A Commentary of The National Catholic Center on Health Care and the Life Sciences

has followed, scientists have been actively competing to arnings on defy nature and successfully create the world’s first child W via an —with little consideration of the Artificial Wombs ethical consequences. Ethical Dilemmas The use of artificial wombs risks undermining our As birth control has become more widely accepted, so understanding of motherhood and, by extension, parent- has the idea that sex could be separated from procre- hood. We learn from both Scripture and science that the ation. Assisted­ reproductive technologies, such as egg womb is a sacred space. Natural maternal–child bonding and sperm donation and surrogate motherhood, have is affirmed by medical experts as essential to promoting made it possible to have children without engaging in the health of mother and child. The nine-month gestational the conjugal act. Now, if some scientists have their way, period is a time in which an essential trust is established the practice of will allow for the creation of between the two individuals, not merely through emo- children entirely separate from the womb and outside tions, but through biochemistry and the exchange of of the human body. ­certain hormones.5 This bond is permanent and is felt in In 1924, J. B. S. Haldane, at the time a professor of bio- both the mother and child for the rest of their lives. The use chemistry at Trinity College, Cambridge, coined the word of artificial wombs would intentionally sever this bond, ectogenesis (from the Greek words ecto for “outer” and and the consequences of such a radical activity would be genesis for “beginning” or “generation”) to describe what impossible to foretell. 1 he predicted to be the future of reproduction. Haldane Moreover, ectogenesis would very likely aid in the thought that by 2074 less than 30 percent of births would social quest to reduce the importance of the two-parent, be natural, human births. More recently, transhuman- mother-and-father tie to their child and in some cases ist activist Zoltan Istvan, along with other researchers, could introduce multiple parties into the parenting pro- predicted that “ectogenesis will be here in 20 years, and cess. By rendering the womb an arbitrary location, 2 widely used in 30 years around the world.” ectogenesis risks rendering biological ties unnecessary. While Haldane and Istvan have hailed the develop- The rise of gamete donation and surrogacy has already ment as great progress for science and women alike, it intentionally separated children from their biologi- raises serious questions about the well-being of the chil- cal origins, and ectogenesis would only further aid in dren that would be conceived via artificial wombs, the normalizing this process. Whereas children were once meaning of motherhood, the continued commodification linked to their parents via the conjugal act, ectogenesis of the human life, and the increased likelihood of deep- would allow for the possibility that two unconnected rooted eugenics. individuals could decide to make a child to their liking, The mechanics of ectogenesis, while relying on highly independent of any type of marital fidelity or long-term sophisticated technology, is pretty straightforward. Istvan commitment to one another or their child. Moreover, if writes, “Basically, it appears as an -filled the creation of children is reduced to mere contracts and aquarium with a bunch of feeding tubes and monitoring laboratory experimentation, the two-parent standard cables attached to a live, developing organism. Those becomes an arbitrary norm. The floodgates would then tubes bring the nutrients, oxygen, etc. needed to grow an organism and help it survive; the cables monitor February 2015 Volume 40, Number 2 ­everything going on inside the tank.” 3 In recent years, the push for ectogenesis has largely been championed by researchers in Japan and China through experimenta- Warnings on Artificial Wombs tion with animals and human embryos alike. While their Undermining the Idea of Parenthood advancements were limited, the movement was given Christopher White great hope when Hung-Ching Liu at Cornell University created an artificial where an embryo successfully Confusion about Sex and Gender implanted. At a 2001 conference she noted, “The embryo grows very happily and very healthy.” 4 She allowed the Solutions to Two Complex Problems original embryo to grow for six days but noted she had Edward J. Furton plans to allow them to develop longer. In the decade that

Defending the Dignity of the Human Person in Health Care and the Life Sciences since 1972 Ethics & Medics February 2015 be open to multiple parents without any logical standard and partial ectogenesis. Complete ectogenesis entails for limitations. what has been described here as an effort to intentionally For those utilizing such technologies, it is likely to create a child using an artificial womb from the outset be an expensive process, and those paying for these ser- of conception. Partial ectogenesis, however, would allow vices will most assuredly seek to create the child of their for “the continued development of an already generated choosing. This will result in an attempt to create designer human transferred from a maternal womb to an 10 children through the selection of preferred sperm and artificial womb” to present an alternative to abortion or eggs. This, too, will incentivize a greater push for the to save the life of the fetus or the mother during a high- buying and selling of eggs and sperm and an expansion risk pregnancy. Catholic moral philosopher Christopher of the market for gametes. In the thirty years since egg Kaczor