Foundations: No.67 Autumn 2014

The Ethics of IVF

Many contemporary Christian ethicists acknowledge the threat of artificial conception to the moral law but conclude that it may be used legitimately for a married couple where only one or two embryos, derived from them, are created and implanted at each attempt. This paper challenges such conclusions by highlighting several threats to the moral law even in such an “acceptable” context. These include transgression of the Sixth and Seventh Commandments in the threat posed respectively to the early life of the embryo, and to the integrity of one aspect (procreative union) of the “one fleshness” of marriage.

Introduction

The cover of the November 1982 issue of Life magazine showed a photograph of one Elizabeth Jordan Carr sitting on the laboratory bench on which she began her life, in front of the microscope under which her conception was supervised and holding the petri dish in which she was conceived.[1] Elizabeth was the first child in the US to result from the technique of In Vitro Fertilisation (IVF), born three years after the world’s first IVF child, Louise Brown, in England.

We have since become accustomed to the consequences of this technological feat. There are now an estimated 5 million IVF babies in the world. Yet such an image may help to shock us into realising the enormity of the revolution that has occurred. For the first time in the history of mankind, fertilisation can take place outside the mother’s womb. To this point in history, with the exception of Adam, Eve and the Lord Jesus Christ,[2] there had only been one route to the creation of life – through sexual intimacy. In developing IVF, man has departed from God’s original design by inventing a new means that requires neither sexual intimacy nor even the presence of the mother and father for the formation of new life.

The science of artificial conception[3]

A woman is given hormone stimulation so that she produces several eggs (rather than the usual solitary egg each menstrual cycle), which are then collected by a laparoscope (a slim microscope inserted into the abdomen). In the laboratory the eggs are then incubated with sperm in a special biochemical environment and fertilisation occurs after some hours, with the formation of one or more embryos. This process is monitored by technicians through a microscope. Over the next three to five days the embryo(s) divide(s) into a bundle of over 50 cells. One or more of these are selected for insertion into the carrying mother’s womb, where they subsequently implant if pregnancy is to proceed.

Another technique of intracytoplasmic sperm transfer (ICST) permits the injection of the genetic material of a sperm into the egg, enabling fertilisation in circumstances where the usual process of sperm/egg union in fertilisation is not possible.

Not all attempts at IVF are successful. Currently, success rates vary between 15-40% per cycle, depending on the age of the woman and the cause of infertility.[4] Various approaches have been used to increase success, since the emotional and financial pressures to maximise the success rate are considerable. One approach is to fertilise several embryos and select, using various physical qualities, the most “healthy” embryo for implantation. Another approach is to implant several embryos at a time, assuming that not all will survive. Whilst the latter procedure has increased success rates, it has also increased the number of multiple pregnancies, which themselves pose a health risk to fetuses. Because of the risk of multiple pregnancies, current UK guidance recommends that a maximum of only two embryos are inserted into the mother’s womb in any one cycle.

It is now possible to store embryos (as well as sperm and eggs) in sub-zero conditions either by freezing, or by means of the newer technique of vitrification.[5] Such storage techniques, however, pose a risk to the survival of the embryo.

This paper primarily focuses on the ethical issues related to IVF and ICST, although many of these issues are also relevant to other applications of these technologies.

Current legal regulation in the UK

In the UK an “independent” organisation called the Human Fertilisation and Embryology Authority (HFEA) is responsible for regulating and supervising the use of reproductive technologies in all fertility clinics and research laboratories. It regulates the terms under which artificial conception may be offered, including to whom and the nature of consent that is required. The law places limitations on what procedures may be performed on the embryo that is to be implanted, although several of these limitations have been eased during the last two decades.

Current UK law allows research on human embryos, with consent of the egg and sperm donor, up to the age of fourteen days, at which time the embryo must be destroyed. It is, therefore, legal to create embryos purely for the purposes of research. Since 2008 it has also been legal to form human/animal hybrid “embryos” for experimental use.

A review of the HFEA website (www.hfea.gov.uk/) shows the extra-ordinary diversity and complexity of the regulations that have been drawn up in response to this new technology.

