Is IVF Morally Permissible: A Dialogue, Part 2

This week Sean and Scott continue the conversation about the morality of IVF. Don't forget to listen to Part 1, last week, when they defined and explained the nature of IVF and began the conversation about the moral permissibility of practicing it. This week, we uncover further differences and clarify the moral issues beneath the debate.

Episode Transcript

Sean: All right, friends, welcome back. We've got part two for you this week where Scott Rae and I, Sean McDowell, had a conversation about in vitro fertilization. We went an hour and five minutes longer than planned, felt we needed to nuance it, and when we were done, it felt like we just got started. So, we cut it in two parts, and this is part two today, brought to you by Talbot School of Theology at 51����. Enjoy. [...] I want to read something, and then you just respond in terms of what you think. I think you'll disagree, but I don't know how to phrase it better myself than Stephanie Gray Connors in her book Conceived by Science. She's Catholic, and so, obviously, understand where she's coming from. We're not going to find chapter and verse, a Bible passage that says…because the technology wasn't available. So, in some ways, it's a theology of the body and biblical principles that we have to play off and see if it works. So, here's, kind of, the case that she makes. She's talking about how at the moment of…so, she's contrasting conception in IVF with conception in God's design inside the woman. And she says, in IVF, it enlists a third party to do so at the moment of conception, which is interesting. You bring a third party in at the moment of conception. And then she walks through some of the differences between how IVF conceives, and how it naturally conceives inside. So, she says, for example, if a woman shows signs of ovulation on Tuesday, but her egg is not released until Thursday, and she and her husband have sex each day Monday to Friday, the semen from which these five acts of sex will contain the winning sperm? Which one? We don't know. In other words, there's a built-in contingency there that we cannot control. There's something about God's design for a couple's ability to be fruitful and multiply that is hands-on, but also hands-off. We can't force somebody into existence. They're receiving someone whom God brings into existence. So, her argument is that IVF, in contrast, is making someone. It's literally manufacturing a human person. So, the parents aren't receiving new life as fruit. Rather, instead, a new human is beginning at the hands of a stranger. So, her argument—and I think I'm inclined towards it—is that IVF does not actually mimic what happens naturally. It actually changes it. So, God designed the body that sex is necessary, whereas IVF makes sex unnecessary. You don't buy it, but tell us why.

Scott: I don't, because the physician…calling a physician, an infertility specialist, a third party, I think, is completely different than the other third parties that we ruled off the table.

Sean: Like a surrogate or a donor?

Scott: Like donors or surrogates. Completely different. And the reason is because the physician makes no soulish contribution to the child like a donor does. The donor or surrogate contributes, and contributes not just physically, but soulishly as well. That's a big intrusion to the matrix of marriage. The infertility specialist is simply a physician who is helping alleviate one of the general effects of the entrance of sin. And I think calling that a third party is misleading. And I don't think that's true, any more than a lawyer who prepares adoption papers is a third party in an adoption agreement. I just don't think that's true. I don't see this as…The uncertainties about whether conception is going to occur and the hands-off approach that's needed with natural conception is exactly the same with IVF. You don't have control over how many embryos are successfully fertilized. After the sperm and egg come together, it's hands-off, and you trust God in the same way that a couple does when they're trying to conceive naturally. So, I don't see that as being relevant. And I don't see this as manufacturing a child. Now, if you are doing gene editing and choosing the traits of your child based on your desires, or if you're choosing the sex of your child, that's moving us much more down in that direction. I don't think this is it, because I think what we're trying to do here is not to manufacture a child. We're trying to alleviate the effects of infertility.

Sean: So, a few thoughts on this that maybe would help. I think you're unmistakably correct that there's not a soulish contribution in the way a donor would be, for sure. Of course, that's still two individuals coming together. That's not like a third soul that's being a part of it. So, it's still two individuals, whether it's a donor or not. We would take issue with a donor for separate reasons and concerns, not, in principle, the soulish contribution. So, it's a third party, but not in the same way. I agree with that. I think the question is, and maybe we just leave it out there for our viewers to think about and look at, is it okay to have an outside party intervene and try to control and direct the process of conception, removed outside of the human body—which is God's original design for it—into a beaker? That's the question. It seems like you don't have moral issues with it.

Scott: I don't.