has promoted this distinction as one possible and sperm donation has become highly commercialized, valid use of the technology that is still consonant with we already know that this market has institutionalized efforts ofDonum vitae and Centesimus annus to protect life high-risk, invasive medical procedures for women who at all stages and ensure that children are brought into sell their eggs.6 Furthermore, it has created a generation existence through environments of care and protection, of children who have been conceived without any access facilitated by the conjugal union of husband and wife. to their medical histories and in many cases suffer from The exception of partial ectogenesis seems to be a genealogical bewilderment.7 legitimate one under certain circumstances, though as Yet in this pursuit of perfection, the expectations of we have seen with the development of many reproduc- parents seeking to create their unflawed child will most tive technologies, the mere existence of the possibility of assuredly yield greater demands for abortion if the devel- their usage has led to a societal push for a full embrace of oping child proves to have abnormalities or is declared their implementation, with some even promoting them to be “defective.” After all, in such a system, the parents as a right. are mere purchasers of a product, and their product must As we are reminded in Donum vitae, “In the light of the meet their satisfaction. truth about the gift of human life and in the light of the Finally, for those seeking to create the right embryo moral principles which flow from that truth, everyone is ­using hand-picked sperm and eggs, this will almost invited to act in the area of responsibility proper to each.” 11 certainly result in the creation of multiple embryos. In The ethical considerations of ectogenesis show that we selecting the most desirable, parents are likely to use must be ever wary of and ever responsible in its usage—if preimplantation genetic diagnosis to screen for potential we are to promote its use at all. genetic disorders. Some have attempted to mask this as a kind or beneficent action, but it is plainly eugenic. Ecto- Christopher White genesis does not require multiple embryo implantation, so Christopher White is the director of research and education at the creation of multiple embryos will undoubtedly lead to the Center for Bioethics and Culture Network in Pleasant Hill, a surplus that will have to be frozen, offered for scientific California. research, or destroyed. 1 J. B. S. Haldane, Daedalus or Science and the Future (New York: The Future of Reproduction ­Dutton, 1924). 2 Zoltan Istvan, “Artificial Wombs Are Coming, but the Contro- In Donum vitae—issued by the Congregation for the versy Is Already Here,” Motherboard, August 4, 2014, http:// Doctrine of the Faith in 1987 before ectogenesis seemed motherboard.vice.com/read/artificial-wombs-are-coming-and a real possibility—the Church warned that “attempts or -the-controversys-already-here. hypotheses for obtaining a human being without any 3 Ibid. 4 connection with sexuality through ‘twin fission,’ Christine Rosen, “Why Not Artificial Wombs?,” New Atlantis 3 or parthenogenesis are to be considered contrary to the (Fall 2003): 71. 5 Megan Galbally et al., “The Role of Oxytocin in Mother-Infant moral law, since they are in opposition to the dignity both Relations: A Systematic Review of Human Studies,” Harvard 8 of ­human procreation and of the conjugal union.” Pope Review of Psychiatry 19.1 (January 2011): 1–14. St. John Paul II in his 1991 encyclical Centesimus annus 6 Institute of Medicine and the National Research Council of the added that “among the most important of these rights, National Academies, “Assessing the Medical Risks of Human mention must be made of the right to life, an integral part Oocyte Donation for Stem Cell Research: Workshop Report” of which is the right of the child to develop in the mother’s (2007). 7 Hillary B. Alberta, Roberta M. Berry, and Aaron D. Levine, “Risk womb from the moment of conception.” 9 From these two Disclosure and the Recruitment of Oocyte Donors: Are Adver- documents, it would seem that the Church’s opposition to tisers Telling the Full Story?,” Journal of Law, Medicine and Ethics ectogenesis, while not explicitly stated, is quite obvious. 42.2 (Summer 2014): 232–243. The mother–child bond should be held intact and priori- 8 Congregation for the Doctrine of the Faith, Donum vitae (February tized from the moment of conception, as indeed this is the 22, 1987), I.6. only form of procreation that ensures that a child is to be 9 John Paul II, Centesimus annus (May 1, 1991), n. 47. 10 known and loved by his biological parents. Christopher Kaczor, A Defense of Dignity: Creating Life, ­Destroying Life, and Protecting the Rights of Conscience (Notre Dame, IN: Nonetheless, new thinking has emerged that has University of Notre Dame Press, 2013), 51. attempted to distinguish between complete ectogenesis 11 CDF, Donum vitae, III. 2 Ethics & Medics February 2015 ­ Transgendered Students Confusion about Here is another problem that Catholics did not cause, but are asked to resolve. When a parent informs a Catholic Sex and Gender school that a child will soon present as a member of the opposite sex, how should the administration respond? Increasingly, Catholic schools will have to settle on policies concerning children who, in appearance and dress, come The Catholic Church holds that a sex-change operation to school having “changed their sex.” does not truly alter the gender of a person. Does that mean that a wife is obliged to continue to remain a lov- In discussing this question, we must first realize that ing