Do You Favor or Oppose Stem Cell Research?

by William Cutrer, MD, and Sandra Glahn, ThM

Today the number of news stories focusing on bio-ethical topics has skyrocketed. We hear about cloning, test tube babies, stem cell research, euthanasia, the Human Genome project, and even biotech stocks on the NASDAQ; and people want to know more about the hows and the whys. In this column we will explore from a Christian worldview the ethics associated with these complex medical and ethical concepts. Our goal here is not to tell readers how to think because godly men and women sometimes arrive at different conclusions. Rather, our hope is to stimulate deep thinking and appropriate action. Having experience in both the theological/ethical and medical elements of the discussion, we have sought to present a balanced, non-alarmist perspective.

In each column we’ll look at dilemmas created by bleeding-edge developments in science and technology with a view to applying some biblically based morality. And we’ll explore how biotech stuff affects you, giving you the chance to ask questions so we can address what you want to know.

Does the birth control pill cause abortion?

What do you do when you find yourself at the bedside of a terminally ill patient? What if he or she asks for your help to end the struggle? If you agree, does it make a difference if your involvement is voluntary, involuntary or non-voluntary? That is, would you help facilitate the withdrawal of treatment or would you go so far as to encourage physician-assisted suicide?

Your friend finds out she’s pregnant after rape or incest and asks your advice. Or her doctor tells her that the baby has an abnormality. What will you do?
Are more people today infertile than in the past? Can Christian infertility patients work with in vitro clinics? If you respect life at the one-cell stage, what procedures can you use?

What about cloning? Can it be done, should it be done? Are there lines of experimentation that Christians can support?

In the process of exploring these issues, we’ll seek to demonstrate a Christian consensus in many key areas and learn to extend grace to others in cloudier issues. Ultimately, we will depend on God’s wisdom to guide us:

“If any of you lacks wisdom, let him ask of God who gives to everyone liberally” (James 1:5).

Although we will explore issues not specifically addressed in the Bible, we’ll frame our opinions through a scriptural grid. It’s the only way to walk the path of making informed, biblically based decisions at the edge of ethics in places where our generation is the first to go.

Human Genome Research: Exploration or Exploitation?

Bill Cutrer, M.D., and Sandra Glahn, Th.M.

On June 26, 2001, President Clinton, Prime Minister Blair, and both of the key scientists involved in the research announced the completion of the initial sequencing of the human genome. In our last column, we explored the “up” side of this great accomplishment.

But what about the cautions? What are the dangers? As far as is publicly known, the ethical principles have all been upheld in the process so far—no life loss, no harm done, and enormous potential for good. But that is not to say the potential for evil is not present.

Making Private Information Public

Here’s the “down” side of all this research: we are now positioned to predict more accurately those persons who are at high risks for developing genetic disorders. That’s good, isn’t it? Yes, because it can direct them to prevention or treatment. But here’s the problem. Unfortunately, a person diagnosed as being “at risk” genetically might also find his or her diagnosis economically and socially “risky” before any signs of disease develop. Depending on who has access to personal genetic information, businesses could discriminate by refusing to hire someone with a higher-than-average risk for cancer or debilitating disease. An insurance company could easily deny coverage to the very group of people most needing their financial resources. Corporate greed has motivated the discrimination that has already taken place for some with currently diagnosable genetic disorders. Insurance companies now disqualify people for “pre-existing conditions,” but presently patients have at least shown some sign of disease before being denied coverage. In the future with genomic diagnosis, we could see people denied coverage years before symptoms appear.

What does this mean?

It tells us that, while we can be optimistic about the potential for impacting certain diseases, we must be vigilant to set limits on how others can use this information. Writing from the Center for Bioethics and Human Dignity, Ben Mitchell, Ph.D., observed, “We have no national policy which prohibits discrimination against persons on the basis of genetic code. Gene therapy without appropriate protocols of informed consent and research protection has already resulted in the loss of the life of young Jesse Gelsinger. Must others die needlessly?”

Making Public Information Private

In addition, we need to support and encourage laws that keep genome research in the easily accessible public domain, rather than letting it be dominated by the private sector. Unfortunately, people are already “buying up” sites on the genome, as though they are something to be owned. The rationale is that if one of these purchased spots is identified as the key location for a certain cancer, the “owner” will have an overnight financial windfall.

The heads of both United States and British governments have said the human genome should not be the property of any private interest. Yet the president of Celera Genomic has linked his work on human gene sequencing to his company’s financial interests. Should science serve mankind or should it be done in service to a few elite humans? Again, it comes back to greed. First Timothy 6:10 reminds us, “The love of money is a root of all kinds of evil.”

Looking even further down the road, how would genetic information affect social interaction and marriage? If you knew the genome of your prospective mate, and thus for your offspring—potential for such diseases as cancer, diabetes , and Alzheimer’s—would we use this information to keep our “family gene pool” strong? Could the state require a blood test to be sure folks with recessive genes don’t marry? Would a certain type of genome be required to fill government posts? The possibilities are endless.

What should we do? We should not oppose the research itself just because the potential for evil exists. Rather, we need to stay informed and speak up to ensure that ethical and legal guidelines are in place before the technology is readily available. We already have laws against certain kinds of discrimination (age, race, gender, religious); we need to add “possibility of genetic disorder” to the list. Recognizing the potential for good and evil in all medical research, we must be vigilant to protect those who could easily be exploited by our newly gained knowledge. And we need to assure that the knowledge that could benefit the entire human race does not become the product of a few private investors.

Human Genome Project: Big Deal or Big Hype?

by Bill Cutrer, M.D., and Sandra Glahn, Th.M.

It’s been in the news for more than a year now–the ability to sequence the human genome. What does it mean? Is this bad news or good?

An MD/PhD posting his comments online wrote this: “These are just sequences, folks. Even after we identify the proteins they encode, it may take thousands of years to figure out what the proteins do, how they interact with each other, and how they relate to health. Imagine this: somebody gives you all the words in Heller’s Catch 22—in alphabetical order. How far is that from putting together the book? Multiply it by a million. This is where we are now. In all likelihood, it will result only in very gradual changes, over thousands of years.” In short: No big deal.

Contrast that with the big press conference on June 26, 2001, with President Clinton, British Prime Minister Blair, and both of the key scientists. We heard statements such as, “Understanding the human genome will revolutionize the practice of medicine….” Francis Collins, a professing Christian who heads the International Human Genome Project, said on national TV, “We have caught the first glimpses of our instruction book, previously known only to God.” In short: It is a big deal.

So who’s right? Big deal or Big hype? Is this something to get excited about, or worried over? What are the legal, ethical, and social implications?

Look at it this way. Picture a deck of cards—a really big deck. This deck has roughly 3.2 billion cards. What the joint work of the U.S. government’s National Human Genome Research Institute (public) and Celera Genomics (private) has accomplished is figuring out, in simple terms, what “card” is in position in the deck. Their approaches, though different, focused on discerning what gene or “card” was in each place.

The ethical principles of beneficence, non-maleficence, justice and autonomy were all upheld in the process—no life loss, no harm done, and enormous potential for good. (That is not to say the potential for evil is not there, but as far as we know, the research has upheld ethical principles.)

The announcement means we’ve learned nearly the entire sequence of the cards. Yet we can identify the function in only a tiny percentage of them. We know their chemical sequences, but not their what they do. By comparing sequences with individuals who have known genetic disorders, we already know some of the sites, and we can now discover others fairly quickly. The potential for medical advancement is staggering—truly great news.

In addition, the impact of this discovery is amazing in another way. It affirms our remarkable complexity as humans, and it also affirms our great similarity as a community of persons.

Creation or Evolution?

Some have noted how closely our genome matches that of chimpanzees and other organisms. Their opinions about this have much to do with what perspectives they bring. Celera’s President uses words such as “evolution” to describe what he’s found; Collins uses “God.” All earth creatures have the same basic raw materials, yet we make up a wide variety of living organisms. The biblical account says that the “earth brought forth” the plant and animal life, so we should expect our “building blocks” to be similar because mankind, created in God’s own image, was uniquely created from—right—dust! God formed us from the basic elements of creation: Carbon, hydrogen, oxygen and nitrogen. And then he “breathed” life. (See Gen. 2:7.)

