In vitro Fertilization

Christian and Islamic Perspectives on the Ethical Dilemma of In Vitro Fertilization (IVF) Stephanie Sariles Department of Biology; College of Arts and Sciences Abilene Christian University

After defining IVF procedures and the associated biomedical ethics with each, I will compare and contrast Christian and Islamic perspectives on IVF. Christianity in general does not accept IVF, because it is an unnatural method of reproduction that can affect Christian traditions such as parenthood and marriage. Despite this view, Protestants, in particular, have opened up to IVF as a method for treating infertility. Islam fully accepts IVF provided the married couple follows Islamic law. Sunni Muslims do not accept gamete donation, but Shi’ite Muslims are more flexible with gamete donation and surrogacy.

The development of reproductive Christianity share several similarities in technology has become an answered prayer beliefs and doctrines, however, these for several infertile couples around the religions do not share the same perspectives world. Reproductive technologies, such as in regards to the ethical dilemma of in-vitro artificial insemination and in-vitro fertilization. Islam focuses on the interaction fertilization, have become common options between marriage laws and IVF, while offered by physicians for patients, who Christianity concentrates on the interaction desire to hold their own child in their arms between IVF and a natural order of life even though medically the probability for designated by a sole creator. This them to naturally conceive are low. comparative analysis between two religious Although this scientific development has views of IVF demonstrates that religion is a become a solution for infertility and often factor that contributes to the ethical dilemma viewed as a miracle for some, it has been a of reproductive technologies and influences controversial decision that has caused rifts the societal perspective on IVF. between a person and their faith. The ideas of a sole creator, the natural order of life, Standard IVF and marriage laws have come into question Sir Robert Edwards introduced in- due to the development of the scientific vitro fertilization in 1978. The procedure for intervention in reproduction. Religions IVF has changed since 1978 and has become across the nations have argued their stance more complicated by implementing gene on reproductive technologies. In-vitro therapy and gamete donation, however, fertilization (IVF), for example, has become standard IVF or “simple case” IVF will be an ethical dilemma discussed throughout the the main focus of this paper. Standard IVF world by several doctrines of faith, in which involves a married couple in which the each has developed their own perspective, sperm comes from the husband and the according to their foundation and beliefs. ovum is from the wife. Once the pre-embryo Religions who share similarities in their is formed, it is implanted into the wife’s doctrines have accepted and denied different aspects of in-vitro fertilization, such as Islam and Christianity. Islam and

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In vitro Fertilization uterus.1 Before the pre-embryo is formed, across the world, who suffered from the infertile woman undergoes hormone infertility. His ethical stance on reproductive treatment, which allows the woman to technologies was adopted through the produce more than one egg on her next clinical imperative and the inalienable rights cycle. Her cycle is then monitored carefully of couples to have their own child, as long to detect the moment in which the eggs are as they did no harm.4 “Do no harm” is ready to be removed.2 These eggs are then derived from the Hippocratic Oath, which is placed onto a petri dish to be fertilized by recited by physicians once they have the husband’s sperm. Anywhere from 48 to completed all their boards and examinations. 72 hours after fertilization and the embryos The oath states, I will use regimens for the have cleaved once or twice, they are benefit of the ill in accordance with my transferred to the wife’s uterus. If the ability and my judgment, but from what is to transfer is viable, the embryo develops their harm or injustice, I will keep them.5 In naturally with minimal medical intervention. order to understand this statement, it has to Sir Robert Edwards used a similar basic be viewed in two parts. Injustice speaks to technique to “create” the first IVF baby, the physician’s duty to ensure that the Louise Brown. patient will not be harmed by moral transgressions, while harm speaks to the IVF and Medical Ethics physician’s duty to heal the sick.6 Physicians Edwards knew ethical dilemmas have adopted Edward’s ethical stance, in would arise from the introduction of IVF as which, if the infertile patient consent to the a method for reproduction; however, he treatment and no harm is done then IVF can didn’t shy away from the ethical issues. be used as a method to heal infertility. Medicine, in Edward’s opinion, differed Edwards developed IVF in order to cure from science because they had different infertility among the world’s population, objectives. Medicine is driven by the daily which was considered fully legitimate by the need to treat patients, the ability to assess ethical committee in the UK known as the different techniques, and the opportunity to House of Lords. However, Edwards prescribe expensive medicines.3 Edward’s understood that when in-vitro fertilization interest in discovering the solution to would be presented as a cure for infertility, infertility began with developing it would be viewed as unacceptable to relationships with physicians at the National several people.7 Institute of Medical Research in London, who spoke of the numerous infertile patients Descriptions of Religions involved in IVF that would benefit from his reproductive Ethical Dilemma research that he had been conducting on Religion has played a key role in the animal embryos. As Edwards and his ethical dilemmas surrounding the research team continued to work on advancement of reproductive technologies, reproductive technologies through animal particularly Christianity and Islam. embryos, they believed IVF was a Christianity contains several doctrines that significant clinical imperative to develop, could be expanded on, however, for the which would allow them to help millions purpose of this paper, Christians believe