The provision and outworking of artificial conception

The most obvious demand for artificial conception has come from infertile couples. Rates of infertility have been rising in recent years and this has coincided with increasing demand.[6] Perhaps chief among the reasons for these changes has been the later age at which couples are seeking to have children.[7] This delay has been described as “the compression of reproductive careers”.[8] The terminology is revealing – women are tending to spend the early part of their adult lives, when they are most fertile, in higher education and in advancing their career in the workplace. When they subsequently wish to start a family, they may discover that they are unable to. Another contribution to infertility is the rising levels of blockage of the female reproductive tract following a sexually-transmitted disease.

Over the years, the uses of artificial conception have steadily widened from the initial remit of providing a child for an infertile heterosexual couple to include the following: to allow homosexual couples to raise children; to have a child, by embryo selection, free of certain genetic conditions; and to have a child with the primary intention of having him/her donate tissues to treat a sibling with a genetic abnormality (known colloquially as creating a “saviour” sibling).

In the UK over 200,000 children have been born following artificial conception. This has been accompanied by a profligate use of human embryos;[9] on average, for every baby born by IVF in the UK, over 17 embryos have been created.[10] In more detail, there have been a total of over 3.5 million embryos created, of which 1.4 million have been implanted and 1.7 million have been disposed of unused. Nearly 840,000 have been stored for future implantation, with nearly 5,900 set aside for scientific research and more than 2,000 for donation.[11]

Ethical assumptions of this paper

Scope of Sixth Commandment – life to be protected from conception

Scripture repeatedly declares the creative activity of God from the moment of conception and recognises that life in the womb is a precious gift from God. Psalm 51:5 (“Behold, I was brought forth in iniquity, and in sin my mother conceived me”) describes both David’s life and his sinful nature from conception (and, of course, David had to be alive to possess a sinful nature). Psalm 139:13-16 beautifully and movingly describes God’s involvement in the growth and development of the unborn child from his earliest days. Though small and vulnerable, each human embryo is made in God’s image and is of inestimable value. The Sixth Commandment “requires all lawful endeavours to preserve our own life, and the life of others”.[12] Those to whom these microscopic lives are entrusted ought to carry out their role with fear and trembling, especially when considering the embryo’s vulnerability. Each of their charges is precious in the sight of God, who will demand an account of their care.

The value of life is in no way affected by the context of conception – even when it involves the most blatant sin. God is more than able to bring good out of our errors. It is notable that several of Christ’s ancestors, including Perez and Solomon, would not have been conceived without a clear transgression of God’s laws. Yet God chose to bless their family line and, in so doing, has shown his willingness to use the sins of man for the glorious service of his kingdom.

Scope of Seventh Commandment – sexual union limited to (heterosexual) marriage

The Bible applies the requirements of the Seventh Commandment beyond the strict definition of adultery to include the forbidding of all pre-marital and homosexual relations (1 Cor 6:9) as well as adultery of the heart (Matt 5:27). Thus the commandment forbids many family contexts in which artificial conception is currently offered.

In various ways, reproductive technologies (as well as artificial insemination by donor) facilitate the bearing of progeny who are biologically unrelated to a husband or wife. A married couple “become one flesh” (Gen 2:24), not only in sexual union but also in the consequent genetic or procreative union enacted in the formation of their progeny. The Seventh Commandment has been given to man to protect the integrity, both sexual and procreative, of a marriage. From this we may conclude that the Seventh Commandment proscribes the use of non-spouse sperm or egg, because it constitutes a breach of the marriage’s procreative integrity.

Further discussion on the extent of the Seventh Commandment occurs later in the paper.

Authority and sufficiency of scripture to solve new ethical questions

Christians can be confident that, though technology has raised many new moral questions, “all scripture is given… for instruction in righteousness that the man of God may be complete, thoroughly equipped for every good work” (2 Tim 3:16-17). God knows every fresh ethical dilemma “from everlasting to everlasting” (Ps 90:2). He also knows the direction of the heart of natural man in opposing his commandments. God grants progressive revelation to his church as they “search the scriptures” (Acts 17:11) to discover his will even when the circumstances seem intimidatingly novel and complex.

God’s wisdom in natural conception

God’s original design for conception reflects his character. As with all that he has created, the design is good (Ps 104:28), great and wise (Ps 111:2). It is also holy, being designed and given by God and defined by his holy laws.