partner in marriage to a man who has undergone the child is not at fault. He or she may be in a single-parent this ­mutilating surgical procedure? Suppose the husband household where a member of the same sex is absent; the insists that, if she is a good and faithful Catholic, and child may thus lack an appropriate role model. Or the ­accepts the teachings of the Church, she will continue to mother or father may actively encourage identification with treat him as a man, even though he seeks to present their the opposite sex in order to satisfy some inner and perverse union to others as lesbian. need. For example, a single mother—whether consciously or unconsciously—may prefer to raise a daughter instead How would you, as a faithful Catholic, advise the of the son that she has. She may not like men at all. wife in this matter? On the surface, it appears a complex problem. If you say that the husband does indeed remain a The age in which we live contributes to the confu- man, this implies that she ought to assume that the change sion. The claim that sexual identity is imposed on us is irrelevant. But if you say that the husband has every by ­society—and therefore is malleable and subject to a­ppearance of being a woman, and that this fundamen- choice—is one of the great delusions of our time. There tally undermines the marriage, you appear to set forth a could hardly be a better example of what happens when position that is at odds with the Church. Is he not still a one abandons the natural law tradition in ethics. Sexual man, and a married man at that? differences are objectively established by nature. Not To answer a question such as this, one must see it as too long ago, an expressed desire to be a member of the a compound problem. There is an initial erroneous deci- ­opposite sex was recognized by everyone as an aberration sion that is compounded by reapplying the teaching that of normal psychological health. has just been violated to the new situation. Something of Although the Diagnostic and Statistical Manual of Men- similar nature happens in the production of embryos via tal Disorders, the standard source for describing mental in vitro fertilization. A Catholic couple who has violated disease, continues to list this condition as a psychologi- the prohibition of the Church concerning IVF, and who cal dysfunction, it is no longer explained as a failure to now regrets having “excess embryos,” wants Catholic identify with one’s given sex, but rather as a feeling of advice on what to do about their frozen offspring. If the incongruence between physical sex and “gender identity.” Church is pro-life, surely it must have some solution to The claim that one’s psychological idea of sexual self does this serious problem. not match one’s physical body has been given the name But the problem is that the couple did not follow the “gender dysphoria.” Church’s teaching in the first place. The situation you are The Catholic Church offers no judgment on particular asked to address is disordered—and there is not always medical theories, but rather affirms as central to its theo- a moral course forward when a Catholic has put himself logical tradition that the human being, as a unity of body on the wrong side of a moral issue. and soul, is destined by God to be the sex plainly visible In the case of the husband who wants his wife to live at birth. Baptismal certificates are determined by physi- with him as a lesbian couple, the first error is the mutilating ology and cannot be later revised. Any Catholic policy surgery. This, of course, is intrinsically immoral; it violated concerning children who present at school as members of the principle of totality and integrity. The problem is then the opposite sex must clearly affirm this teaching. compounded by the fact that the action of the husband in Although “cross-dressing” is itself problematic, the undergoing surgery was itself for the sake of achieving Church views with special alarm the further decision to an immoral end. The fact that the husband now attempts surgically alter a healthy male or female body so that one to justify his decision by appealing to Church teaching is “becomes” a member of the opposite sex. Parents should irrelevant. He has already violated that teaching. be especially vigilant against those who would attempt to Generally, the wife must recognize that the marriage persuade them to inflict these surgeries on their children. has been severely harmed—if not destroyed. The mutilat- As noted above, they do not change the sex of the person, ing surgery makes her husband completely sterile. Normal which remains as it was before the mutilation. marital relations are no longer possible. The fact that he Invoking science as a higher standard than Catholic remains a man after the surgery is no point in favor of theology must be seen as illegitimate. Catholics, of course, his wife continuing to treat him and the marriage as it are great champions of science. We embrace all of its was before. He is still a man, but this only shows how ­objective findings, but we also affirm the unity of faith profoundly his decision to mutilate himself has harmed and reason. No scientific finding can contradict the teach- his sacramental union with his wife. ings of the Church. If it does, some error must be present. 3 The National Catholic Bioethics Center

6399 Drexel Road, Philadelphia, PA 19151–2511 www.ncbcenter.org

Volume 40, Number 2 February 2015 Views expressed are those of individual authors and may ­advance positions that have not yet been doctrinally settled.Ethics & Medics makes every effort to publish articles consonant with the magisterial teachings of the Catholic Church.