When our friends who read evolution into this discovery say, “Humans are 99.9 percent the same as the chimp,” consider that .1 percent of 3.2 billion pairs of nucleotides is still a difference of more than three million. And there are apparently only about 300,000 differences between persons. We’re reminded of the children’s game in which students “spot the differences” between pictures. One guy may have an extra button in the “what’s different” picture; or perhaps a girl has a long sleeve on one arm. Well, in Genomics, between the one frame (chimp) and the other frame (human), the student would have to identify 3.2 million differences. So while in percentage it doesn’t look like much, in actuality it would take a bright child more than ten years to identify the differences. In fact, it took our team of scientists more than a decade just to put the stack in order.

How Revolutionary?

So, we have the sequence, and we know which “card” fits where, but we don’t yet know what many of these cards do. That means our online doc is right—this generation will likely not live to see each gene sequence diagnosed or “repaired.” Yet those describing this accomplishment in grand terms are also right. Understanding the building blocks and the ability to impact the 5,000 known genetic diseases is incredibly exciting and likely will change many lives in the next three to five years. We could very well see some “risky” genes identified such as for cancers, early heart attack, or diabetes.

How, then, should we respond to the public announcement of the sequencing of the human genome?

Grapple with the suggestion that such an incredible number of precise combinations could have been the result of chance and time.

Praise God that we have been—in this generation—permitted a glimpse into a yet smaller frame of our construction. The more we discover, the more we can stand in awe of our complexity.

Marvel that we are “fearfully and wonderfully made” (Psa. 139: 14) from a template of merely four basic blocks mixed more than three billion times.

That’s the “up” side. Next time we’ll consider the cautions…

Hope For Infertile Men

by William Cutrer, M.D. and Sandra Glahn, Th.M.

Cigar, the retired Kentucky Derby winner, earned $9,999,815 during his legendary thoroughbred race career. But then he was discovered to be sterile. If he had been fertile, he’d be making $50,000+ in stud fees per effort. Animal husbandry research, driven by the desire for financial gain in cases such as this, has brought us numerous advancements in treating human fertility problems. In the last decade, we have seen particular progress in the treatment of male infertility, which had lagged behind treatment for female infertility.

Let’s say a husband has a very low sperm count, his specimen contains some normal motile sperm. What options are available and ethically permissable? For those who believe they must connect the sex act with conception, there aren’t any good options.

However, for those who believe technology can be employed, there are some possibilities, which would include these high tech micromanipulation procedures.

Intracytoplasmic Sperm Injection (ICSI)

Consider the chicken egg. It has an easily recognizable shell, an egg white, and the yolk. Likewise, the microscopic human egg has a “shell,” a material called cytoplasm (like the egg white), and a nucleus (like the yolk). While the human shell is not hard like the chicken egg, its “shell” cells are denser. And as a woman ages, her remaining eggs usually develop with increasingly tougher “shells.”

To aid husbands with low sperm counts or whose sperm have difficult penetrating the egg, we have ICSI. This involves injecting a single human sperm into a human egg by piercing the shell with a specially prepared microscopic needle. Specialists retrieve maturing eggs from the woman, and they obtain sperm from the male. The embryologist then selects and loads a single healthy-looking sperm into the micro-injecting apparatus.

Having loaded it into the needle, the embryologist stabilizes the egg under the microscope and pierces the “shell.” The sperm is then injected directly into the cytoplasm. From this point, the genetic material of the sperm must align with the egg’s. In a complex series of events, the egg “knows” penetration has occurred, and the genetic material of the egg, located in the nucleus, unravels and aligns with the male’s chromosomes. Only then has a unique individual emerged.

With ICSI doctors have absolute control of number of embryos replaced, so we face no worries about unintended multiple pregnancies, nor must couples face the decision of whether or not to cryopreserve (freeze) “extra” embryos. They also do not face the question of pregnancy reduction.

ROSNI (Round Spermatic Nuclear Injection)

Some men have a zero sperm count but still make sperm… sound impossible? Not really. The “plumbing”— the tubes that bring the sperm from the testicle to be delivered—can fail to develop properly. A key part of the tubing called the vas deferens can fail to develop at all, leaving sperm forever in the testicle to die and dissolve. But, now we can access these sperm with biopsy or even surgery on the testicle to obtain it for use in ICSI or ROSNI.

With ROSNI, doctors obtains immature sperm by needle aspiration via whatever part of the male tubular system has developed. They can then inject the immature sperm into the “egg” using a micromanipulative procedure, much as described in ICSI.

Doctors recommend this procedure for the husband with essentially no chance of producing a biological child otherwise. Using ROSNI, physicians fertilize eggs individually. Thus, as with ICSI, the issues of high order multiples, embryo reduction, and cryopreservation do not come into play.

So far, there is no evidence of birth defects associated with these procedures.

But they do raise some other questions: Is it acceptable to separate procreation from sexual functioning? Should it concern us that an embryologists are the ones to choose half the genetic input of a human being based on a sperm’s visual characteristics? For many sincere believers, these dilemmas are insurmountable; for others they present only minor concerns.

Both groups acknowledge the ultimate sovereignty of God over human creation: Your eyes beheld my unformed substance. In your book were written all the days that were formed for me, when none of them as yet existed (Psalm 139:16).

Again, the problem of using medical science in a situation where natural procreation can never occur may not fit your theological system. Yet ethically speaking, the sperm is the husbands (though obtaining it is quite difficult). The eggs are the wife’s, so we have not gone outside the marriage. And we have accomplished the good goal of trying to produce offspring for two people whom God has joined together.

When Father's Day Never Comes

by William Cutrer, M.D., and Sandra Glahn, Th.M.

Not that long ago, male infertility did not exist. In the “old way” of thinking, if a guy could achieve an erection, we said it must be the “woman’s problem.” But once researchers could analyze and test semen not only for “living” sperm but also count, motility, and a host of other characteristics, we discovered that fertility problems in men are as common as in women.

In the early days of male fertility treatment, we saw a variety of “creative” suggestions. These included “ice therapy,” a “sadistic torture” based on findings that sperm count and motility increase if the testicles are cooled.

Folk wisdom encouraged infertile couples to abstain from relations for two weeks, thinking that would improve the chances. Now we know that if a man with a low sperm count waits to “store up sperm” for longer than two or three days, the sperm count and fertilization potential can actually decrease owing to the increased presence of dead or immobile sperm.

Likewise for those advised to “do it more often,” a marginal sperm count can actually drop to infertile.

Precise testing has helped us to better understand male infertility and, fortunately, doctors can now successfully treat many of the diagnosable problems.

What are some of the issues that Christian couples with male factor infertility must consider?

First, the examination of the semen itself is problematic for some Christians. To evaluate the sperm the specimen must be obtained, often by masturbation, and many Christians consider this practice always wrong. In fact, some infertility clinics have a special “collecting room” equipped with pornographic videos and magazines to “assist” male patients in obtain sperm specimens. However, this clearly violates Jesus’ prohibition against lust:

Matthew 5:28 But I say to you that everyone who looks at a woman with lust has already committed adultery with her in his heart.

However, does that mean that a semenalysis is impossible for Christian couples? We would suggest that the husband could get the specimen with the assistance of his wife, focusing his thoughts on her, and thus not violating the Scriptural mandate.

For some, the procreative aspect of reproduction (babymaking) cannot be separated from the unitive (lovemaking). That is to say, some testing and treatment options are not permissable because the efforts at conception are separate from sexual intercourse. While we believe that physical intimacy is not only a beautiful part of marriage and a theological picture of Christ and the Church (Eph. 5), we are not convinced that medical technological advances cannot be employed to assist husbands and wives to achieve a pregnancy. However, we do respect those holding this view and honor their convictions not to use treatments that violate this position.

For those holding this view, a special condom has been developed to collect the semen during the act of intercourse. While this isn’t as effective medically as direct collection, it is certainly adequate. In fact, for those couples who believe the procreative possibility must always exist with the unitive, tiny pinholes can be placed in these special condoms to facilitate sperm collection while maintaining the “possibility” of conception.

If this seems extreme, or even legalistic to you, hopefully you can appreciate the profound pain of couples experiencing infertility, and the lengths they will go to arrive at a diagnosis and treatment plan while staying within the acceptable ethical boundaries of their faith systems.

Next time we’ll explore some of the treatment options for male infertility and the ethical questions they raise.

