Presentation Transcript

1. Fertility in Women’s Health: Catholic Moral Teaching

   Integritas Institute Bioethics Symposium April 5, 2014 Rebecca Davis Mathias, PhD
2. Infertility Challenges Great burden for couples to bear Especially when they so deeply desire to have a child and live out their vocation to be open to life and welcome the gift of children from God Infertility treatment must respect God’s design for married love The Church, with sincere compassion and empathy . . . offers guidance and hope through her teachings
3. Infertility Challenges On how to understand and approach infertility in a way that reverences and protects the dignity of the human person and respects God’s divine plan for married love. The challenge is to diagnose and address problems so these bodies can function as they should – and there is no moral problem in doing this, any more than there is in other medical treatments to restore health. (Life Giving Love in an Age of Technology)
4. Natural Law Moral teachings flow principally from the natural law, lexnatualis, understood in the light of the revelation Christ has entrusted to his Church Natural law is a law written in the human heart, recognized by reason, a law distinct from the positive law of any State
5. Ethical and Religious Directives for Catholic Health Care Services - Preamble From this source, the Church has derived its understanding of the nature of: The human person Human acts The goals that shape human activity
6. Ethical and Religious Directives - 38 When the marital act of sexual intercourse is not able to attain its procreative purpose, assistance that does not separate the unitive and procreative ends of the act, and does not substitute for the marital act itself, may be used to help married couples conceive.
7. Ethical and Religious Directives - 39 Those techniques of assisted conception that respect the unitive and procreative meanings of sexual intercourse and do not involve the destruction of human embryos, or their deliberate generation in such numbers that it is clearly envisaged that all cannot implant and some are simply being used to maximize the chances of others implanting, may be used as therapies for infertility.
8. Ethical and Religious Directives - 40 Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.
9. Ethical and Religious Directives - 41 Homologous artificial fertilization (that is, any technique used to achieve conception using the gametes of the two spouses joined in marriage) is prohibited when it separates procreation from the marital act in its unitive significance (e.g., any technique used to achieve extracorporeal conception).
10. Ethical and Religious Directives - 43 A Catholic health care institution that provides treatment for infertility should offer not only technical assistance to infertile couples but also should help couples pursue other solutions (e.g., counseling, adoption).
11. 3 Moral Considerations There is a moral order This moral order can be known What it means to be human is the basis of this moral order
12. Three Fonts of Morality Act Intention Circumstances or Consequences
13. Questions for Moral Decision-Making Act What? Intention Why? Circumstances Who & to Whom? When? Where? How? Foreseeable Consequences? Viable Alternatives?
14. Humanae Vitae Pope Paul VI’s July 25, 1968 Official, magisterial teaching of the Catholic Church On the regulation of birth Issue ignited controversy Prior to Vatican II (1962 – 1965) Prominent Catholic theologians raised questions
15. Humanae Vitae Pope John XXII appointed a commission to study the subject It started with 6 men, mostly scientists Grew to over 60 members Including 4 women Dialogic for 3 years
16. Humanae Vitae At end of commission’s 3rd meeting in 1964, Pope Paul VI urged group to: Continue its deliberations, listen to the anxiety of so many souls, and work diligently without worrying about criticism or difficulties.
17. Humanae Vitae Prophesies that contraception would lead to: Promiscuity Sexual diseases [STIs] Abortion Divorce Increasing anti-life mentality and culture
18. Humanae Vitae § 7 The question of human procreation cannot be limited to mere scientific analysis
19. Caritas in Veritate(2009) The Church demonstrates a commitment to monitor and critique due respect for human dignity and human flourishing as technology progresses For example, in Caritas in Veritate Pope Benedict XVI advocates that the Church’s mission is primarily a moral and evangelical one and not a technical one of medicine or economics
20. Blessed Pope John Paul II Great defender of HV Provides a personalist understanding of sexuality Theology of the Body (1997)FamiliarisConsortio(1981) Promotes Natural Family Planning (NFP)
21. Blessed Pope John Paul II - NFP Fertility is offered to one’s partner and lovingly received Fully human - it allows for transcendence of desire through self-control in the service of a higher good Fully giving and open to acceptance of children
22. Science Betrayed If Not in the Service of Humans Blessed John Paul II claims that . . . Science and faith are not foreign to one another, but on the contrary, both need and reciprocally complement each other. . .
23. Blessed John Paul II We are now touching upon the autonomy of the sciences. Today the postulate of unlimited freedom in scientific research is often defended. In this regard, if on one hand [sic] it is necessary to recognize the right of the sciences to apply the methods of research that are proper to them;
24. Blessed John Paul II on the other, one cannot agree with the affirmation that the field of research itself is not subject to any limitations. The boundary is, precisely, the fundamental distinction between good and evil. This distinction takes place in [the person’s] conscience.
25. Conscience Deep within the conscience men and women discover a law which they have not laid upon themselves but which they must obey. Its voice, ever calling them to love and to do what is good and to avoid what is evil, tells them inwardly at the right moment: do this, shun that.
26. Conscience For people have in their hearts a law inscribed by God. Their dignity lies in observing this law, and by it they will be judged. Vatican Council II, Pastoral Constitution on the Church in the Modern World
27. Conscience The ability to reason or discern well the moral decisions we face in our every day living Practical wisdom – well-informed Process of determining right from wrong Not a magic voice in our heads
28. Humanae Vitae § 12 This doctrine, often set forth by the teaching authority, is founded upon the inseparable connection, willed by God, and which man cannot break on his own initiative, between the two meanings of the conjugal act: union and procreation.