An Important Proviso ­corrective surgery and wrongful cross-dressing or surgical mutilation. But it can be a beacon of moral truth. In light of these concerns, it is important to note one factor that compels us to be cautious in these cases. Some Duties of Catholic Schools children suffer from genuine genital ambiguities or defor- mities at birth. These may make the external appearance of As a general rule, a Catholic school must affirm the sex unclear. Internal organ structure may also be missing fundamental truth of the natural law that sexual identity or inappropriately developed. Genetic evidence can guide is determined by our physical nature. Each of us is a body– our judgment, but sometimes not even this is possible, as soul union, and it is the body that displays our sexuality. is the case among those who suffer from androgen insen- This is a philosophical and theological conviction that is sitivity syndrome. not subject to judgment by external authorities, including that of science. The theology of our faith is deeper than Consider the following possibility: A child born with any scientific theory. ambiguous genitalia is surgically altered at birth as a means of eliminating the deformity. The surgeon, ignoring Sexual identity cannot be changed by personal whim the genetic evidence, advises the parents that it would be or desire; hence, the Church’s teaching against mutilation easier to alter the genitalia so as to give the child a female follows the God-given law of nature, though at the same rather than a male appearance. This approach is more time, we must remember once again that the child is the likely, he tells them, to produce good surgical results. The victim here. The child has either undergone an inappro- parents decide to follow the advice without giving due priate surgery as an infant (that is now being corrected) consideration to the genetic evidence. or is being allowed or encouraged by a parent to cross- dress, either as an end in itself or with an eye toward As this supposedly female child grows older and immoral surgery. The student, therefore, must receive experiences his masculine identity, he would eventually the compassionate concern of the teachers and the school realize that the physical alterations made to his body were administration. inappropriate. He might tell his parents that he now wants to return to his proper physical identity and mode of dress. From a practical perspective, the child who presents Here Church teaching would encourage the decision of as a member of the opposite sex at school faces potential the child. The original operation—although intended to ostracism at the hands of fellow classmates. The admin- be reparative—was in fact a mutilation; it did not conform istration should take decisive steps to limit this harm. At to the child’s genetic identity. the same time, the whole episode presents the school with an opportunity to publicly proclaim, by way of a letter to Therefore, the presentation of a child at Catholic school the parents of all who attend the school, the teachings of as a member of the opposite sex may in some cases be the the Catholic Church on embodiment, sexual identity, and result of a good decision that follows Church teaching. The respect for our created nature. correction of a previous error should not be discouraged, but welcomed. Given the confidentiality that is rightly Edward J. Furton, MA, PhD ­involved in so intimate a matter, Catholic schools are Edward J. Furton, MA, PhD, is editor in chief of Ethics & ­Medics not in a position to distinguish between cases of proper at The National Catholic Bioethics Center in Philadelphia. 4

Ethics & Medics is a publication of The National Catholic Bioethics Center. Regular annual subscription rate for 12 issues includes both the print version by mail and online access at www.ncbcenter.org/em: U.S. A. $28; foreign $38; institutional $55. Individual copies are available at $3.00 each. TO SUBSCRIBE, please write to The National Catholic Bioethics Center, 6399 Drexel Rd., Philadelphia, PA 19151–2511, e-mail [email protected], or phone (215) 877–2660. Publisher: John M. Haas, STL, PhD; Editor: Edward J. Furton, MA, PhD. Contents © 2015 The National Catholic Bioethics Center. ISSN 1071–3778 (print), ISSN 1938–1638 (online). For permission to reuse material from Ethics & Medics, please access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, ­Danvers, MA 01923, phone (978) 750–8400.