Surrogacy: Womb for Rent?

by William Cutrer, M.D. and Sandra Glahn, Th.M.

Womb for rent? Isn’t that what Abraham and Sarah tried with Hagar?

A Christian couple recently went to a surrogacy agency and paid approximately $50,000 for services. They were matched with a surrogate, who went on to carry their twins to term.

Say the word “surrogacy” and most people automatically think about nightmare court cases and convoluted family structures. Many Christians have been outspoken against surrogacy arrangements, labeling it clearly as sin.

However, the fact that there are approximately 100,000 frozen embryos slated for destruction should give us pause here. What if, instead of allowing the destruction of human life, we considered gestational surrogacy arrangements to keep these embryos from being destroyed? What may not be wise in an ideal world may actually be the best solution in this ethical dilemma.

The couple mentioned above had undergone an in vitro fertilization procedure during which multiple eggs were retrieved and six fertilized. Three embryos were then placed in the wife’s uterus, and the remaining three were cryopreserved (frozen). The wife went on to give birth, but medical complications required doctors to remove her uterus at the time of delivery. That left the couple with three frozen embryos and no means of carrying them.

Because the husband and wife believe life is precious, even at the one-celled stage, they felt they had no choice but to find a woman who would help them carry the embryos to term. For them, this was an application of their respect for life, recognizing that “children are a gift from the Lord” (Psa. 127:3).

Consider that there are two types of surrogacy arrangements.

Traditional surrogacy is generally used when carrying a pregnancy is life threatening to the mother and/or when the adopting mother has neither functioning ovaries nor uterus. The surrogate donates her own eggs and the use of her uterus. A physician inseminates her with the sperm of the husband, and the resulting child is biologically related to the surrogate (the “third party”) and the husband of the couple. Traditional surrogacy carries with it more complicated issues than sperm, ovum, or embryo donation because in a surrogate arrangement, the donor has contact with the child through the nine-month gestation and birth, and she has a biological connection to the child.

Gestational surrogacy, the arrangement used by the couple mentioned above, is an arrangement in which a surrogate provides a “host uterus” for a woman who is able to produce her own eggs. In this case, the surrogate receives the couple’s embryo conceived through an ART procedure, (reference our earlier column) and/or she receives an embryo that has been cryopreserved and would otherwise be destroyed.

The typical surrogate mother is married, has at least one child, and is between 25 and 35 years old. Many have had elective abortions in the past and volunteer to bear a child as a means of healing from past decisions.

Surrogacy is expensive. Some centers estimate it costs between $35,000 and $50,000. Most of that does not go to the surrogate. It covers counselors’, attorneys’ and physicians’ fees. Beyond the obstacle of cost comes the long process of matching.

In the case of embryo donation, Snowflake Adoption Services (which seeks to match embryos with gestational surrogates) estimates that it costs approximately $6,000 for embryo adoption through their help. However, Internet services are emerging to link couples wanting to find “parents” for their frozen embryos with couples wanting to “adopt” the embryos. In this case, the cost for matching runs about $60, and the medical details are worked out between the couples involved. In an unusual twist of events, gestational surrogacy could provide a creative means of pro-life involvement.

The issue of whether or not couples should cryopreserve embryos is a completely different debate. But in cases such as this—where embryos are suspended endlessly in a cryopreserved state—it would appear that the “sanctity of life” ethic may take precedence in favor of surrogacy arrangements. Perhaps surrogacy is sometimes the best solution in a complicated scenario.

Myths/Facts: When Mother’s Day Never Comes

A Primer on Infertility/Pregnancy Loss

by William Cutrer, M.D., and Sandra Glahn, Ph.D.

Every year on a Sunday in May, pastors ask mothers to stand. In some churches all the mothers will receive a flower. Restaurants will offer bargain meals to families honoring Mom. On Mother’s Day we honor the sacrifices our mothers have made and continue to make—and well we should. But for millions of couples, Mother’s Day is “M-Day,” the most dreaded holiday of the year. For these couples—the ones experiencing fertility problems—this day serves as a reminder of what they long to have but which eludes their grasp. A child.

When it comes to infertility, a lot of myths get passed around. Maybe you’ve heard some of them.

Myth: Infertility and sterility are the same thing.

Fact: Infertility is not sterility. Infertility is the inability to conceive after one year of unprotected intercourse and/or the inability to carry a pregnancy to term (600,000 women miscarry in the U.S. each year). Secondary infertility is when couples who have had one child (or more) are unable to conceive or carry to term again.

Myth: Infertility is rare.

Fact: Infertility is quite common. Approximately one in six couples of childbearing age experience fertility problems.

Myth: Infertility is a woman’s problem.

Fact: Infertility is shared about equally between the genders. About 30 percent of infertility problems are due to female factors, 30 are due to male factors, and 35 percent are a combination of both. The other five percent remains unexplained.

Myth: All the people in the Bible who were infertile were women.

Fact: We have to be careful to avoid viewing the Bible as an exhaustive textbook on infertility. While, the scriptures describe a number of couples who had difficulty conceiving, the stories are not about the process of infertility per se. And women are not the only infertile people. The levirate marriage laws (Deut.25:5,6) suggest male fertility problems. In addition, Ruth was married for ten years to her first husband without children. After he died, she went on to marry Boaz and give birth to Obed, King David’s grandfather. This would suggest that her initial inability to conceive was due to male factor infertility.

Myth: Infertility is caused by the inability to relax.

Fact: Infertility is not caused by the failure to relax. Ninety-five percent of the time it is due to a diagnosable medical cause. About sixty percent of all couples who seek treatment will eventually have a biological child. The percentage is much lower for couples who do not pursue medical treatment. Common causes in the female are ovulation or hormonal problems, endometriosis, anti-sperm or anti-embryo antibodies, blockage which prevents gametes from meeting, and/or structural or functional problems with the uterus or cervix. In men, it is caused by poor sperm penetration or maturation, hormonal problems, and/or blockages of the male reproductive tract.

Myth: Infertility is not any more common than it used to be; it’s just that we’re talking about it more.

Fact: The number of couples diagnosed with fertility problems is on the rise. Delayed childbearing and sexually transmitted disease are partially responsible. Environmental factors may also play a role.

Myth: Just adopt—then you’ll get pregnant.

Fact: Adoption is not a cure for infertility. Five percent of couples who end treatment and adopt end up getting pregnant. Five percent of couples who end treatment and choose not to adopt end up getting pregnant.

Myth: Couples going through infertility are having fun trying to have a baby.

Fact: Fifty-six percent of couples experiencing infertility report a decrease in the frequency of their sexual relationship. Both women (59%) and men (42%) report a decrease in sexual satisfaction, and infertile couples overall report having five times the sexual difficulties of fertile couples.

Myth: Real Christians are against any assisted reproductive technologies.

Fact: Godly people, should they choose to use assisted reproductive technologies, must do so in a way that honors the dignity of life, even at the one-celled stage.

Proverbs 30:16 says, “There are three things that are never satisfied, four that never say, ‘Enough!’: the grave, the barren womb, land, which is never satisfied with water, and fire, which never says, ‘Enough!’” Couples are often encouraged to learn from this that the deep desire of humans to have children is part of the way God has structured the world. Their stress is a normal response to an abnormal situation.

Do you know a couple struggling with fertility problems? Say a prayer for them as they face the daily heartbreak that accompanies such a loss.

A Journey through Miscarriage

by Sandra Glahn, Ph.D. and William Cutrer, M.D.

“A person’s a person no matter how small . . .”

—Dr. Seuss, Horton Hears a Who

Six hundred thousand U.S. women experience miscarriage each year.

One in every 50 couples trying to have children experience multiple miscarriages.

As many as 120,000 couples each year suffer at least their third consecutive miscarriage.

Typically, when a couple faces a pregnancy loss, they find themselves constantly analyzing what they could have done differently. They chide themselves with “I shouldn’t have used that disinfectant,” or “I shouldn’t have gone camping.” “Grandma told me not to lift my arms above my head, but I did.”

To better understand some of the anguish, we need to begin with some medical facts.

What causes it? There is no evidence that excessive work, reasonable exercise, sexual intimacy, having been on birth control pills, stress, bad thoughts, nausea, or vomiting are responsible for miscarriage. The most common reason for pregnancy loss is random chromosomal problems. Knowing this, people often say, “Miscarriage is God’s way of taking those children with serious birth defects.” This is both cruel and unhelpful. At a time like this, logic doesn’t help. It only raises more questions: “So why couldn’t God take this child before I found out I was pregnant?”

