Article: Homologous Intrauterine Insemination: Does It Replace the Marriage Act?
WASHINGTON, D.C., SEPT. 22, 2010 (Zenit.org).- Here is a question on bioethics asked by a ZENIT reader and answered by the fellows of the Culture of Life Foundation.
Q: Could you tell us the state of Church teachings on homologous intrauterine insemination between spouses, using a seminal reservoir to obtain the semen? -- J.A.A. of Santiago de Chile
William E. May offers the following response:
I presume that by "homologous intrauterine insemination," J.A.A. is referring to the procedure known as GIFT, an acronym that stands for "gamete intrafallopian tube transfer."
What is GIFT?
GIFT can be described as follows: It is like in vitro fertilization (IVF) in that the woman's ovaries are hyperstimulated to produce many eggs, which are retrieved either by laparoscopy or an ultrasound guided procedure. It is unlike IVF in that the fertilization of the eggs occurs not outside the woman's body but within it.
After the egg or eggs are retrieved, they are placed in a catheter with sperm, with an air bubble separating the sperm and egg(s). Sperm is provided either by masturbation or by using a perforated condom during previous marital acts. The catheter is then inserted into the woman's body (and she can be either a person other than the wife of the man whose sperm are used -- heterologous form of GIFT -- or be his wife -- homologous GIFT); the ovum or ova and sperm are released from the catheter and fertilization and conception can then take place within the woman's body. This is caused by the concentrate of sperm placed in the catheter and released after its insertion into her body, or perhaps by sperm released into her body by the marital act in association with which the catheter is inserted.[1]
It is important to note that the procedure was originally developed by Dr. Ricardo Asch and his associates at the University of Health Science Center in Houston, Texas, as an offshoot of IVF, and the husband's sperm was collected by masturbation. Informed that the Catholic Church condemns masturbation, even as a way of obtaining a husband's sperm, Asch and other doctors who used the method suggested that sperm be obtained by using a perforated condom during the marital act.[2]
Magisterial teaching
There is no definitive teaching of the magisterium on GIFT as such. "Donum Vitae" (Instruction on Respect for Human Life in its Origins and on the Dignity of Procreation), Part II, B, No. 6, states: "If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit."[3]
The issue, then, is whether GIFT, if the eggs (ova) used are those of the wife of the man whose sperm will be used for fertilization (homologous intrauterine insemination), "assists" or "replaces" the conjugal act.
Different and opposing theological opinions
Some theologians regard it as legitimate, a way of "facilitating or "assisting" the conjugal act to achieve its procreative purpose; others reject it as immoral because it does not "facilitate" or "assist" the conjugal act, but rather "replaces" or "substitutes" for it.
Arguments for GIFT
Two representative proponents of this position are the Rev. Donald G. McCarthy; and Peter Cataldo.
McCarthy argues as follows: "The conjugal act in the described procedure remains the essential step in getting the ovum and sperm to meet. This step is followed by the repositioning of the ovum and sperm in a manner which markedly increases the likelihood of fertilization. Hence, GIFT ... can be seen as a medical procedure which assists, rather than replaces, the conjugal act. ... In conclusion, while the GIFT technique uses technology to assist fertilization, it simply re- positions the sperm and ova to enhance the desired outcome of fertilization. The link between the marital act and procreation is realized by technical assistance."[4]
Cataldo offers a more extensive defense of GIFT as morally acceptable because it assists or facilitates the marital act in achieving its goal of generating new human life. He writes as follows: "A procedure replaces the conjugal act if it determines, of itself, those conditions which immediately secure the success of fertilization; a procedure assists the conjugal act if it does not determine, of itself, those conditions which immediately secure the success of fertilization, but rather allows fertilization to take place under immediate conditions which are natural."[5]
Using this criterion, Cataldo argues that GIFT is a morally legitimate procedure: "I believe that GIFT with a conjugal act assists that act because the immediate conditions of fertilization are not determined or created by the procedure itself. Unlike IVF and the other procedures which replace the conjugal act, fertilization itself takes place in GIFT within natural conditions which are essentially the same as those in which a pathology is not present."[6]
Arguments against GIFT
This is the position defended by Germain Grisez,[7] Donald DeMarco,[8] Benedict Ashley, OP, and Kevin O'Rourke,[9] and me.[10] Here I present their basic argument: First of all, the procedure was originally developed as a variant of IVF and the husband's sperm was collected by masturbation. Informed that the Catholic Church condemns masturbation, even as a way of obtaining a husband's sperm, the doctors [Asch and others as noted already] who used the method suggested that sperm be obtained by using a perforated condom during the marital act.