1 McCormick, R.A., 1997 5 Miles, S.H, 2004 (59) 2 Singer, P., 1985 6 Miles, S.H., 2004 3 Edwards R.G., 2007 7 Edwards, R.G., 2007 4 Edwards, R.G., 2007

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In vitro Fertilization

Jesus Christ was sent by God to save all of perspectives in regards to the ethical humanity from eternal death. They also dilemma of IVF. believe that Christ is the center of the Bible and part of the Holy Trinity. This would Christian Perspective on IVF include God the father, Christ the son, and Christians, both Protestants and the Holy Ghost. Christianity can be divided Roman Catholics, generally are opposed to into two main groups Roman Catholicism IVF and often reject reproductive and Protestantism. Roman Catholicism technologies as a method for conception. accepts seven sacraments, which are Roman Catholics are opposed to any confirmation, penance, extreme unction, medical intervention that disrupts the natural baptism, Holy Communion, holy orders, and process of reproduction from birth control to marriage. Protestants derived from the IVF. Protestants are hesitant to accept IVF, opposition to the Roman Catholic rule in the but are more open to the idea of IVF as a early 16th century. Protestants can be divided treatment for infertility. into several denominations, but as a whole In 1869, Pope Pius defined an they have several core beliefs including only animated and unanimated fetus to be the two of the seven sacraments. These are same and not have any distinctions. The baptism and the Lord’s Supper.8 Pope removed the distinction in order to Christianity, particularly Protestantism, is mandate the punishment for abortion at any often compared to Islam. This comparison is stage, which led to the opposition to birth often made due to the text-centered religion, control. This set the precedent for the the parallels between how the texts are Roman Catholic perspective on reproductive interpreted, and the problems that arise technologies. This mandate from the Pope through an absence of centralized authority supported the Church’s stance that the soul figures and structures.9 Islam’s central belief and life begin at conception.11 The Roman is that Muhammad was a messenger of God, Catholic Church has opposed artificial birth but Muslims do not worship him.10 They control because it is an unnatural medical follow the teachings found in the holy intervention of conception that defies Qur’an, which was revealed to Muhammad, Christian tradition.12 The tradition being who was deemed as the final prophet of violated by birth control is the reproductive Allah. Islam has foundational principles dependence on sexual intercourse. Another called the five basic pillars that address reason birth control is opposed by the prayer, alms tax, fasting, the pilgrimage to Catholic Church is due the severance of the Mecca, and one God who appointed link between intercourse and procreation. Muhammad as the final prophet. Islam is Any procedure or object that breaks the link divided into two sects Sunni Muslim and between intercourse and procreation is Shi’ite Muslim. Sunni Muslims believe that deemed unnatural. This idea of unnatural Abu Bakr is the rightful caliph, while Shi’ite conception was carried over to reproductive Muslims believe that Mohammed Ali is the technologies. Conception outside of its rightful caliph. Christianity and Islam are natural context is wrong due to the belief distinct religions that are often compared that sex without the possibility of conception due to their similar doctrines and faith is unnatural and defies the order of life. ideologies, but they have different According to the Catholic Church, IVF is an