Other factors include uterine structural imperfections, environmental causes, infections, blood incompatibility, and immunologic problems. While a single pregnancy loss is more likely the result of chromosomal abnormality in the fetus, maternal factors are thought to trigger repeated losses. But in most cases, the specific reason remains unidentified. Nevertheless, it is extremely difficult to convince a woman who has lost a pregnancy that she could not have somehow prevented this tragedy.

What are the types of pregnancy loss? In the case of a biochemical pregnancy, the “pregnancy hormone” (hCG) is detectable in the blood. In a biochemical pregnancy loss, the pregnancy has ceased to develop in the early weeks. A so-called “blighted ovum” occurs when the placental portion of the embryo develops, but not the fetus. Using the term “blighted ovum” is both sexist and inaccurate, as it blames the female (ovum), when technically, once fertilized, it isn’t an “ovum” any longer. “Miscarriage” is a more appropriate label.

And the case of an ectopic or tubal pregnancy, the embryo implants in a fallopian tube or extra-uterine site, necessitating removal, if possible, before the tube ruptures. An ectopic pregnancy can be life-threatening to the mother, and is virtually always fatal to the child. There are the rare instances of implantation on the intestines (abdominal pregnancy) and occasionally a baby can make it, but this is very risky and highly unusual.

Unfortunately, it is currently impossible to take an embryo from the tube and “re-implant” it into the uterus. Well-meaning people who suggest prayer and waiting upon God to “see if the pregnancy will ‘migrate’” are misguided. This is the equivalent to telling someone with crushing substernal chest pain to pray and wait for the pain to move. If cholesterol plaques clog your arteries causing a heart attack, hopefully you rush to the emergency room for angioplasty or bypass. An ectopic pregnancy is just as dangerous to a mother’s life, and close medical observation is required. In addition, the embryos don’t move from the tube to the uterus.

Although seventy-five percent of miscarriages occur before the end of the twelfth week, they can occur at any time during the gestation period. Some couples experience added grief because they’ve believed the misconception that “once you get past the third month, you’re home free.”

Why do we feel so terrible about it? Depending on personality and background, each person’s response differs. Men and women in general have different feelings about these losses as well, with women tending to feel more of a bond with the lost child. The intensity of pain depends on a number of factors, the most significant of which is the psychological investment in the pregnancy. Often the longer couples have been trying to conceive, the greater their sense of loss.

According to one psychologist, the wave of grief often crests between three and nine months after the loss, although some report that it takes between 18 months to two years for the scars to heal. And the healing process can be disrupted by other life difficulties.

Those who have experienced failed IVF cycles, failed adoptions and the loss of one or more children in a multiple pregnancy have identified many of the same feelings as those who have miscarried.

If you are called upon to support someone who has just lost a pregnancy, the key here is not to be the “answer person,” but to provide time, empathy, patience, informed care, compassion, kindness and the encouragement to talk without trying to find solutions. Ethics here require the appreciation for the sanctity of life—respect for the life lost, concern for the pain, and the need for healing through community.

Curing The Baby Blues

Finding Ethical Solutions for Infertile Couples

by William Cutrer, MD, and Sandra Glahn, ThM

They’re the frozen unchosen. Children on ice. Frozen babies, if you will. A couple engages in a custody battle over their unused frozen embryos. Meanwhile some researchers want to destroy “extra” embryos in hopes of curing diseases. And while some infertile women pray for their eggs to fertilize in IVF cycles, others give permission to have their “excess” embryos destroyed. Bring up the topic of “infertility,” and invariably someone will mention these sorts of ethical quagmires—pulled straight from the headlines.

In the process of creating a child together, why are couples often so willing to enter such a complex maze of moral dilemmas? Because, simply put, infertility is hard stuff. God’s first command to Adam and Eve related to conceiving children, and most couples dream about their union producing a child who is the product of their love. Wrapped up in childlessness, then, are unfulfilled longings and the death of precious dreams. Ever since the Fall, after which God told Eve he would multiply her pain in conception and childbirth, we see problems with human reproduction. Researchers have determined that the depression and anxiety infertile couples experience are equivalent to the pain suffered by patients suffering from terminal illness. Proverbs 30:16 hints at this when it tells us that a “barren womb” is among four things on earth that are “never satisfied.”

What exactly is infertility? Defined medically, it’s the inability to conceive or carry a child to term after one year of unprotected intercourse. It has many causes, but the idea that “infertile couples just need to relax and they’ll get pregnant” is a myth. In ninety-five percent of cases, there’s a diagnosable medical reason. Fertility problems are as common in men as in women, and the number of couples appears to be on the rise due in part to delayed childbearing, sexually transmitted diseases, and environmental factors.

What Can Couples Do About It?

Some argue that infertility is a matter of “God closing the womb” (e.g., Sarah, Hannah), thus insisting that faith alone should be sufficient. Others believe that, while God is able to open and close wombs, He has permitted limited insight into the complex functioning of the human body. (Few would accuse doctors of “meddling” when they treat diabetes with insulin, infection with antibiotics, or cancer with chemotherapy.) Recognizing that approximately sixty percent of couples pursuing treatment will go on to experience live birth, those in favor of medical treatment argue that therapy is appropriate as long as no scriptural principle is violated. Admittedly, scriptural principles are sometimes violated, as is evidenced by the uproar about researchers using stem cells from destroyed embryos, mostly obtained from fertility clinics. So for couples believing that some medical treatment can fall within the will of God, the next question is this: how far can or should we go with such intervention?

Medication – Based on the premise that drug therapies qualify as moral, many treatment options qualify as “fertility enhancing.” A simple course of antibiotics can be “fertility treatment” for the man with a prostate infection. Replacement hormone may be a “fertility drug” for a woman with low thyroid. Yet when we talk of fertility drugs, we usually mean specific ovulation-inducing medications. These hormones may bypass built-in protective mechanisms, resulting in the maturation of multiple eggs. Careful monitoring with ultrasound can help avoid multiple births and some ethical dilemmas.

Surgical intervention – Diagnostic surgery can uncover hidden causes of infertility, and corrective surgery often helps. Surgeons may, for example, correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, surgery can reverse vasectomies or repair structural damage and varicose veins in the testicles.

High Tech Options – Many Bible-believing Christians approve the use of artificial insemination, in vitro fertilization, and other high tech procedures, provided the egg and sperm come from the married partners and precautions are taken to honor life even at the one-celled stage. Couples using in vitro fertilization should limit the number of eggs fertilized to the number of babies they are willing to carry to term. By doing so they avoid having to later decide both about the destruction of “excess” embryos and about “selective reduction” in cases where the pregnancy results in six or seven babies. Some couples opt for freezing embryos; others have reservations about cryopreservation, feeling that it exposes the embryo to unnecessary risk and that it presumes on the couple’s future. At the very least, couples cryopreserving embryos should have a plan for carrying each one to term.

Adoption – Pharaoh’s daughter adopted Moses. A family member adopted Esther when her parents died. God calls all those who believe in Christ his children through adoption. Thus, the Bible draws a beautiful picture of the adoption relationship.

Of the many losses in infertility, adoption is the solution for only one—the loss of the ability to parent the next generation. Successful “embryo adoption” brings with it the addition of the pregnancy, birth, and nursing experiences not possible in traditional adoption arrangements. Yet the genetic family traits of husband and wife are not passed down. While not a great option in an ideal world, embryo adoption does provide a solution for couples who have chosen to have embryos cryopreserved but who want to avoid authorizing their destruction. Consider the couple who had eight embryos created during an IVF cycle. Doctors implanted three in the wife’s uterus and froze five. After she had triplets, the wife had emergency surgery to remove her uterus. That left this couple with three choices—to allow embryo destruction, find a surrogate, or connect with someone willing to “adopt” them.

Embryo adoption is relatively new—developed because of the more than 100,000 frozen embryos in the U.S. alone. One Christian embryo adoption program works like a full-service adoption agency connecting couples wanting to carry these embryos with couples who have “extras.” At the moment this costs about $6,000. However, some Internet services charge less than $75/month for these couples to advertise and connect with each other.