The design of natural conception is full of his wisdom in both its process and purpose. Though beyond our full comprehension (Ps 145:3), God has allowed us to glimpse the “fringes of his ways” (Job 26:4). Over the last few decades science has revealed many wonders of the secret place of the mother’s womb (Ps 139:15), which were formerly as inaccessible as “the lowest parts of the earth” (Ps 139:15). What we have learnt should fill us with grateful awe, as we discover how life forms from the husband and wife and then grows after fertilisation from the first single cell to maturity. The process is expertly governed by God’s biological laws[13] in such an orderly and effective way, out of sight and beyond our control. This process is neither haphazard, unconnected, isolated nor transient, but rather purpose-ful, integrated, relational and enduring.

To effect his perfect will, God has hedged in the perfections of his biological laws of conception (part of general revelation) with his moral laws (part of special revelation), which protect life (Sixth Commandment) and require sexual intimacy to occur within, and only within, the committed and secure relationship of marriage (Seventh Commandment). The jewel of his design of procreation has been placed firmly in the clasp of his moral law. And just as a jewel and clasp fit perfectly, we must note how closely the biological and moral laws relate to each other.

There are at least two reasons why we should anticipate such a close connection. First, both biological and moral laws have their origin in the same all-wise God, who created them to be enacted as a unit. Their interdependence will be clearly seen as we examine the ethics of reproductive technology. Secondly, God cares about the means as well as the end results. The moral law, as presented in the Decalogue, encompasses not only what we ought to do, but also how we ought to do it. For example, the Eighth Commandment, “You shall not steal”, defines how we should accumulate wealth rather than prohibiting its general acquisition. I shall examine the relevance of the how of the Seventh Commandment to artificial conception later.

When we consider the two interrelated expressions of God’s goodness in his biological and moral laws, we may expect blessing to ensue when both are respected. As a doctor, I am particularly aware of the goodness of his biological laws. When bodily function is enabled to work as God originally intended, without the interference of disease and decay, it cannot be improved upon. We can, likewise, expect blessing for a couple who subject their plans for conception to both aspects of his design, i.e. natural conception within a married relationship. Calvin reminds us that “our use of God’s gifts is never immoderate when it respects the purpose for which God made and intended them, since he made them to do us good, not harm”.[14] God has given the jewel its clasp in order to maintain and radiate its glory.

The central question of this paper is whether it is possible to deliberately turn our back on the wisdom of God manifest in natural procreation and still expect to receive God’s blessing. Since God’s blessing always and only accompanies obedience to his laws, we might more specifically ask whether it is possible to “re-master” the biological events (“laws”) of conception without breaking the moral law that define its use? Put another way, can the jewel of conception be modified without damaging the clasp of the moral law that holds it in place?

Is infertility a disease?

Though married couples may expect to receive God’s blessing through natural conception, what of those who are unable to do so? Specifically, does being unable to conceive according to God’s biological laws (i.e. suffering from infertility) justify the use of artificial conception? A doctor’s role is to restore a patient’s functioning to mimic as nearly as possible that which would have occurred had disease not intervened. The Christian paediatrician Dr John Wyatt helpfully likens the role of medicine to the attempts of a painting restorer who seeks to return a masterpiece to the painter’s original work.[15] If infertility is a disease, then is it legitimate to attempt to restore normality through medical intervention as is attempted in the management of other diseases? I will try to answer this question in two steps.

First, is infertility a disease? Infertility, like other physical disabilities, is not itself a specific disease but may be caused by a range of diseases including, for example, Fallopian tubes blocked from infection (obstructing access of the sperm to the egg) or damage to the ovaries from radiation. For some couples there is no obvious cause – but the medical assumption is that something is malfunctioning and doctors simply do not understand why. The Bible describes infertility, alongside disease, as an expression of his judgment on sin (e.g. Exodus 23:25-26), though its experience, as with disease, is not necessarily directly related to an individual’s spiritual state. Many godly couples in the Bible suffered the pain and disappointment of infertility, e.g. Abraham and Sarah, and Zacharias and Elizabeth. Infertility is, therefore, a manifestation of the fallen world. It would seem legitimate and compassionate to seek and provide traditional medical interventions for its relief, such as hormone support or opening up blocked tubes.