This shows, I think, that with GIFT the marital act is merely incidental to the entire procedure, used only as a way of obtaining sperm in a nonmasturbatory way. Since the sperm have been deliberately, intentionally withheld from a marital act or series of marital acts, they cannot be said truly to be integral to the marital act when the catheter containing these sperm and the wife's ovum are inserted into her body. Although subsequent fertilization of her ovum may be caused by sperm introduced into her body during the accompanying marital act, such fertilization would be per accidens and not per se.
Conclusion
Here I have done my best to present accurately the contradictory positions of different theologians for and against GIFT. Either that which is defended by people like McCarthy and Cataldo is true, or that which is defended by Grisez, De Marco, Ashley/O'Rourke and me is true, but both cannot be; one must be true, the other false. Readers should study their arguments and evidence they advance to support them and make up their own minds as to which views make more sense.
Notes
[1] See David S. McLaughlin, "A Scientific Introduction to Reproductive Technologies," in Reproductive Technologies, Marriage, and the Church, ed. Rev. Donald G. McCarthy (Braintree, MA: The Pope John XXIII Medical Moral Center, 1988), pp. 55-56. See also John M. Haas, president of National Catholic Bioethics Center, "Begotten, not Made: A Catholic View of Reproductive Technology," http://www.usccb.org/prolife/programs/rlp/98rlphaa.shtml.
[2] On this see Rev. Donald G. McCarthy, "Catholic Medical Teaching and TOT/GIFT: Response: A Response to Donald DeMarco," in McCarthy (ed.), Reproductive Technologies, Marriage and the Church (St. Louis: Pope John XXIII Medical Moral Center, 1988) p. 144.
[3] The 2008 Congregation for the Doctrine of the Faith Dignitas Personae, a sequel to Donum Vitae, does not consider the morality of GIFT. The 2009 edition (5th edition) of Ethical Directives for Catholic Health Care Services, directive No. 38, declares: "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".
[4] GIFT? Yes! Ethics & Medics 18/9 (Sept. 1993): 3-4 at 4.
[5] "Reproductive Technologies," Ethics & Medics 21/1 (Jan. 1996): 1-3 at 2.
[6] Ibid.
[7] See Grisez's Difficult Moral Questions, Vol. 3 of his The Way of the Lord Jesus, Question 52, pp. 242-249 (originally published by Franciscan Herald Press, 1997; reprinted 2007 Alba House).
[8] See DeMarco, "Catholic Moral Teaching and TOT/GIFT," in Reproductive Technologies. (see footnote 2 above), pp. 47-49.
[9] See the 4th edition of their Health Care Ethics (Washington, D.C. Georgetown University Press, 2002), pp. 47-49.
[10] See my Catholic Bioethics and the Gift of Human Life (Second Ed. Huntington, IN: Our Sunday Visitor, 2008), p. 93.
* * *
William E. May, is a Senior Fellow at the Culture of Life Foundation and retired Michael J. McGivney Professor of Moral Theology at the John Paul II Institute for Studies on Marriage and Family at The Catholic University of America in Washington, D.C.
Q: Could you tell us the state of Church teachings on homologous intrauterine insemination between spouses, using a seminal reservoir to obtain the semen? -- J.A.A. of Santiago de Chile
William E. May offers the following response:
I presume that by "homologous intrauterine insemination," J.A.A. is referring to the procedure known as GIFT, an acronym that stands for "gamete intrafallopian tube transfer."
What is GIFT?
GIFT can be described as follows: It is like in vitro fertilization (IVF) in that the woman's ovaries are hyperstimulated to produce many eggs, which are retrieved either by laparoscopy or an ultrasound guided procedure. It is unlike IVF in that the fertilization of the eggs occurs not outside the woman's body but within it.