Most experts encourage couples who pursue infertility treatment to exhaust medical options before pursuing adoption—whether traditional or with frozen embryos—as going through infertility and adoption require working through separate sets of losses. This is why so many infertile couples find it aggravating when others tell them, “You can always adopt.”

Infertile couples usually grieve deeply the loss of a jointly created child. For them, adoption will never fill this void. However, once they reach the “resolution” stage of their infertility, other options look more appealing. Only then can adoption become a wonderful means of seeing their dreams and longings come to life.

Additional Question/Answer about Infertility:

Do most infertile couples seek such high-tech treatment?

No. Approximately five percent of infertile couples seek reproductive technologies as a means of resolving their fertility problems. The number of Christian couples pursuing these treatments is probably significantly lower than that. Probably most of these passively resign themselves to the “will of God,” often hesitating to seek even the simplest forms of treatment.

Is it wrong to pursue medical treatment for a fertility problem?

Not necessarily. Beginning with the premise that producing offspring is good and moral—clear from God’s command to the first couple to “be fruitful and multiply” (Genesis 1:22)—couples begin by asking if any medical intervention is moral. Some argue that infertility is a matter of “God closing the womb” (Sarah, Hannah, etc.) and they go on to insist that faith alone should be sufficient in all areas of life.

Others believe that, while God is able to open and close wombs, He has permitted limited insight into the complex functioning of the human body. Recognizing that approximately ninety-five percent of infertility cases stem from diagnosable medical conditions and that approximately sixty percent of couples pursuing treatment will go on to experience live birth, they argue that medical therapy is appropriate as long as no one violates scriptural principles. We would say that in the same way we would support using antibiotics for infections and chemotherapy for cancers, we use medical intervention to cure fertility problems. One biblical support for this would be that Paul told Timothy to take wine for his stomach’s sake (1 Tim. 5:23).

What can be done with fertility drugs?

Specific ovulation-inducing medications constitute what most call “fertility drugs.” These hormones bypass built-in protective mechanisms, resulting in the maturation of multiple eggs. Drug therapy for the male has been less encouraging. But in those men helped by drug therapy, we find no additional risk of multiple pregnancies, as the human egg normally allows only one sperm to penetrate.

For couples believing medical treatment can fall within the will of God, the next question is this: how far can or should we go with such intervention and still honor the Lord?

Join us in the next column as we explore this question.

So What Is Cloning?

by William Cutrer, MD, and Sandra Glahn, ThM

First we had Dolly the sheep; then there was Dotcom the pig. Now we have a whole barnyard of clones. What’s next? A human being?

Clonaid says yes. It was probably a hoax, but other companies are seeking to do the same thing.

Has technology gone too far? To enter this discussion, we need to define a few terms. Two different processes have been described as “cloning” and we need to differentiate between them.

Cloning by Fission—This is the embryo “splitting” technique, or “artificial twinning.” When a fertilized egg begins to divide, every cell has totipotency—that is, any one of the cells in the embryo has the potential to develop into an entirely new individual.

When a split happens naturally at this stage, you get identical twins. This can be done and is being done in the laboratory now with humans. Solid Christian thinkers differ on whether they believe this violates the sanctity of life. Henceforth, we will call this “twinning,” not cloning. The development of such totipotent embryos carries with it both risks and benefits. Is the goal to replace people or body parts? Is it simply to have another child?

Cloning by Fusion— Start by taking the chromosomes from a non-germ cell. (A non-germ cell could be any of the 210 kinds of cells from an adult such as skin, hair, or blood.) Insert them into an egg (ovum) that has had the nucleus removed, and voila! You have a developing egg with all the chromosomes coming from another cell. All the “switches” that had been “turned off,” making it a specialized nucleus—such as a skin cell—suddenly got “turned back on” causing the reactivation of all the potential locked in the DNA.

How does this work? Well, take your Aunt Betty, for example. If we scratched a cell off the tip of her nose and inserted the nucleus into her egg, then transfer it to her own uterus, so could give birth to her own identical twin!

Using this process to clone adult cells (skin, hair) for medical treatment carries with it the possibility of growing skin for burn victims, liver cells to treat liver failure, and perhaps neural cells to combat diseases such as Alzheimer’s. The resulting technology might even allow patients such as Christopher Reeve to walk again.

Yet this cloning by fusion has some problems. First, it took 377 attempts to clone one Dolly the sheep (who lived six years before being euthanized on Valentine’s Day, 2003). To clone humans, scientists lose an enormous number of human embryos in the process.

Second, while we favor cloning adult cells (skin, hair, liver, neural) for medical treatment, cloning by fusion, when it involves embryo cells, creates a “dominion problem.” In Genesis 1:28-29 we read this:

“God blessed them and said to them, “Be fruitful and increase in number; fill the earth and subdue it. Rule over the fish of the sea and the birds of the air and over every living creature that moves on the ground.”

“Living creature” here refers to the plant, fish, and animal kingdoms, not other humans. When we overstep our God-given areas of dominion and begin taking human life—even at the one-cell stage—we violate the sanctity of life, autonomy, and other key ethical principles.

Those supporting fission (twinning) but not fusion (cloning) must carefully differentiate between the two, so researchers understand clearly what we support and oppose.

The plant and animal kingdoms appear to fall within our boundaries of “dominion.” We experiment on mice and plants, but not humans. So while cloning critters may seem a little bizarre, there’s nothing within most ethical systems that screams “violation” when scientists do so to help develop healthier, more disease-resistant plants or animals. Yet for those who believe human life is precious, even at the one-cell stage, the problem comes when researchers apply some areas of this science to human embryos.

Life Terms

Defining What We Mean

by William Cutrer, M.D. and Sandra Glahn, Th.M.

“When I use a word,” Humpty Dumpty said in a rather scornful tone, “it means just what I chose it to mean—nothing less, and nothing more.”

“The question is,” said Alice, “whether you can make words mean so many different things.”

—Alice Through the Looking Glass, Lewis Carroll

Alice tried to convince Humpty Dumpty that words have whatever meaning we assign to them, and it would appear that some modern researchers have followed suit. When talking about human embryos, confusion over precise terminology causes many disagreements among those concerned about current medical advances. However, if we value the sanctity of human life, we need to understand some terms so we can best articulate our position.

Embryo. In the Wonderland that is life, an embryo is the very early stage of human development. It is separate from the portion of the developing group of cells that become the placental or supportive tissue. After the sperm penetrates the egg and the chromosomes from the father and mother align in the egg, fertilization has occurred. In a natural cycle, this event takes place in one of the female’s fallopian tubes.

Pre-embryo. Many refer to the resultant living, growing tissue as a “pre-embryo,” because as this developing ball of cells grows, precisely which of the cells will become the baby and which will become the supporting, nutrient delivering structures is unknown. In fact, several of these early cells could die and the pregnancy can still proceed on the basis of the health of another cell.

Unfortunately, some crafty Alice-types, in an effort to get around those who oppose research on the human embryo, have “creatively” used the term “pre-embryo” to convince pro-lifers that life has not yet begun. However, that is not the case.

The earliest cells are believed to be “totipotential.” That is, each cell can generate all the tissues necessary for a baby’s development. How the one cell is “chosen” remains unclear. Yet while we can’t tell which cell will develop into the infant, it is not a problem for a sovereign God who “weaves us together in our mother’s womb” (Psa. 139). Clearly, no genetic material is added after this fertilization moment, and the cell from which all of the infant’s cells will derive exists within this cell mass.

Implantation. In approximately seven days, the growing collection of cells invades into the wall of the uterus (womb), an event technically called “implantation.” Some medical resources define this process as “conception”—a definition carried forward from the days before much was known about this complex and beautiful process. By current common usage, the term “conception” is often used interchangeably with fertilization, so it becomes critical that the words are clearly understood. Why? Because by the previous technical definition of “conception,” a woman could use a method of “contra-ception” that destroyed the growing mass of cells before the seven-day implantation event. To those who understand that all of life’s genetic machinery originates with the fertilization event, such an intervention—after fertilization but before implantation—would be an abortion, not a pregnancy-preventing method. The manufacture of the term “pre-embryo” further desensitizes individuals to the humanity and personhood of fertilized, dividing eggs created by assisted reproduction techniques. In this case, an embryo by another name is easier to destroy. Voilá! Alice has succeeded.