Second, is management of fertility by attempts at artificial conception a legitimate medical intervention? The treatment of disease can sometimes justify actions that could, with other motives, be sinful. A surgeon is, for example, allowed to cut a patient open, with his permission, to remove an inflammed appendix. The overall aim is to save life by restoring the body to as near normal function as possible. Sometimes a substitute for loss, for example an artificial limb or tooth filling, may be used with benefit. In achieving fertility for an infertile couple, could artificial conception be justified as a means of attaining as near-normal function as possible? If making love does not, for some, make babies, is it acceptable to use medical technology to enable an alternative means of conception? We must note, however, that this approach involves the creation of a person, not a lifeless material substitute. In doing so, we are no longer restoring a masterpiece but creating another in order to fulfil a couple’s desires. For this reason the process has entirely different ethical implications which need testing against the moral law, especially those aspects of the law concerning the protection of life, marriage and procreative unity.

Taking conception into our own hands

In our assessment of the legitimacy of artificial conception, we may learn from the response to infertility by Abraham and Sarah (Gen 16-21). The parallel to a contemporary infertile couple is limited but the account does help to establish certain principles. In the context of God’s promise of an heir, Abraham, in the face of advancing age, loses his trust in God’s power and providence. Rather than trusting that God’s promise would be fulfilled by legitimate means through this wife, Sarah, Abraham listens to his wife’s unwise solution by taking her servant Hagar as his wife, who bears him Ishmael. God then appears to Abraham and makes it clear that Abraham’s untrusting solution to the problem was not God’s, who subsequently provides a heir through Sarah. Though Abraham is charged with caring for both Hagar and Ishmael as family members, the means of Ishmael’s conception was clearly against God’s moral (though within his permissive) will.

From this we learn that:

• God may permit man to go against his moral will in the matter of conception.
• God expects man to be patient and trusting in the matter of fertility and to be wary of rushing into a human solution as a response. However, it would be false to conclude from this passage alone that pursuing an artificial means of conception is necessarily wrong in certain circumstances.
• Nevertheless, the resulting child is to be fully respected as one made in God’s image.

We should also note that, unlike Abraham and Sarah, most infertile couples are not blessed with God’s promise of future offspring and that many faithful couples have not been so rewarded.

The question is whether artificial conception, even for a married couple, might fall, as that of Ishmael’s, outside “the counsel of the Lord” (Ps 33:11).

The ethical stance of practitioners and legislators

It is informative to look briefly at the ethical perspectives of those involved in establishing the techniques and overseeing their application in society.

Robert Edwards, who, together with Patrick Steptoe, was responsible for the first IVF baby, experimented with human embryos for ten years before this landmark event. Sadly, therefore, he seems to have been no respecter of early life nor of God’s commandments, being dismissive of any impediment to his work “for vague religious or political reasons”.[16] Many contemporary practitioners of reproductive technologies would share his liberal attitude to experimentation with, and wastage of, human embryos.

Those appointed by Government to establish the legal boundaries under which such technologies would be practised expressed only muted concern about the potential for such activities to break God’s laws. The chair of the government committee, Dame Mary Warnock, wrote, “An absolute central consideration in the work of the committee… was the difference between what one might personally think was sensible, or even morally right, and what was most likely to be acceptable as a matter of public policy. Time and again, we found ourselves distinguishing, not between what would be right or wrong, but what would be acceptable or unacceptable.”[17] Clearly the unity of God’s laws in both public and private, and the remit of Government to legislate according to these laws was far from the mind of the committee, who were apparently willing to permit in law what they knew to be wrong. Fear of conflict was no doubt one consideration as Warnock explained, “The language of right and wrong was inflammatory… it sounded arrogant and provoked conflict.”[18]

The HFEA arose out of the work of the committee chaired by Dame Mary Warnock. The committee recognised that the techniques of artificial conception raised a plethora of ethical questions and challenges which never previously existed. In response the HFEA has drawn up a vast array of rules that seem to be based on pragmatism, perceived needs, a hunger for scientific progress and the “popular view”. These rules may be viewed on the HFEA website.[19] The complexity of the ethical challenges and the resultant rules is striking. Is such complexity perhaps a manifestation of a departure from the givens of the biological and moral laws that should govern normal conception?