Sean: I would take some issue with that.

Scott: And the reason for that is because, you know, God's design is affected by the general entrance of sin, and [the general entrance of sin] has caused that brokenness.

Sean: So, I think maybe a helpful point we could draw out is how far technology can go to alleviate suffering and pain? Like, what technologies are okay, and what are not? And I think for me, the line that I would draw is, like, when we see Jesus healing, He restores things back to their original design, to function the way the eye or the hand or the body originally functioned. So, in infertility, I would draw a distinction between saying somebody can take a drug to increase the number of eggs, surgery to fix the body, which restores it to God's original design, how it's supposed to take place. In vitro fertilization, in my view, goes outside of that, and is not just fixing the process. I think it's changing it in a fashion. What say you?

Scott: Then I think there are other medical technologies that you have to reject.

Sean: Such as?

Scott: Dialysis. Because dialysis doesn't cure anything. It just does an end run around kidney disease. It filters the blood independently of the kidney and puts it back in the system. And there are probably a handful of others that I think you're going to have to reject too.

Sean: That's interesting. So, I guess I would maybe make a distinction between a technology that is keeping somebody alive versus a technology that is changing a process in itself of conception. That seems to me a different thing with dialysis. The person is literally dying. How do we keep them going? Maybe a heart transplant, you could make the same kind of thing. Versus, let's use the technology to intentionally end run around a process. Strikes me as there might be a difference there.

Scott: I think they're both end runs. And what you're doing is you're enabling, as best you can, a person to live—to restore other natural functions by bypassing the one that has failed. And I think you're doing exactly the same with IVF. It's just that the difference is that the kidney is designed to filter impurities out of the blood, whereas the reproductive system is designed to produce a child. So you're just allowing the system, which has been broken by the entrance of sin, to be restored, to function, to produce what it was originally designed to produce. But I gotta grant you, it's not fixing anything. But there are other technologies that don't do that either.

Sean: Yeah, I don't know. I have to think about this. That's a fair point. If bringing a second person into the process is the same, and if we can make dialysis comparable to procreation, I'm not sure that I would fully accept that as being comparable in terms of medical care. But fair point. Let our audience wrestle with that. See which one they find compelling. Okay, let's keep going. We're pushing back on the time here. But I think our goal is what's at stake, what's for and against, and to let people see and reason through it. That's the whole goal. So, hopefully, we're doing that. Is it ever okay to freeze an embryo? So, I would take some issue with this.

Scott: I would too.

Sean: Let me lay out why in principle, and then you can tell me. I think sometimes we talk about embryos—like “donating embryos”—the way we wouldn't talk about donating an adopted child, which even our language amongst Christians seems to indicate that we don't really believe at conception that you have a distinct, living human being. I don't know that we Christians have thought that through really well. So, is it okay to freeze a full human being against their will? I don't know that that's okay.

Scott: Without their consent.

Sean: Exactly, without consent. And we know that a lot of them will not survive it. Now, it seems to me there's a difference between somebody who's in a medical condition and the only way we can help them is to potentially freeze them. Not that that ever happens, but that's different than creating a human being.

Scott: This is not for the embryo's benefit.

Sean: Exactly. And they're created knowing many will be frozen, and many of those will die and be damaged thawing out. And the other thing I'll throw in there is, like, if we freeze a human being…does the human being have a right to grow and develop along a certain timeline? It's like, we're doing an injustice to that embryo, which is a human being, by freezing them, literally freezing in time and physically freezing them. It's problematic to me.

Scott: Yeah, now some people say, look, these are the frozen and chosen. And there's something to that. But all freezing does is it just temporarily stops the embryo's metabolic processes and puts them on hold. So, I think the attrition rate is very troubling to me. But the reason for the attrition is also important. Now, that's why freezing embryos and freezing eggs are two completely different things.

Sean: Agreed. I agree with that.

Scott: Thawing eggs is a lot harder to do. And the attrition rate on thawing a woman's eggs is off the charts.

Sean: Because an egg is not a human being.

Scott: Right. And there are other reasons. But I think if my physician friend is right that the reason for the attrition is because there's some sort of defect in the embryo that is incompatible with life, and it will miscarry, then that removes some of the moral tension for me. But if that's not true, and there are other reasons for embryos not being able to thaw successfully, then that raises my level of moral discomfort with freezing embryos.