For some, the destiny of frozen (cryopreserved) embryos presents major ethical concerns. Using the term embryo to describe the tiny human being from its fertilization event, whether or not we can identify the precise cell of origin, gives proper significance to its presence. Decisions about the ethics of many of the available technological advancements hinge on understanding and communicating precisely using the unique vocabulary of the specialty.

Defining when life begins. One more thing—in cloning (by fusion, reference past article), there is no actual moment of “fertilization.” In this process egg and sperm are not joined, but rather the nucleus of one cell is inserted into an enucleated egg (that is, an egg with all its genetic material removed) and stimulated to grow. Thus, all the genetic material is extracted from and identical to the “donor” cell. The result would be a new individual with precisely the same genetic makeup as the donor—an “identical twin” perhaps ten, twenty, thirty years or more after the birth of the sibling.

If this type of cloning is possible with humans, as accomplished in sheep, pigs and cows, this new life would begin when the “genetic switches” were reactivated, making this first cell “toti-potential.” The twin would begin from this one cell stage. So in this case, it is unhelpful to say, “Life begins at fertilization.” Rather, it is important to clarify here that life begins at the moment when chromosomes are re-activated. (In this type of cloning, the chromosomes have aligned long ago, but have had portions deactivated.)

If we want to communicate our position, we need to clean up the murky looking-glass of terms to describe life at its tiniest stages so that our words reflect clearly what we mean to say.

Join us next time as we explore further the subject of cloning.

Raising Ethical Questions

Throw Out the Baby with the Bath Water?

by William Cutrer, MD, and Sandra Glahn

What do you think? True or false?

We should outlaw the suction tool used for performing abortions.
The abortion pill, RU486, should remain illegal in this country.
Genetic screening is unethical.

In each of these cases, we must distinguish actual evil from the potential for evil:

While doctors use the suction tool to perform abortions, they also use it for diagnostic and therapeutic dilation and curettage (D & C). It’s safer than the old metal curettes. So are we against the tool itself or the wrongful use of it?
The “abortion pill,” RU486, has potential for positive use in that it blocks progesterone production. RU486 might be helpful for treating some breast cancers. Are we opposed to RU486 itself, or do we oppose its use for elective abortions?
Some object to genetic screening because insurance companies have used the information to charge outrageous premiums for those found to be at risk for future illness. Do we oppose the screening or the wrongful use of this information by insurance companies?

In each of these cases, we need to consider a foundational guideline: Draw the fence around the evil itself, not around the potential for evil. As Augustine said, “The potential abuse of a thing does not preclude its use.” Many subcultures within the Christian community show a tendency to draw too wide a fence. Rather than oppose the immorality itself, they sometimes expand the moral limits to include anything that might “lead” to sin.

For example, some judge others for drinking because “it can lead to drunkenness.” They gloss over verses about Jesus turning water into wine and Paul’s suggestion that Timothy take wine for the sake of his stomach. In the West, we [usually]don’t use alcoholic beverages to treat disease, but we should consider parts of the world where painkillers and anesthetics remain unavailable.

The tendency to broaden the boundary of limitations—to be stricter than God—has been around since the beginning. According to the record we have, God never told Adam and Eve that they could not touch the fruit. Here’s what God said:

“You are free to eat from any tree in the garden; but you must not eat from the tree of the knowledge of good and evil, for when you eat of it you will surely die” (Genesis 2:16b–17).

Yet Eve says that God told them “don’t touch” (see Gen. 3:3). So as far back as the original first family, we see a drift toward widening the boundary of limitations while at the same time violating the actual limits.

When it comes to medical ethics, we must avoid doing the same thing. In each of the above cases, the tool, the medication, and the research are amoral. They can be used for bad purposes, but they also have potential beneficial uses.

Thus, when we hear the term “genetic engineering” or the “Genome project,” we must not immediately yell “nay!” envisioning a super race of designer babies or, at the opposite extreme, a race of people with the IQs of fish, designed to do menial tasks.

Developments from genetic research in the next few decades will probably relate to identifying and treating illnesses. This is a far cry from The Lost World. So while it’s always wise to consider the potential for extreme abuses before they happen, we must focus most of our energies on issues that currently confront care providers: How do we stop the existing excesses? How can we as a Christian community constructively provide direction, if not hard, fast answers for those seeking guidance? How do we view the technology? How do we view life? How can we bring the latter two together for the ultimate glory of our Creator God?

This was excerpted from our chapter in Genetic Engineering: A Christian Response

Defining Bio-Ethical Terms

Biobabble.edu

by William Cutrer, MD, and Sandra Glahn, ThM

Imagine yourself sitting on an ethics board of your local hospital. You face the task of making a recommendation in this situation:

The patient, a teenage young woman, has atypical leukemia. All the usual therapies have failed and she awaits a suitable match for bone marrow transplantation. None are available and her death is imminent.

Your options:

Remove a sample of the patient’s bone marrow, isolate her own stem cells, grow them in culture. Then destroy her own marrow and the cancer with chemotherapy and radiation, and inject her with her own “cloned” cells.
Derive a cloned cell line of matching marrow from banked adult stem cells, destroy her diseased marrow and blood lines, then transplant these “cloned cells.”
Derive a cloned cell line from fetal stem cells obtained through aborted fetuses.
Derive a cloned cell line from fetal stem cells obtained from a live born baby’s blood sample.
Inject the patient with a virus (viral vector) containing a corrective gene that will divide and conquer the cancer cells’ abnormal growth.

As you consider each of these options, how did you arrive at your opinion? What steps did you take mentally to come to the point of feeling that you could or could not recommend any or all of the choices? (At this writing, A is being done with some success; B is working for some specific types of cancers; with C—while researchers have obtained stem cells and clones, to date they have developed no successful treatments; D has been done by taking bone marrow from a baby and or/sibling, and culturing a cell line; E is still on the horizon.) Each offers some promise in the future and has been offered as possible solution to the life-threatening disease. Yet how do we determine the morality of each of these and other methods?

Initially, we will need to learn the for key vocabulary words of the ethicist, so we can converse intelligently in this arena.

These are the four key principles—the building blocks to ethical understanding and discussion:

Beneficence – Does it do good?
Nonmaleficence – Does it avoid doing harm?
Autonomy – Does it respect self determination— the patient’s right to decide for him- or herself?
Justice – Does it give what is right or due?
When you have an issue to consider, first “run it through” the grid of asking these four questions. Next, understand that these principles fall within three major systems—each of which have merit, and each of which can be viewed through a biblical world view.

Utilitarian Ethics – Does it do the most good for the most people?
Deontological Ethics—Does it conform to rule or law? In this case, does it violate God’s law?
Virtue-based Ethics—What would a person of virtue do in this situation?

If Virtue-based Ethics sounds a lot to you like “What would Jesus do?” you’ve got the right idea. And as long as we keep in mind the eternal perspective of God—that life extends beyond temporal existence, and suffering does not by definition end with mortal life—believers can contribute to the discussion using the Utilitarian Ethic.

As to Deontology, we have the word of God, and if God’s law declares something immoral, we have our ethical answer.

How then do we apply these principles and systems to the case in view? Were it now possible to clone bone marrow cells from the patient, from an adult, or from a fetus without sacrificing any life with the end goal of treating our test case, would it be ethical? Moral? Right?

Take Option A above and consider it in light of the four key principles. Then consider it through each of the three ethics systems. Do that with each option. What did you find?

Sorting Out Bioethics: Series Introduction

by William Cutrer, MD, and Sandra Glahn, ThM

Today the number of news stories focusing on bio-ethical topics has skyrocketed. We hear about cloning, test tube babies, stem cell research, euthanasia, the Human Genome project, and even biotech stocks on the NASDAQ; and people want to know more about the hows and the whys. In this column we will explore from a Christian worldview the ethics associated with these complex medical and ethical concepts. Our goal here is not to tell readers how to think because godly men and women sometimes arrive at different conclusions. Rather, our hope is to stimulate deep thinking and appropriate action. Having experience in both the theological/ethical and medical elements of the discussion, we have sought to present a balanced, non-alarmist perspective.

In each column we’ll look at dilemmas created by bleeding-edge developments in science and technology with a view to applying some biblically based morality. And we’ll explore how biotech stuff affects you, giving you the chance to ask questions so we can address what you want to know.