Whilst acknowledging that such technologies have been practised by many scientists and doctors with a sincere desire to help infertile couples, it seems that the heady mixture of science and procreation has tempted man to burst God’s bonds of moral restraint (Ps 2:3). If normal conception ennobles man, might not artificial conception have tempted man to delusions of grandeur about his power and self-worth? How quickly man forgets that “It is he who made us and not we ourselves” when he denies that “the Lord, he is God” (Ps 100:3). Rather he is tempted to take on a God-like status as he starts to think that he has made others.

A common evangelical analysis

In contrast to government legislators and many practitioners in this field, evangelical ethicists have generally expressed wide-ranging concerns about aspects of artificial conception, which are discussed in some detail below. Their general conclusion is that, provided certain conditions are met, it is possible to provide IVF to a couple without breaking the moral law.[20] [21] [22]

The conditions deemed “acceptable” can be summarised as follows: the process should be limited to the fertilisation and implantation of one or two embryos so that there is no (or limited) threat to life through excess of embryos or multiple pregnancies, and the technique should only be offered to a married (heterosexual) couple who alone donate the egg and sperm from which the embryo is formed. Under such conditions, when new life is formed and marriage is blessed with children, IVF is seen to be positively upholding the Sixth and Seventh Commandments by affirming both the sanctity of life and the sanctity of marriage.

It is my contention that such conclusions mistakenly minimise the scope of the moral law. I will now analyse the practice of artificial conception in respect of the Third, Sixth and Seventh Commandments both when the technology is being used in a less restricted context (marked “liberal”), as is usual in most UK fertility clinics,and when it is being used in the more restricted context recommended by many Christian ethicists (marked “acceptable”).

The Sixth Commandment

(i) Research techniques (“liberal” and “acceptable” contexts)

The development of reproductive technology has required the use of experiments involving the intentional and routine destruction of the embryo. In this way, such a service today stands on the shoulders of those who have determinedly disobeyed God’s laws. IVF clinics continue to depend upon such experiments for refining their techniques.

Because of the need to break God’s laws in order to acquire this knowledge, we can be sure that the science of artificial conception involves man acquiring a “forbidden knowledge” – information concerning the growth and needs of the early embryo, which God intends that only he should know, and which has been wisely and kindly hidden from man until the development of IVF. In this regard, might not man be guilty of lifting up his heart in pride by concerning himself “with great matters” whose moral implications are “too profound” (Psalm 131:1,2)? If this be so, we cannot expect blessing to result from the continuing use of such knowledge to achieve similar ends.[23]

(ii) Current practice (“liberal” context only)

The natural process of conception frees the parents from the responsibility of selecting qualities in an embryo after conception. This reflects the principle of unconditional love of parents for their child, regardless of qualities and abilities. In contrast, most laboratories employ the technique of fertilising several embryos, selecting those to be implanted or stored and then destroying the remainder, in a process which seeks to favour the implantation of “healthy” embryos deemed to be more likely to progress successfully. Selective embryo destruction is also used in the process of “pre-implantation genetic diagnosis” (PGD) in which parents carrying a genetic abnormality seek to conceive a healthy child. Similar embryo selection based on genetics is employed in attempts to create a so-called “saviour” sibling, in which any embryo whose genetic material is of no help to his sibling is destroyed.

(iii) Current practice (“liberal” and “acceptable” contexts)

The natural method of conception helps to ensure that the mother’s body nurtures and protects the embryo between fertilisation and implantation. Though this protection can be breached due to abuse, disease or by deliberate violation (abortion), in normal circumstances this protection is effective.[24] In contrast, artificial conception allows man to take on a role previously undertaken by the God-controlled processes of the natural world. Just as, from the moment that man might gain control of the weather, he would have a moral responsibility for all famines and floods, so too, when man starts to feed, select, store and transport early life, he saddles himself with the new ethical burden of the embryo’s wellbeing.

All the routine laboratory procedures carry a definable risk to the embryo. The longer that the embryo is permitted to develop in the petri dish, the more likely the embryo is to die.[25] Survival rates after freezing and after the newer technique of vitrificaton vary between 52-95% and 53-98% respectively.[26] And we have much to learn about the potential hazards to early life in such an unnatural environment. For example, since fertilisation naturally occurs in the dark of the woman’s reproductive tract, there is a debate among scientists about whether visible light might harm the embryo. Even when no deliberate selective destruction is planned, artificial conception constantly exposes the embryo to the vulnerability of existence outside the womb. The most competent laboratories are not immune to errors in technique, accidental spills, mislabelling and power failures. There is no guarantee to the outcome of any stage of the process from fertilisation to implantation. Every attempt at artificial conception must, therefore, be considered as a trial of life for the embryo. Both parents and laboratory staff (to whom they delegate the duty of care) must jointly share in moral responsibility for the preservation of new life.