8 Nesbitt, R.B., 1962 11 Jones, D.G., 2004 9 McGrath, A.E., 2007 12 McDowell, J.D., 1998 10 Ali, S.R., 2007

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In vitro Fertilization unnatural method of conception and should fundamental in a marriage.17 This view not be accepted. This stance has been the allows the temporary postponement of official Roman Catholic position on assisted reproduction; therefore, accepting the reproductive technologies. Since Pope Pius’ unnatural perspective of birth control. statements, other institutes have supported Protestants lean towards the total his claims such as The Potential Academy relationship between spouses rather than the for Life in 2004. They supported the official act of intercourse that leads to conception. Roman Catholic view on artificial This allowed for the acceptance of birth reproductive technologies because these control. IVF should not be problematic to technologies are on the same level as Protestants because conception as the result desiring a product that has good quality.13 of intercourse is not an issue. The total The reduction of a child to a product relationship of a couple is more important removed the natural process of conception, than the physical act of intercourse. Even which paralleled the views of the Pope. The though Protestants were accepting of birth Pope viewed sexual intercourse between control there was still opposition to IVF. spouses as a natural act, which gave God- Paul Ramsey established the foundations of given designs to reproduction.14 However, the Protestant’s response to IVF in the late the Vatican does not oppose the unnatural 1970s. He envisioned that IVF would medical intervention of dialysis, respirators, damage the family and marriage. This belief or blood transfusions as it does IVF.15 These would be supported by Lass Bass who stated procedures help sustain God’s design not that the production of humans in laboratories create it; therefore, they are acceptable to the was no longer human procreation and would Catholic Church. According the Roman lead to the slow destruction of parenthood.18 Catholic Church, unlike the procedure of The idea of parenthood would be a concern dialysis, IVF is an unworthy method of for Protestants and as a result generated creating a new life because it replaces God, great opposition to IVF. They feared that who is the sole creator of life. Kevin Kelly, IVF would encourage parents to become a devout Catholic, however, in 1987, obsessed with having a child of their own opposed the Catholic position because he that is genetically similar to them.19 The saw the greater significance in the integrity obsession over a genetically similar child of human relations as love, marriage and threatens the purpose of Christian parenthood, in which, these could not be parenthood, which is a commitment to defined by the single physical act of nurture a child, not to provide genetic intercourse.16 inheritance. Protestants favor adoption as an Even though Catholics oppose IVF, alternative to IVF because adoption supports due to the unnatural process that removes Christian parenthood traditions. Ramsey’s the link between intercourse and concerns were dismissed after Louise Brown reproduction, Protestants believe that was born. The birth of the first IVF baby intercourse and reproduction are changed Christian writings because it was independent from each other. Protestants evident that IVF was a viable medical view the purpose of intercourse as the procedure for conception.20 Protestants capacity to express love, which is could not accept that baby Louise should

13 Jones, D.G., 2004 17 McDowell, J.D., 1998 14 McCormick, R.A., 1993 18 Jones, D.G., 2004 15 McDowell, J.D., 1998 19 McDowell, J.D., 1998 16 McDowell, J.D., 1998 20 Jones, D.G., 2004

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In vitro Fertilization have never been born just because she was be carried out by an expert physician. Also conceived through IVF and not “naturally.” no third party donors are allowed and all forms of surrogacy are forbidden.24 As noted Islamic Perspective on IVF by these guidelines, IVF is acceptable as Both Sunni and Shi’ite Muslims are long as the procedure remains between the open to IVF as long as the procedure and the married couple. This is in obedience to the couple are following Islamic law. Islam is fatwas. As stated above, the fatwas assure open to IVF, however, it has set strict rules the conception within marriage. An due to the threat that IVF poses to the important aspect of Sharia law is fidelity in institution of marriage and family, which marriage. In the Middle Eastern countries, compose the center of Muslim society. Both marriage is viewed as a contract between denominations of Islam view husband-and- husband and wife.25 According to Sharia wife IVF as an uncontroversial procedure law, adultery would be breaking the terms of due to the stigma that infertility carries.21 In this contract and a serious offense. This the Middle East being stigmatized as offense is punishable by death to the abnormal due to medical issues, such as offender. The use of a third party as a donor infertility, isolates the couple from the rest would be illegal according to Zina.26 Zina is of the society. This fear of being an outcast the term for Sharia law that is concerned in society in conjunction with prophet with sexual relationship outside of marriage. Muhammad advocating for treatment of The donation of gametes and the use of a disease, assisted reproductive technologies, surrogate is adultery, which defies Sharia like IVF, are welcomed in Muslim culture.22 law. Besides the legal repercussions of this Even though both Sunni and Shi’a Islam defiance, the consequence of not following accept IVF as a treatment for infertility, they Zina is the confusion of kinship relations.27 have diverged in their interpretation of The confusion of kinship relations leads to Sharia law, also known as the Islamic law. indirect disobedience to fatwas, which are Sunni Muslims have accepted IVF as concerned with the confusion of familial a method for reproduction, but follow the lineage. decrees that fatwas have set for assisted Shi’a Islam up till the late 1990s reproductive technologies. Fatwas concerns agreed with Sunni Muslim decrees in are in the protection of sanctity of life, regards to gamete donation, however, the conception within marriage, no confusion of Supreme Jurisprudent of the Shi’a Muslim family lineage, no mixing of genealogy, and branch issued a fatwa that allowed the designating the gestational carrier to be the donation of gametes to be used in assisted mother.23 These fatwas have influenced reproductive technologies.28 This decree, Muslim physicians, who have defined the however, does not apply to all Shi’ite guidelines that are accepted in the Middle Muslims because of their religious practices Eastern medical communities in regards to that differ from Sunni Islam. Shi’ite assisted conception. According to these Muslims practice ijithad, which is medical guidelines, artificial insemination precedence given to individual religious with the husband’s semen is allowed. IVF is only allowed between marriages and must

21 Clarke, M., 2008 25 Inhorn, M.C., 2006 22 Mahmoud, F., 2012 26 Inhorn, M.C., 2006 23 Mahmoud, F., 2012 27 Clarke, M., 2008 24 Inhorn, M.C., 2006 28 Inhorn, M.C., 2006