Does the birth control pill cause abortion?
What do you do when you find yourself at the bedside of a terminally ill patient? What if he or she asks for your help to end the struggle? If you agree, does it make a difference if your involvement is voluntary, involuntary or non-voluntary? That is, would you help facilitate the withdrawal of treatment or would you go so far as to encourage physician-assisted suicide?
Your friend finds out she’s pregnant after rape or incest and asks your advice. Or her doctor tells her that the baby has an abnormality. What will you do?
Are more people today infertile than in the past? Can Christian infertility patients work with in vitro clinics? If you respect life at the one-cell stage, what procedures can you use?
What about cloning? Can it be done, should it be done? Are there lines of experimentation that Christians can support?

In the process of exploring these issues, we’ll seek to demonstrate a Christian consensus in many key areas and learn to extend grace to others in cloudier issues. Ultimately, we will depend on God’s wisdom to guide us:

“If any of you lacks wisdom, let him ask of God who gives to everyone liberally” (James 1:5).

Although we will explore issues not specifically addressed in the Bible, we’ll frame our opinions through a scriptural grid. It’s the only way to walk the path of making informed, biblically based decisions at the edge of ethics in places where our generation is the first to go.

The Christian and Contraception: My Thoughts

My Tapestry post today: 

Because I coauthored The Contraception Guidebook (Zondervan/Christian Med. Assn), and contraception has been in the news lately, I have received some requests to add my two cents to the contraception conversation. It’s not my favorite topic, but I do have some opinions. And they are moderate, which tends to hack off those at both ends of the spectrum. But here goes.

·      Do I think contraception is of the devil? No. I think it is a gift from God. It can be abused, but that does not make it evil.  

·      Do I think all Christians who choose to use contraception lack trust in God? No.

·      Much oral contraceptive use is about something other than preventing babies. Ask any woman who is doubled over with cramps or has had a laparoscopy for endometriosis or has a serious acne problem or irregular periods. I went on the pill for a while after I lost my seventh pregnancy and then had an ectopic. I did so precisely because I held a high view of life—I didn’t want any more embryos to die in the tomb that was my uterus.

·      Does it bother me that Christians through the ages have generally opposed contraception? No. Some of the methods they opposed were downright unhygienic, and I would have opposed them, too. Does the Bible say anything on the subject? Not specifically. Yes, it says children are a gift from the Lord. But they are not the main gift or the only gift, and using contraception does not necessarily mean one is “refusing the gift.”

·      I see the purpose of marriage as oneness (“two shall become one”—see Genesis 1and Ephesians 5), not reproduction. Reproduction is a gift and a blessing, but not the end goal of marriage. If reproduction were the goal, I would expect to see Paul in 1 Corinthians 7 mentioning a focus on baby making in addition to what he says about sex meeting needs; and I would expect Song of Songs to have at least one reference to the potential for little Shulamites. But instead it's all about pleasure.

·      I think couples can choose to be childless without devaluing marriage or being out of God’s will. Just as some choose not to marry for the sake of the kingdom, people can determine that having children is not the best option for them, all things considered.

·      I think a lot of middle- and upper-class people lack compassion toward lower-class people on the issue of insurance coverage for contraception. Hormones usually require monitoring, and monitoring involves doctors. And doctors cost money. Not everyone has money.  

·      I think it’s offensive when men are the primary commentators on issues that primarily affect women for the same reason that women should not be the primary spokespersons for erectile dysfunction. The ones who have the periods, deal with the endometriosis and cramps, use the tampons and/or pads, take the pills, use the sponges or the Nuva rings…we should be the ones leading this conversation. I’m not at all suggesting men should not weigh in on the topic. But when men are the primary speakers here, they tend to have an instant credibility problem. This topic is one where we should see men and women partnering to speak.

·      When people do speak on the topic, they need to watch their rhetoric. Saying that women wanting insurance coverage for contraception are “helpless without Uncle Sugar coming in and providing for them a prescription each month for birth control because they cannot control their libido or their reproductive system without the help of government”—is offensive. I have taken the pill. I have wanted insurance to cover it. And I did not do either because my libido was out of control or I needed Uncle Sugar. I wanted insurance to cover it so I could afford to keep doing ministry. My insurance covered abortion. It seemed only fair, then, that it also cover meeting my pro-life reproductive needs as well.

·      I despise abortion.  Abortion rates go down when contraceptive use goes up. If we oppose baby-killing, it stands to reason that we should support preventing the creation of unwanted children. We are not enabling people. They are going to have sex, regardless, as the stats have shown. The question is whether they will also conceive. 

·      We should never assume that someone who uses contraception takes a low view of human life. In most cases of which I am aware, people use contraception because they have a high view. They want to avoid abortion, provide for their families, and give the children they do have their love and care. And such choices are not about devaluing life (or materialism, as some accuse).

·      Part of showing mercy to the poor or those less fortunate is helping impoverished people who wish to limit family size have the ability easily to do so.

·      I believe life begins at fertilization and that a zygote, being made in the image of God, is endowed with full rights of personhood. Doing unto others and speaking for those who can’t speak for themselves means defending the human who is too tiny and undeveloped to speak for him- or herself. It is far better to prevent the creation of an unwanted/unplanned pregnancy than to destroy one. The debate is not over when life begins. Even the secular medical books concede that human life begins when the DNA from male and female gametes align. The debate is over whether the fully human zygote is a person and thus has rights of personhood.

·      We cannot assert with confidence that the pill causes abortion. There are a lot of “more sure than right” dogmatic statements being thrown around about this. The same hormone required to make a woman ovulate is what prepares the uterine lining. So if breakthrough ovulation happens, the uterus is probably prepared—which explains why many of us have friends who conceived while on the pill and carried to term. My doctor friends tell me that if the uterine lining were improperly prepared in such cases, we would see a much higher incidence of “uterine attachment” issues with women who have conceived while on the pill. And we just don’t see that.

For my take on whether the pill causes abortion, see this post:   Aspire2 Blog: Does the Pill Cause Abortion?  And then this Tapestry post about pills and abortion. (The journal article a commenter referenced in the latter does not appear to exist.)

·      If Jesus is the TRUTH, we need to have higher standards of storytelling on this issue. But only if we want to be like him. (Sarcasm alert.)

·      Rhythm is actually an effective method when used diligently. (In countries where that’s the only viable option, it’s surprisingly more effective than in the USA.) But I still don’t really recommend it unless the couple is committed to “outercourse.” With the rhythm method, during the one time of the month when a woman typically experiences the most pleasure, intercourse is out. So if the couple is inactive at this time, she may live in a perpetual state of sexual frustration. Thus, it seems that the one method most Christians approve is the only one that expressly contradicts 1 Corinthians 7. Ironic.

·      What do I think about Plan B? It’s complicated. See this post:  Aspire2 Blog: Does Plan B Cause Abortion?

Humans made in the image of God have a responsibility to their Creator and their community to prayerfully seek wisdom about their family building options. Are you wrestling with questions about contraception in your own life? Pray with your spouse, committing your most intimate details to Christ. Do you need to show someone grace on this issue? We do find such a variety of people and opinions in God’s varied pattern book of people, don't we? "Be kind to one another, tenderhearted..." 

Contraception and Conscience

The subject of contraception has stayed in the center of the news this week. As well it deserved to.

It all started years ago with a mentality that went and still goes something like this: “You don’t like our morals? Hey —you don’t have to live by them. Go build your own hospitals and make your own rules.”

People spent millions on their religiously motivated hospitals, offering care as a practical application of a worldview that calls us to “do justice, love mercy and walk humbly with [our] God.” In Dallas denominational titles such as “Presbyterian” refer as much to major hospitals in the area as they do to churches.

But now some Christian-run hospitals hear, “Too bad. We’re going to impose our ethics on you and you have to abide by them, anyway. We’re going to force our morality on you, while insisting that no one can legislate morality (we use that line whenever your morals feel limiting to us)."

And the politicos are surprised at the pushback? Seriously?

If you know anything about the contraception book Icoauthored, you know I take a moderate position on the subject. And I’m disinclined to think the pill causes abortion—certainly not frequently.  I actually think a believer can in good conscience use contraception.

But I also believe in the legal right of those with more conservative views on the subject to operate within their own free consciences as they administer care. That should be a basic American value. I believe we call it religious liberty.