All of us take risks with our lives and those of others every day – e.g. each time we venture onto the roads. Yet even in relatively low risk circumstances, we must remember that we are required to make “all careful studies, and lawful endeavours, to preserve the life of ourselves and others”.[27] Therefore, it is right to minimise risks by driving carefully and wearing safety belts. There are circumstances when actions with a higher risk to life may be justified – e.g. when a doctor prescribes a medication with dangerous side effects in order to treat a patient with a life-threatening cancer. Here the high risk is justified because the outcome is likely to be life-saving rather than life-destroying. The overall motivation is, therefore, life-honouring. But the situation with IVF is quite different since there is no moral necessity to form life in the first instance.

And we now know that the risks to the life and health of the artificially conceived embryo continue long after implantation. They are at greater risk of intra-uterine death and long-term abnormality than those conceived by normal means.[28] There are several reasons for this: Multiple pregnancies, which pose a significant threat to the life and health of the offspring, are more likely to result from IVF, even though in recent years guidance encourages the placement of a maximum of two embryos in the womb. Another reason may be the less favourable uterine environment provided by some infertile women. In addition, those conceived artificially are more vulnerable to certain epigenetic conditions (caused by changes to gene function that cannot be accounted for simply by the DNA sequence). The reason for this is not clear, though the effects of the artificial embryo environment of the laboratory may contribute.

(iv) Young life as a commodity (“liberal” and “acceptable” contexts)

In contrast to the natural means of conception, the process of IVF, even in an “acceptable” context, places man in the deciding role at each step of the process – in choosing, for example, which clinic to use, when and how to proceed, how many cycle attempts to undergo and whether, if any, embryos might be stored for future use. This leads to the burden of numerous and weighty decisions. It also leads to the perception of the embryo as a commodity and a plan, rather than as a person and a heavenly gift. As O’Donovan points out, how easily we forget that, like the Lord Jesus, a child is “begotten not made”.[29] Such an attitude to conception tempts us to diminish the value of early life and so to break the Sixth Commandment.

The Seventh Commandment (“liberal” context only)

The most common transgression of this commandment is in “aiding and abetting” an immoral relationship when this technology is used to enable cohabiting couples to conceive. However, the offer of artificial conception is not restricted to heterosexual couples. Whereas natural processes ensure that a homosexual couple is infertile, artificial conception allows them to acquire a child through sperm donation and/or surrogacy. Whereas natural conception allows a woman to be sure that she conceives only from her husband’s sperm, artificial conception permits another man to be the sperm donor. There have been several well-publicised mix-ups with embryos, for example, when black twins were born to a white couple.[30] Whereas the natural method ensures that a child is carried by the same woman who conceived the child, reproductive technology allows up to three biological mothers – cellular, genetic, carrier – to which a fourth, the adoptive mother, may be added.[31]

The natural method of conception ensures a tight temporal and spacial association between intercourse, fertilisation and implantation. Artificial conception allows the long-term storage of sperm, eggs and embryos for future use or research, thereby loosening these associations. This raises a range of important ethical issues, including whether it is ever right to suspend an embryo’s life in storage with no guarantee of progress to maturity. Such storage also allows implantation to occur at a time when the mother has subsequently divorced and remarried or separated from the father. This has given rise to several legal cases where women have demanded the use of “their” embryos following the demise of a relationship with the embryo’s father.[32]

The Third and Seventh Commandments (“liberal” and “acceptable” contexts)

The most fundamental objection to artificial conception arises from the fact that any attempt to “remaster” the natural means of conception interacts with one of God’s holy ordinances (marriage) and one of God’s holy works (sexual union). God created them both and has bound them together with his holy laws. The Westminster Shorter Catechism describes the requirement of the Third Commandment as “the holy and reverend use of God’s names, titles, attributes, ordinances, word, and works” (italics added). Might we be guilty of offending God’s holiness by replacing his design of procreation with ours?