29. Humanae Vitae § 12 For, by its intimate structure, the conjugal act, while most closely uniting the spouses, enables them to procreate new lives according to laws inscribed in the very being of man and woman.
30. Humanae Vitae § 12 It is by safeguarding these two essential aspects, union and procreation, that the conjugal act preserves in its fullness the sense of true mutual love and its ordination towards man’s most high calling to parenthood.
31. Donum Vitae (1987)Evangelium Vitae (1995)Dignitas Personae (2008) From the moment of fertilization, the new life is a human being with unconditional respect and moral rights Because the embryo must be treated as a person, it needs to be cared for as any other human being
32. Donum Vitae (1987)Evangelium Vitae (1995)Dignitas Personae (2008) Teachings allow for fertility medication to encourage ovulation (a source of many higher-order multiple births) Surgery to correct conditions like varicoceles and endometriosis Forbids procedures that substitute medical techniques for human intercourse
33. Donum Vitae (no. 13) Certainly, techniques aimed at removing obstacles to natural fertilization, as for example, hormonal treatments for infertility, surgery for endometriosis, unblocking of fallopian tubes or their surgical repair, are licit. All these techniques may be considered authentic treatments because, once the problem causing the infertility has been resolved, the married couple is able to engage in conjugal acts resulting in procreation, without the physician’s action directly interfering in that act itself. None of these treatments replaces the conjugal act, which alone is worthy of truly responsible procreation.
34. Donum Vitae (Introduction) No biologist or doctor can reasonably claim, by virtue of his scientific competence, to be able to decide on people's origin and destiny. This norm must be applied in a particular way in the field of sexuality and procreation, in which man and woman actualize the fundamental values of love and life.
35. Best Options? Pope Paul VI Institute - Omaha, NE Founded by Thomas W. Hilgers in 1985 Trains physicians to treat infertility in harmony with church teachings Adoption ? Infertility is not a problem to overcome, but can be an opportunity
36. Best Options? Embryonic stem cell research opposition is clearly prohibited Often relies on “left over” embryos from IVF Hormonal treatment with certain drugs have side-effects http://www.ivpcare.com/patient/Pharmacy/products/prod_inf.asp?gclid=CLetqoWk3J0CFRYhDQodXDqeMQ
37. Best Options? Use of perforated condom to circumvent hypospadias LTOT – Low Tubal Ovum Transfer Moving sperm deposited in the vagina, uterus, fallopian tube Temporary removal of sperm or ova to “wash” or “capacitate” for relocation in the fallopian tube
38. Best Options? Accumulating sperm from a series of marital acts and introducing them into the wife’s vagina Sperm is conserved, concentrated and placed in wife’s generative tract in association with marital act SIFT (Sperm Intrafallopian Tube Transfer GIFT (Gamete Intrafallopian Tube Transfer)
39. Best Options? Some Catholic moral theologians like McCarthy, Griese, Cataldo, and Carlson defend GIFT Other Catholic moral theologians like Doerfler, Seifert, Demarco, Tonti-Filipini, Griesz, May and Ashley-O’Rourke are against it TOTS (Tubal Ovum Transfer with Sperm)
40. Reproductive Technologies Eventual success rate is roughly 50 – 70 % for all women Up to 86% for women under 35 Church documents highlight GIFT or ZIFT (Zygote Intrafallopian Transfer) Rarely used due to medical inferiority Reproductive Cycle can be $12,400
41. Protection of Couple’s Health and Safety People who seek fertility treatment often feel vulnerable Goal = protect health and safety of individuals Ensuring reproductive techniques are safe and affordable Able to make informed decisions
42. Science Empowered by Love? Morality - challenge about what is most deeply human and choices which are either life- enhancing or life-diminishing Dignitatis Personae offers reasoned argument in support for the culture of modern science as “an invaluable service to the integral good of life and dignity of every human being.” (nos. 3 & 37)
43. 9. Follow Up 8. Implement the Plan
44. Resources: Natural Family Planning http://www.irh.org/nfp.htm http://nfpandmore.org/nfphowto.shtml http://www.billings-centre.ab.ca/general/index.html http://familydoctor.org/online/famdocen/home/women/contraceptive/126.html
45. Resources US Conference of Catholic Bishops, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/resources/infertility.cfm Paul VI, Humanae Vitae, no. 8, http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html Congregation for the Doctrine of the Faith, DignitasPersonae, nos. 6 and 9, http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html US Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 5th Ed., http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf
46. Resources Congregation for the Doctrine of the Faith, Donum Vitae, (February 22, 1987), http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html. “Reproductive Technologies,” Natural Family Planning Program, United Stated Conference of Catholic Bishops, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/catholic-teaching/upload/Reproductive-technologies.pdf.
47. Resources Benedict XV1, Caritas in Veritate, http://www.vatican.va/holy_father/benedict_xvi/encyclicals/documents/hf_ben-xvi_enc_20090629_caritas-in-veritate_en.html Health Ethics Guide, (Ottawa, ON: Catholic Health Association), 2000, 81. John Paul II, Evangelium Vitae (March 25, 1995), http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae_en.html, nos. 18-20, 44-45.