouses the right to have a child, but only the right to perform those natural acts which are per se ordered to procreation.(57) A true and proper right to a child would be contrary to the child's dignity and nature. The child is not an object to which one has a right, nor can he be considered as an object of ownership: rather, a child is a gift, "the supreme gift" (58) and the most gratuitous gift of marriage, and is a living testimony of the mutual giving of his parents. For this reason, the child has the right, as already mentioned, to be the fruit of the specific act of the conjugal love of his parents; and he also has the right to be respected as a person from the moment of his conception.

Nevertheless, whatever its cause or prognosis, sterility is certainly a difficult trial. The community of believers is called to shed light upon and support the suffering of those who are unable to fulfill their legitimate aspiration to motherhood and fatherhood. Spouses who find themselves in this sad situation are called to find in it an opportunity for sharing in a particular way in the Lord's Cross, the source of spiritual fruitfulness. Sterile couples must not forget that "even when procreation is not possible, conjugal life does not for this reason lose its value. Physical sterility in fact can be for spouses the occasion for other important services to the life of the human person, for example, adoption, various forms of educational work, and assistance to other families and to poor or handicapped children".(59) Many researchers are engaged in the fight against sterility. While fully safeguarding the dignity of human procreation, some have achieved results which previously seemed unattainable. Scientists therefore are to be encouraged to continue their research with the aim of preventing the causes of sterility and of being able to remedy them so that sterile couples will be able to procreate in full respect for their own personal dignity and that of the child to be born.

III. MORAL AND CIVIL LAW

THE VALUES AND MORAL OBLIGATIONS
THAT CIVIL LEGISLATION
MUST RESPECT AND SANCTION IN THIS MATTER

The inviolable right to life of every innocent human individual and the rights of the family and of the institution of marriage constitute fundamental moral values, because they concern the natural condition and integral vocation of the human person; at the same time they are constitutive elements of civil society and its order. For this reason the new technological possibilities which have opened up in the field of biomedicine require the intervention of the political authorities and of the legislator, since an uncontrolled application of such techniques could lead to unforeseeable and damaging consequences for civil society. Recourse to the conscience of each individual and to the self-regulation of researchers cannot be sufficient for ensuring respect for personal rights and public order. If the legislator responsible for the common good were not watchful, he could be deprived of his prerogatives by researchers claiming to govern humanity in the name of the biological discoveries and the alleged "improvement" processes which they would draw from those discoveries. "Eugenism" and forms of discrimination between human beings could come to be legitimized: this would constitute an act of violence and a serious offense to the equality, dignity and fundamental rights of the human person. The intervention of the public authority must be inspired by the rational principles which regulate the relationships between civil law and moral law. The task of the civil law is to ensure the common good of people through the recognition of and the defence of fundamental rights and through the promotion of peace and of public morality.(60) In no sphere of life can the civil law take the place of conscience or dictate norms concerning things which are outside its competence. It must sometimes tolerate, for the sake of public order, things which it cannot forbid without a greater evil resulting. However, the inalienable rights of the person must be recognized and respected by civil society and the political authority. These human rights depend neither on single individuals nor on parents; nor do they represent a concession made by society and the State: they pertain to human nature and are inherent in the person by virtue of the creative act from which the person took his of her origin. Among such fundamental rights one should mention in this regard:

a) every human being's right to life and physical integrity from the moment of conception until death; b) the rights of the family and of marriage as an institution and, in this area, the child's right to be conceived, brought into the world and brought up by his parents. To each of these two themes it is necessary here to give some further consideration.

In various States certain laws have authorized the direct suppression of innocents: the moment a positive law deprives a category of human beings of the protection which civil legislation must accord them, the State is denying the equality of all before the law. When the State does not place its power at the service of the rights of each citizen, and in particular of the more vulnerable, the very foundations of a State based on law are undermined. The political authority consequently cannot give approval to the calling of human beings into existence through procedures which would expose them to those very grave risks noted previously. The possible recognition by positive law and the political authorities of techniques of artificial transmission of life and the experimentation connected with it would widen the breach already opened by the legalization of abortion. As a consequence of the respect and protection which must be ensured for the unborn child from the moment of his conception, the law must provide appropriate penal sanctions for every deliberate violation of the child's rights. The law cannot tolerate - indeed it must expressly forbid - that human beings, even at the embryonic stage, should be treated as objects of experimentation, be mutilated or destroyed with the excuse that they are superfluous or incapable of developing normally.