We may consider this possibility further by examining artificial conception in the light of the Seventh Commandment, which protects God’s holy ordinance of marriage by delineating the use of his holy “work” or design of sexual union. I have previously noted that God is concerned with how his moral law is applied. Both the how as well as with whom of “be-coming one flesh” needs to be considered. It is my contention that the breadth of this commandment includes both the sexual and procreative (genetic) dimensions of “one fleshness” in prescribing the how of both sexual intimacy and procreation.

This view is consistent with two other moral considerations of the Seventh Commandment. First, I have already argued that the with whom, as defined by this commandment, may be threatened even when sexual union has not occurred. This may happen when conception by a married woman results from non-husband sperm; the commandment is still breached, even in circumstances in which the need for sexual intercourse has been circumvented by the use of artificial insemination or in vitro fertilisation. Secondly, we need to recognise that theologians have long considered the how of sexual union to be defined by this commandment, for example, in the proscribing of anal intercourse, in both heterosexual or homosexual union. In the words of Augustine in the heterosexual context this constitutes the “use of a member of a woman not granted for this”.[33]

Might we then correctly apply the Seventh Commandment to define the how of procreative union, regardless of whether it has originated from sexual union? In many ways artificial conception rejects God’s wise design of procreative union, occurring distant from the mother in alien surroundings and achieved as a result of the actions of a team of individuals rather than by a husband with his wife. If such a conclusion be correct, there are profound implications for this area of applied science. All artificial conception would then be proscribed on this basis alone, regardless of any other consideration such as its threat to early life. (Such a conclusion would still leave open the possibility of other medical interventions to treat infertility such as hormone support or opening up blocked tubes.)

To conclude that only the natural means of conception is permissible would seem to conflict with the Dominion Mandate, which allows the application of technology for the good of man in line with an increase in his knowledge. Historically, an unbridled devotion to natural things, whether materials or processes, at the expense of technological progress, has been seen in the unbiblical perspective of the Romantic Movement. In this paper, however, the natural means of conception are not held up through any misplaced loyalty to the supremacy of natural events, but rather in the recognition that only in natural reproduction are God’s laws faithfully upheld. The freedom to use modern technology as an expression of the Dominion Mandate is never absolute. Man as vice-regent always needs to consider the will of his master. All technological progress needs to be tested against the moral law.

Conclusion: Artificial conception not legitimate

A desire to apply science to fulfil the longings of infertile couples to have children is a laudable aim. Yet we must be on guard lest strong and unfulfilled desires, or happy outcomes, lure us to pragmatic conclusions, in which due regard is not given to God’s moral law and in which the end may seem to justify the means. The Bible provides many examples of godly men who have fallen into this error, including the decidedly human initiative of Abraham with Hagar. Not everything that is possible is right to pursue, even when it seems quite able to fulfil our felt needs. It is for this reason that this paper has focussed neither on the suffering of infertility nor on the joy granted to those who have conceived through artificial means.

Many contemporary Christian ethicists acknowledge the threat of artificial conception to the moral law but conclude that it may be used legitimately for a married couple where only one or two embryos, derived from them, are created and implanted at each attempt. This paper challenges such conclusions by highlighting several threats to God’s commandments even in such an “acceptable” context, as follows:

• The development as well as the on-going refinement and provision of artificial conception has been and continues to be dependent upon the routine and deliberate destruction of early life and the application of forbidden knowledge gained by the development of reproductive techniques. In this way, artificial conception transgresses the Sixth Commandment.

• All attempts at artificial conception must be considered as a deliberate trial of life for the embryo. The moral responsibility for the survival of the embryo lies with both parents and clinic staff. The legitimacy of such a trial must be questioned because there is no absolute moral necessity for the embryo’s formation. The risks of such a trial include those associated with routine methods for enabling fertilisation, growth, implantation and, if attempted, long term storage of the embryo. In this way also, artificial conception transgresses the Sixth Commandment.

• Artificial conception threatens the integrity of one of God’s holy ordinances (marriage) and one of God’s holy works (sexual union). In disrupting the natural means of conception, it threatens procreative union, which is one aspect of the “one fleshness” of marriage; for this reason, artificial conception may been considered to transgress both the Third and Seventh Commandments.

For these reasons, I conclude that it is not possible to “re-master” the biological events of conception without breaking the moral law and, therefore, artificial conception cannot be recommended as a legitimate practice.