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In vitro Fertilization reasoning.29 This individualism allows Conclusion Shi’ite Muslims to come to their own Assisted reproductive technologies conclusions in regards to whether gamete have become widely accepted across the donation is right or wrong. Several Shi’a different continents since the introduction of authorities still prohibit gamete donation, or Louise Brown, in the late 20th century. IVF any third party involvement during IVF, is an option that physician around the globe while others have found flexibility and offer to infertile couples as a method for openness to donation during IVF conception, however, the ethical dilemma of procedure.30 This difference of opinion in IVF is much more complicated. The regards to the third party involvement is comparison between the Roman Catholic, found within the Shi’a community, but has the Protestant, and the Islamic views of IVF not been translated into the Sunni displayed the interaction between religion community. Another religious practice that and assisted reproductive technologies. is found in Shi’ite Islam, but not in Sunni Christianity does not accept IVF, because it Islam is mutca. Mutca is the practice that is an unnatural method of reproduction that allows for the temporary marriage between a can affect Christian traditions such as single Muslim woman and a married or parenthood and marriage. Despite this view, single Muslim man for a fixed time period Protestants, in particular, have opened up to and payment.31 This religious practice has IVF as a method for treating infertility. This allowed flexibility in regards to sperm or view correlates with physicians who view egg donation because it revokes the issue of reproductive technologies as a method to adultery within a marriage. Even though the treat illnesses. Islam fully accepts IVF religious practices of ijithad and mutca have provided the married couple follows Islamic allowed the acceptance of gamete donations law. Sunni Muslims do not accept gamete during IVF, Shi’ite Muslims follow strict donation, but Shi’ite Muslims are more rules in how donation is practiced. These flexible with gamete donation and rules are: a couple in need of a donor must surrogacy. These different perspectives on attend Shi’a religious court, where the IVF have influenced society and the decisions will be made case-to-case. In this application of assisted reproductive case-to-case decision, the infertile couples’ technologies in different medical case is reviewed. The couple must bring a communities. In the Middle East, IVF is a witness to testify on behalf of their common practice because Islam has relationship and their IVF doctor must accepted this method of conception and present evidence of their inability to Islamic law is used to guide the rules of IVF conceive naturally. A woman that is married treatment for an infertile couple. Christian and requesting a sperm donor will be denied perspectives on IVF are still changing and because she is not able to participate in a this method of conception has become a mutca marriage.32 The infertile couple, more common practice. The analysis of regardless of Shi’a acceptance of gamete Islam and Christian views of IVF reveal the donation, must follow the decision made by complicated dilemma that exist between the religious court. religion and reproductive technologies, which influences the society around them.

Literature Cited

29 Inhorn, M.C., 2006 31 Inhorn, M.C., 2006 30 Inhorn, M.C., 2006 32 Inhorn, M.C., 2006 Dialogue & Nexus | Fall 2016-Spring 2017 |Volume 4 6

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Ali, S.R., Liu, W.M., Humedian, M. (2007). Islam 101: Understanding the Religion and Therapy Implications. Professional Psychology: Research and Practice, 35(6), 635-642. Clarke, M. (2008). New Kinship, Islam, and the Liberal Tradition: Sexual Morality and New Reproductive Technology in Lebanon. The Journal of the Royal Anthropological Institute, 14(1), 153-169 Edwards, R.G. (2007). Reminiscences on Learning about Morals and Ethics in Biomedicine. Ethics, Law, Moral Philosophy of Reproductive Biomedicine. 2(1). 7-11. Inhorn, M. C. (2006). Making Muslim Babies: IVF and Gamete Donation in Sunni versus Shi’a Islam. Culture, Medicine & Psychiatry, 30(4), 427-450. Jones, D. G. (2014). Christian Responses to Challenging Developments in Biomedical Science: The Case of In Vitro Fertilisation (IVF). Science & Christian Belief, 26(2), 143-164. Mahmoud, F. (2012). Controversies in Islamic Evaluation of Assisted Reproductive Technologies. Islam and Assisted Reproductive Technologies: Sunni and Shia Perspectives, 70-98. McCormick, R.A. (1997). Therapy or Tampering: The Ethics of Reproductive Technology and the Development of Doctrine. Bioethics. 4. 97-122. McDowell, J. D. (1998). Ethical Implications of In Vitro Fertilization. On Moral Medicine: Theological Perspectives in Medical Ethics, 2, 505-508. McGrath, A. E. (2007). Christianity’s Dangerous Idea: The Protestant Revolution- history from the sixteenth century to the twenty first. 190-200. Miles, S.H. (2004). The Hippocratic Oath and The Ethics of Medicine. 55-65. Nesbitt, R.B. (1962). A Protestant Believes, 40-58. Singer, P. (1985). IVF: The Simple Case. Making Babies: The New Science and Ethics of Conceptions, 544-548.

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