The political authority is bound to guarantee to the institution of the family, upon which society is based, the juridical protection to which it has a right. From the very fact that it is at the service of people, the political authority must also be at the service of the family. Civil law cannot grant approval to techniques of artificial procreation which, for the benefit of third parties (doctors, biologists, economic or governmental powers), take away what is a right inherent in the relationship between spouses; and therefore civil law cannot legalize the donation of gametes between persons who are not legitimately united in marriage. Legislation must also prohibit, by virtue of the support which is due to the family, embryo banks, post mortem insemination and "surrogate motherhood". It is part of the duty of the public authority to ensure that the civil law is regulated according to the fundamental norms of the moral law in matters concerning human rights, human life and the institution of the family. Politicians must commit themselves, through their interventions upon public opinion, to securing in society the widest possible consensus on such essential points and to consolidating this consensus wherever it risks being weakened or is in danger of collapse.

In many countries, the legalization of abortion and juridical tolerance of unmarried couples makes it more difficult to secure respect for the fundamental rights recalled by this Instruction. It is to be hoped that States will not become responsible for aggravating these socially damaging situations of injustice. It is rather to be hoped that nations and States will realize all the cultural, ideological and political implications connected with the techniques of artificial procreation and will find the wisdom and courage necessary for issuing laws which are more just and more respectful of human life and the institution of the family. The civil legislation of many states confers an undue legitimation upon certain practices in the eyes of many today; it is seen to be incapable of guaranteeing that morality which is in conformity with the natural exigencies of the human person and with the "unwritten laws" etched by the Creator upon the human heart. All men of good will must commit themselves, particularly within their prof essional field and in the exercise of their civil rights, to ensuring the reform of morally unacceptable civil laws and the correction of illicit practices. In addition, "conscientious objection" vis-à-vis such laws must be supported and recognized. A movement of passive resistence to the legitimation of practices contrary to human life and dignity is beginning to make an ever sharper impression upon the moral conscience of many, especially among specialists in the biomedical sciences.

CONCLUSION

The spread of technologies of intervention in the processes of human procreation raises very serious moral problems in relation to the respect due to the human being from the moment of conception, to the dignity of the person, of his or her sexuality, and of the transmission of life. With this Instruction the Congregation for the Doctrine of the Faith, in fulfilling its responsibility to promote and defend the Church's teaching in so serious a matter, addresses a new and heartfelt invitation to all those who, by reason of their role and their commitment, can exercise a positive influence and ensure that, in the family and in society, due respect is accorded to life and love. It addresses this invitation to those responsible for the formation of consciences and of public opinion, to scientists and medical professionals, to jurists and politicians. It hopes that all will understand the incompatibility between recognition of the dignity of the human person and contempt for life and love, between faith in the living God and the claim to decide arbitrarily the origin and fate of a human being.

In particular, the Congregation for the Doctrine of the Faith addresses an invitation with confidence and encouragement to theologians, and above all to moralists, that they study more deeply and make eves more accessible to the faithful the contents of the teaching of the Church's Magisterium in the light of a valid anthropology in the matter of sexuality and marriage and in the context of the necessary interdisciplinary approach. Thus they will make it possible to understand ever more clearly the reasons for and the validity of this teaching. By defending man against the excesses of his own power, the Church of God reminds him of the reasons for his true nobility; only in this way can the possibility of living and loving with that dignity and liberty which derive from respect for the truth be ensured for the men and women of tomorrow. The precise indications which are offered in the present Instruction therefore are not meant to halt the effort of reflection but rather to give it a renewed impulse in unrenounceable fidelity to the teaching of the Church.

In the light of the truth about the gift of human life and in the light of the moral principles which flow from that truth, everyone is invited to act in the area of responsibility proper to each and, like the good Samaritan, to recognize as a neighbour even the littlest among the children of men (Cf . Lk 10: 2 9-37). Here Christ's words find a new and particular echo: "What you do to one of the least of my brethren, you do unto me" (Mt 25:40).

During an audience granted to the undersigned Prefect after the plenary session of the Congregation for the Doctrine of the Faith, the Supreme Pontiff, John Paul II, approved this Instruction and ordered it to be published.

Given at Rome, from the Congregation for the Doctrine of the Faith, February 22, 1987, the Feast of the Chair of St. Peter, the Apostle.

JOSEPH Card. RATZINGER
Prefect

ALBERTO BOVONE
Titular Archbishop of Caesarea in Numidia Secretary