Upload
garey-fisher
View
217
Download
2
Embed Size (px)
Citation preview
Fertility in Women’s Health: Catholic Moral TeachingIntegritas Institute Bioethics Symposium
April 5, 2014Rebecca Davis Mathias, PhD
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
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)
Infertility Challenges
Moral teachings flow principally from the natural law, lex natualis, 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
Natural Law
From this source, the Church has derived its understanding of the nature of:
1. The human person2. Human acts3. The goals that shape human
activity
Ethical and Religious Directives for Catholic Health Care Services - Preamble
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.
Ethical and ReligiousDirectives - 38
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.
Ethical and ReligiousDirectives - 39
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.
Ethical and ReligiousDirectives - 40
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).
Ethical and ReligiousDirectives - 41
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).
Ethical and ReligiousDirectives - 43
3 Moral Considerations
1. There is a moral order2. This moral order can be
known3. What it means to be
human is the basis of this
moral order
Three Fonts of Morality
1. Act2. Intention3. Circumstances or
Consequences
Questions for Moral Decision-Making
1. ActWhat?
2. IntentionWhy?
3. CircumstancesWho & to Whom? When? Where? How?
Foreseeable Consequences? Viable Alternatives?
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
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
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.
Humanae Vitae Prophesies that contraception would lead to:
1. Promiscuity2. Sexual diseases [STIs]3. Abortion4. Divorce 5. Increasing anti-life mentality and culture
Humanae Vitae § 7The question of humanprocreation cannot be limited to mere scientificanalysis
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
Caritas in Veritate (2009)
Blessed Pope John Paul II
Great defender of HV Provides a personalist
understanding of sexuality
Theology of the Body (1997) Familiaris Consortio (1981)
Promotes Natural Family Planning (NFP)
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
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. . .
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;
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.
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.
Conscience
For people have in theirhearts a law inscribed by God.
Their dignity lies inobserving this law,
and by it they will be judged.
Vatican Council II,Pastoral Constitution on the Church in the Modern World
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
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.
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.
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.
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
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
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 thephysician’s action directly interfering in that act
itself. None of these treatments replacesthe conjugal act, which alone is worthy of truly
responsible procreation.
Donum Vitae (no. 13)
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.
Donum Vitae (Introduction)
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
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
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
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)
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)
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
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
Science Empoweredby 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)
8. Implement the Plan
9. Follow Up
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
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, Dignitas Personae, 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
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.
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.
Resources