Sean: Okay. So you have reservation, discomfort.

Scott: I’d say serious reservations about that.

Sean: So, some people that will have IVF have said things like, if there's extra embryos, I promise they'll be donated, even if they're frozen for a period of time. That's one way some have told me. Maybe not everybody has to do that if they insert each one. But that seems to invite a certain level of, okay, wait a minute, you've created human beings in this contingent state that can be harmed.

Scott: Right.

Sean: That in itself is problematic to me if IVF leads to that, even if you have the intention of adopting it out.

Scott: Right. And I think this is part of it. I think in a fallen, broken world, we may not have all the moral purity that we want for this. And the reason I say that is because I think I would support…and I call it embryo adoption; I don't use the term embryo donation for that. I call it putting embryos up for adoption. I think that's a moral, l acceptable option for couples. What troubles me about that is, I think it does contribute to a cavalier attitude toward creating embryos in the lab. But I think we have a lot of excess embryos that are going to be destroyed. And the best option, I think, in a fallen, broken world is that those be put up for adoption. Much better than them being destroyed, and much better than them being subject to experimentation. So, I would be very supportive of the embryo adoption program. We interviewed…

Sean: Hannah Strege. Yeah. She was in my class.

Scott: The first snowflake baby ever is a 51���� grad. So, I think I don't have a problem with that per se, although freezing embryos for that purpose, I think, is still troubling to me.

Sean: Okay. Can I circle back? It's been in the back of my mind because I've been thinking about that dialysis thing. I’ll throw out one more distinction for you, and you can tell me if you buy it or not. So, is there a difference between a right to life and a right to having children? We do have a right to life. And so, a technology such as dialysis to preserve a right to life is different than a right to having children.

Scott: I would phrase it differently, and I'd say the answer is no.

Sean: Okay. Tell me why.

Scott: I would say we don't have a right to have children. We have a right to attempt to have children. Those are two different things. You do not have a right to a child.

Sean: Okay.

Scott: You have a right to attempt to have a child. And IVF, I think, is among other reproductive technologies giving couples a chance to exercise that right within moral parameters that we've only briefly touched on.

Sean: Sure. We have. Okay. So, fair enough, and I would agree with that. That goes back to, is IVF within the realms of the right that somebody has in a God-ordained way of having a child, or does it go beyond it? That's maybe where we differ.

Scott: That's where we differ.

Sean: But there seems to me there is a distinction between…would you, maybe concede is not the right word, but a technology when it comes to—

Scott: Concede to you? Nothing. [laughs]

Sean: [laughs] Not the best word. Whatever. You get the point. Oh, now I lost my train of thought…between a technology that does an end run and dialysis to save life is different than one that I have a right to try to be a parent. To have a child. That seems very, very different. Like, we make moral distinctions when we can take life and when we can't. I think trying to have a child is different than keeping somebody alive, and what technology we use for one doesn't necessarily translate to the other.

Scott: But it's enabling the system to produce the product that it was designed to produce. It's enabling the body to be free of toxins. It's enabling the reproductive system to produce a child. I don't see a difference between those.

Sean: Okay. So, if life is at stake or not doesn't change the equation for you. Fair enough. Okay. Let's keep going. People can wrestle with that one. All right. So, one of the questions—I'm curious about your take on this—is some of the arms that have come up to children that are conceived through IVF. And I guess you could reject this, or you could embrace it, say it's worth it. One of our friends, Katie Faust, has put together just a whole document on some of the data coming out of the effects. And, for example, she draws out the very nature of conceiving in a beaker outside of the body. At the most fragile state of a human being outside of the womb, its intended environment invites some of these potential harms. I think there's a point to that. But she says, for example…this is an article on her site, "Them Before Us." Let me see. So, risk to kids. “The IVF process consists of multiple steps from hyperovulation and extraction of eggs to manipulation and fertilizing embryos in a petri dish at the time they're most vulnerable.” So, increased risks for disease with children conceived through artificial reproductive technology, more susceptible to fetal growth restrictions. She cites specific cases here of cardiovascular factors that are elevated for children conceived through IVF. Higher fasting blood glucose levels, higher risk of type 2 diabetes, premature birth. A study from Michigan State University talks about children born—this is kids with birth defects through IVF, so not all kids—with birth defects through IVF had approximately seven times the cancer risk as opposed to children with birth defects conceived naturally. A 2019 Danish study of more than a million children found that babies conceived through assisted reproduction via frozen embryo transfer were more than twice as likely to develop childhood cancer, particularly leukemia and neuroblastoma. The World Journal of Clinical Pediatrics found that children conceived through IVF have a higher rate of brain damage, often associated—you don't need the details. Males tend to develop typically, but females show less advanced breast development and more bone age. I mean, the studies go on and on. Even some on the level of, like, cognitive development and intellectual development, they cite. So, is this a risk? What do you make of that data? And does that make you rethink it all, IVF?