So the administration made concessions—necessary concessions that our liberties demand. They did right in making them.

But.

The whole issue raises a huge question that can’t go away with the concessions: You seriously considered it wise to trample on freedom of conscience for people seeking to “do good”?  As Peggy Noonan wrote in the Wall Street Journal, “If the church is forced to go against its conscience, religious liberty in America is not safe.

If religious liberty is not safe, you are not safe” That’s true across party lines. “Religious liberty should not be a partisan issue."

Amen, sister. A-a-amen!

Abortion and Sex-Selection

This morning's New York Times ran a powerful piece on the ramifications of abortion worldwide in terms of sex selection. Women across the globe abort daughters because more honor comes to them when they birth sons. And their ability to do that came largely from the West's influence and aid.

We cannot call this a male-against-female crime committed due to patriarchy. Women are as complicit as men. This is a powerful-against-powerless issue. The end result (so far) is that 160 females' lives have been extinguished. New ramifications: More kidnapping of females, sex trafficking, and prostitution.

Does the Pill = Abortion?

It's my day to blog over at the women's tapestry site. Today's entry is about whether the pill causes abortion. Is a person who takes the pill really murdering, as a Dallas-area leader recently claimed?

Does Plan B Cause Abortion?

On August 24 I wrote a piece about Plan B, which the FDA had just approved. Afterward, someone left this comment:

How do they (scientists) not know whether or not Plan B sheds or doesn’t shed the uterine wall? That seems like it would be simple to find out. If Plan B did in fact do this...would this change some of your opinions?

In my original entry, I quoted William Cutrer, M.D. He is a graduate of Dallas Seminary, has been an ob-gyn for about two decades, and has been on the front lines of the pro-life movement offering free obstetrical care to thousands of women at risk for abortion. He currently teaches at Southern Seminary in Louisville, Kentucky. I have asked him to respond to this reader’s question because it’s so important that we understand the medicine. Here is what he had to say:

Before we can talk about the ethics, we have to be on the same page about how Plan B works. That requires an understanding of some of the events in a woman’s menstrual cycle required for an embryo to implant. This is a complex synchrony, and many factors can alter the process. But we begin with some basics:

1. There can be no pregnancy without ovulation. No egg = no embryo.
2. For an egg to mature enough to ovulate, there must be the gradual increasing production of estrogen in the ovary.
3. The estrogen has two effects—it matures the egg and it grows the uterine lining.
4. Estrogen won’t happen without messenger hormone (FSH) from the pituitary gland being secreted appropriately for several days before ovulation.
5. Progesterone, named for its ability to support (pro) a pregnancy (gestation), begins to be secreted by the part of the ovary that ovulated. Ovulation followed by progesterone production can’t happen unless the pituitary gland releases a burst of another messenger hormone (Luteinizing hormone, or “LH”).
6. The estrogen grows and “thickens” the lining of the uterus during the run-up to ovulation, and the progesterone “sweetens” this thickened lining by increasing the glycogen (sugar stores) in those cells.
7. Once ovulation occurs, fertilization takes place in the fallopian tube. The growing embryo divides several times over the course of about three days before arriving in the uterus. It “floats” there for a few more days before beginning the process of implantation.
8. From the time of ovulation to implantation, progesterone has had a number of days to prepare the estrogen-thickened lining for the arrival of the embryo. In the treatment of infertility patients, including those at risk for miscarriage, we occasionally add natural progesterone to make sure the lining of the uterus is optimally favorable for an implantation.

Now, Plan B = progesterone. That’s all it is—just progesterone. Unlike combination oral contraceptive pills, which contain both estrogen and progesterone, Plan B contains only progesterone in a synthetic form.

One could anticipate that, if taken before the LH surge triggering ovulation, Plan B/progesterone would block the release of an egg, thus preventing fertilization. Once ovulation has occurred, it is doubtful that progesterone alone would a ) block the FSH thereby inhibiting secretion of estrogen (thus thinning the lining or, more accurately, preventing the thickening) or b) be enough, with only the two-dose, when withdrawn, to cause the uterus’s lining to slough off, as happens in a menstrual period.

The effect of Plan B on the ability of the embryo to travel as it needs to down the tube, on cervical mucus, and other potential factors has yet to be evaluated.

If Plan B were to be strong enough to cause “shedding of the endometrium,” we would see withdrawal bleeding a few days after taking the pills. But, if fertilization had already occurred, the ovary would still be making more progesterone in all likelihood, which is why there’s a clear “warning” in the packaging that comes with Plan B that says it does not work after implantation has begun.

So, the only ethical question remaining is this: Does Plan B have any significant effect as an abortifacient when taken during the time between ovulation and implantation? That remains a much tougher window to evaluate, particularly since the product is relatively new. Studies seem to suggest that it will prevent ovulation, but won’t prevent implantation of an embryo.

Consider recent research by members of the Population Council’s International Committee for Contraception Research (ICCR) and other scientists. It shows that “the most popular method of emergency contraception appears to work by interfering with ovulation, thus preventing fertilization, and not by disrupting events that occur after fertilization.” See
http://www.popcouncil.org/publications/popbriefs/pb11(2)_3.html

My personal feeling about Plan B is this: it’s acceptable in cases of rape/incest where ultrasound demonstrated that ovulation has not yet occurred. In such cases, Plan B could block the LH surge, preventing ovulation, and avoiding an unwanted pregnancy—not by destroying an existing embryo, but by blocking ovulation.

Otherwise, as sold over the counter, without any medical advice or evaluation, I would oppose its use, and do oppose its sale without prescription. My opinion is that this drug will be misused in many ways by people who don’t understand its mechanism of action, and it may result in more unwanted pregnancies and possible surgical abortions because people will use Plan B thinking it prevents every pregnancy regardless of when in the cycle the pills are taken.

Does the Pill Cause Abortion?

During a radio show, William Cutrer, M.D., and I discussed our book, The Contraception Guidebook. The interviewer quoted a source who said women taking the pill, which is supposed to prevent ovulation, have “breakthrough ovulation” about 50 percent of the time. I found another source on the web (after looking for fewer than two minutes) that put the number closer to 30 to 40 percent. Not surprisingly, the sources quoted in the research were old.

Before I go further, let me say I’m not a big fan of the pill. What I am a fan of is fairness in reporting. Truth. Honestly. That sort of thing.

So here goes.

Back when I was an infertility patient, we could tell how many babies I had the potential to conceive in a given cycle while taking fertility drugs. We knew this by means of a mid-cycle ultrasound. Every menstrual month around day 14, I’d go to the doctor’s office and I’d have a sonogram so we could take a look at the activity going on in my abdomen. If we saw two fluid-filled cysts, that meant two ova were maturing (there was one microscopic “egg” maturing in each). If we saw three, that meant possible triplets. If we saw four or more, hubby and I abstained. Just in case.

In a normal menstrual cycle, if a woman were to have a vaginal ultrasound, she and the operator would likely see one cyst. And they would assume there was a single egg maturing inside.

Here’s what gets interesting with the pill. Although sonograms confirm that women taking oral contraceptive pills sometimes do have such fluid-filled cysts present, that doesn’t necessarily mean an egg is inside nor does it mean that if it is, it gets released. Consider these findings:

. In 1996, twenty-four healthy female volunteers ages 20–34 with normal ovulatory cycles were included in a study to investigate the effect on inhibition of ovulation of an oral contraceptive. No escape ovulation was observed.

. In 1997, one hundred eighteen women at ten German centers participated in a study that measured the impact of two low-dose oral contraceptives and their ability to stop ovarian activity. No patients ovulated in any treatment cycle.

. In 2002, one hundred women were randomly assigned to receive varying oral contraceptives over a single treatment cycle. Breakthrough ovulation was observed in three subjects in one group. Only one of these escape ovulations was considered the result of treatment failure (the patients either forgot their pills or they took medications that reversed the pills’ effects).

. In a 2002 study, one hundred thirty women took oral contraceptives beginning on the third day. That’s three days later than recommended. And sure enough, these women had significantly more ovarian follicular development than women who take the pill as prescribed. Yet the postponement did not appear to increase actual ovulation rates.

Conclusion: The presence of follicles does not necessarily equal ovulation. Recent research demonstrates that breakthrough ovulation is a relatively rare event.