Scott: Well, I think what I'd like to know is, how elevated is the risk? Is it slight? Is it significant? And I think I just compare that with the overwhelming number of children born of IVF who are completely healthy, and have no obvious health risks that you and I wouldn't be subject to just as a result of normally living life. I mean, the vast majority of kids born of IVF are perfectly healthy kids. Now, that's not to say that the utilitarian outcome determines the morality of it.

Sean: Sure.

Scott: But might there be some additional risks? Maybe. It'd be helpful to know, how much is that risk elevated as opposed to normal conception? So, I wouldn't lose a lot of sleep over that myself, given what the overwhelming majority of IVF kids exhibit.

Sean: So, I guess—and it's hard to give a number—you're willing to tolerate some level of risk and just have to assess what is at risk, how significant it is, how are they affected. That would be the assessment for you, and we just have to look at the data, and maybe compare it to other procedures.

Scott: I'd want to dig a little deeper into that.

Sean: Okay, fair enough. Are you going to do that for your update on Moral Choices? Does that concern you enough?

Scott: It will be mentioned.

Sean: It'll be mentioned. Okay. All right, fair enough. We are totally pushing the time on this one. We've gone way longer than I think we normally do. Did I miss anything?

Scott: Let's hope our listeners think this is as fun as we did.

Sean: [laughs] I hope they're still with us. There's so many more angles we could go with this. Let me ask you this. One more question, then you tell me. What do you make of…the Southern Baptists have come out pretty strongly against all forms of IVF. Every human being is made in God's image. Human beings possess an inherent right to life and the opportunity to reach their full development. Governments are ordained to protect this. This actually stood out to me. They said, "Biblical creation portrays the embodied union of husband and wife as the singular normative expression for procreation." That sounds kind of Catholic in the Southern Baptist Resolution, which interested me. They make the distinction, "All children are to be fully respected and protected, but not all technological means of assisting human reproduction are equally God-honoring or morally justified." So, Southern Baptists seemingly have shifted against this, and because of the apparent consequences they see for it in God's design for sex as embodied, they've rejected it. What do you make of that? And do you see, because I know you're studying this, other trends going that way, or do you think this is an issue Christians are just going to kind of agree to disagree on moving forward?

Scott: I think Christians are going to be divided on this for a long time to come. I do see some folks who, in my view, are becoming more Catholic in their view of this. And I think that's what the Southern Baptists have done, is they've essentially adopted a Catholic view, but without the specific Catholic theology that undergirds the Catholic rejection of IVF. Theirs is based on the moral status of embryos. Now, the Catholic view is based on that unit of procreative connection that always has to be in place. So, I mean, I understand. And if the standard of practice were the only thing available out there, I'd be with the Southern Baptists. Okay? But that's why I think under certain conditions, I think IVF is okay for a Christian. One, if you're not freezing or discarding embryos.

Sean: Oh, so never freezing. You would reject any kind of freezing.

Scott: Let's just put—

Sean: For the most part.

Scott: For the most part. And what that means is that you either do what's called minimal stimulation IVF or natural IVF. Some clinics offer that. Natural IVF is one egg at a time. Minimal stimulation IVF is where they dial back the hormones that enable the woman to release all these eggs, and she releases fewer rather than more. And so, in both of these, you're betting on one round of implants. And especially with the one, if the one egg doesn't fertilize, then you’ve got to start over again, but you don't do all the expensive hormone treatments that enable multiple ovulations. That make sense? I think that'd be a condition. And I think you don't ever implant more embryos than you can safely carry. So, no selective termination, no biopsy of embryos to test for genetic diseases, things like that that are eventually discarded if they have a genetic problem. So, those would be some of the conditions. Now, to be fair, the clinic will look at the couple and look like they've lost their minds.

Sean: [laughs]

Scott: And financially speaking, they probably have. But I think it can be done in this way. And my caution to couples considering IVF is to go in with your eyes open about what the standard of practice is, and know that they're going to assume that embryos are just clumps of cells. They're going to assume that however many you create is irrelevant. They will assume that freezing and thawing them out is okay, and the nutrition from thawing is okay. They will assume that selective termination is okay. All those things. And I would suggest if you tell them what your values are up front, and if they can't live with your values, then go to the next place. It's a business like anything else.

Sean: Fair enough. Let me give a couple qualifications, and then you wrap it up. I think you're right that there's some theological differences between the Southern Baptist and between the Catholic Church. I don't know how far they take it. I do find it interesting—because they said “biblical creation portrays the embodied union of husband and wife as the normative expression for procreation”—it seems to be a sense, maybe I'm misreading it, that going outside of the embodied union is outside of God's design for procreation. It seems that the Southern Baptists are moving that direction, even though probably not fully into a Catholic theology of the body.

Scott: It's different.

Sean: Fair enough. I think I would say I appreciate the reservation against freezing. Part of my caution would be that if we're engaging in any process and it's going to result, by nature, with some unborn human beings being frozen without them giving consent and some being harmed by the process, we shouldn't engage in that process. That would be a caution for me, because this is going to happen as a result of it. I guess I would also say, yes, the majority of children born with IVF won't have the kinds of medical concerns, the brain cancer, the elevated diabetes 2 risk, but some do. And it seems to me one child brought into the world through IVF and then has brain cancer and suffers unnecessarily because of it is one child too many. When we're introducing in a technology outside of God's created design, on top of that, as far as I understand, there are other infertility clinics as effective or more effective, and not as expensive. They get to the root of the issue: why there's infertility. Now they can't promise—like you said, most cannot have children. But I would strongly tell Christians to exhaust all of those before they consider IVF. Obviously, I have concern about IVF. I've expressed those, but try all of those at least first.

Scott: Right, IVF is not the default position.

Sean: Yeah. Anything you want to add to that for my final points? Are you able to express what—

Scott: No, I've said what I needed to. I think maybe the one thing I would add is that I do think that sexual relations are ordered toward procreation. That's the difference between heterosexual couples and same-sex couples. But I don't think the procreation is the sole end of sexual relations.

Sean: I agree.

Scott: There are other aspects of sexual relations that are equally appropriate and can be legitimate ends in and of themselves, which I think is another reason why I don't take that separation of that union & procreation to be intrinsically problematic.

Sean: Fair enough. So, I think even Catholics and myself in this issue would say there are other valuable means and purposes of sex. Can they be severed is at the root of where some of the difference is, that procreative element. Fair enough. We could come back to this at some point. I appreciate this.

Scott: Yeah, me too.

Sean: Like, I have not gone through bouts of infertility. I am somewhat working through this, to be honest with you. And part of this conversation was to push back and get some clarity on it. That's the goal for people watching. So, minimally, I hope you watch this, share with somebody, talk it through, and at least you've been informed on some of the issues and concerns that people raise and where the differences are. I'm exhausted, but this was about as fun of a conversation as I've had in a long time.

Scott: It's good stuff.

Sean: Don't forget to hit — oh, sorry, go ahead.

Scott: Well, and, you know, that we can disagree on things without raising our voice or calling each other idiots.

Sean: Exactly.

Scott: It's a good thing.

Sean: Okay. Fair enough. Thanks for being with us for this unusual two-part conversation on IVF. This episode has been brought to you by the podcast Think Biblically: Conversations on Faith and Culture. We've got programs on this in philosophy and ethics, and, of course, theology and apologetics. We would love to train you to think even more deeply and thoughtfully and biblically about these issues and more. Please send us your comments or your questions to thinkbiblically@biola.edu. And also, please consider giving us a rating on your podcast app and sharing this with a friend. In fact, these two episodes in particular, share with a pastor, share with a youth pastor, share with a counselor so they understand what's at stake with some of these technologies. We appreciate you listening, and we'll see you Friday for a weekly Cultural Update. In the meantime, remember to think biblically about everything.