After the egg or eggs are retrieved, they are placed in a catheter with sperm, with an air bubble separating the sperm and egg(s). Sperm is provided either by masturbation or by using a perforated condom during previous marital acts. The catheter is then inserted into the woman's body (and she can be either a person other than the wife of the man whose sperm are used -- heterologous form of GIFT -- or be his wife -- homologous GIFT); the ovum or ova and sperm are released from the catheter and fertilization and conception can then take place within the woman's body. This is caused by the concentrate of sperm placed in the catheter and released after its insertion into her body, or perhaps by sperm released into her body by the marital act in association with which the catheter is inserted.[1]
It is important to note that the procedure was originally developed by Dr. Ricardo Asch and his associates at the University of Health Science Center in Houston, Texas, as an offshoot of IVF, and the husband's sperm was collected by masturbation. Informed that the Catholic Church condemns masturbation, even as a way of obtaining a husband's sperm, Asch and other doctors who used the method suggested that sperm be obtained by using a perforated condom during the marital act.[2]
Magisterial teaching
There is no definitive teaching of the magisterium on GIFT as such. "Donum Vitae" (Instruction on Respect for Human Life in its Origins and on the Dignity of Procreation), Part II, B, No. 6, states: "If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit."[3]
The issue, then, is whether GIFT, if the eggs (ova) used are those of the wife of the man whose sperm will be used for fertilization (homologous intrauterine insemination), "assists" or "replaces" the conjugal act.
Different and opposing theological opinions
Some theologians regard it as legitimate, a way of "facilitating or "assisting" the conjugal act to achieve its procreative purpose; others reject it as immoral because it does not "facilitate" or "assist" the conjugal act, but rather "replaces" or "substitutes" for it.
Arguments for GIFT
Two representative proponents of this position are the Rev. Donald G. McCarthy; and Peter Cataldo.
McCarthy argues as follows: "The conjugal act in the described procedure remains the essential step in getting the ovum and sperm to meet. This step is followed by the repositioning of the ovum and sperm in a manner which markedly increases the likelihood of fertilization. Hence, GIFT ... can be seen as a medical procedure which assists, rather than replaces, the conjugal act. ... In conclusion, while the GIFT technique uses technology to assist fertilization, it simply re- positions the sperm and ova to enhance the desired outcome of fertilization. The link between the marital act and procreation is realized by technical assistance."[4]
Cataldo offers a more extensive defense of GIFT as morally acceptable because it assists or facilitates the marital act in achieving its goal of generating new human life. He writes as follows: "A procedure replaces the conjugal act if it determines, of itself, those conditions which immediately secure the success of fertilization; a procedure assists the conjugal act if it does not determine, of itself, those conditions which immediately secure the success of fertilization, but rather allows fertilization to take place under immediate conditions which are natural."[5]
Using this criterion, Cataldo argues that GIFT is a morally legitimate procedure: "I believe that GIFT with a conjugal act assists that act because the immediate conditions of fertilization are not determined or created by the procedure itself. Unlike IVF and the other procedures which replace the conjugal act, fertilization itself takes place in GIFT within natural conditions which are essentially the same as those in which a pathology is not present."[6]
Arguments against GIFT
This is the position defended by Germain Grisez,[7] Donald DeMarco,[8] Benedict Ashley, OP, and Kevin O'Rourke,[9] and me.[10] Here I present their basic argument: First of all, the procedure was originally developed as a variant of IVF and the husband's sperm was collected by masturbation. Informed that the Catholic Church condemns masturbation, even as a way of obtaining a husband's sperm, the doctors [Asch and others as noted already] who used the method suggested that sperm be obtained by using a perforated condom during the marital act.
This shows, I think, that with GIFT the marital act is merely incidental to the entire procedure, used only as a way of obtaining sperm in a nonmasturbatory way. Since the sperm have been deliberately, intentionally withheld from a marital act or series of marital acts, they cannot be said truly to be integral to the marital act when the catheter containing these sperm and the wife's ovum are inserted into her body. Although subsequent fertilization of her ovum may be caused by sperm introduced into her body during the accompanying marital act, such fertilization would be per accidens and not per se.
Conclusion
Here I have done my best to present accurately the contradictory positions of different theologians for and against GIFT. Either that which is defended by people like McCarthy and Cataldo is true, or that which is defended by Grisez, De Marco, Ashley/O'Rourke and me is true, but both cannot be; one must be true, the other false. Readers should study their arguments and evidence they advance to support them and make up their own minds as to which views make more sense.
Notes
[1] See David S. McLaughlin, "A Scientific Introduction to Reproductive Technologies," in Reproductive Technologies, Marriage, and the Church, ed. Rev. Donald G. McCarthy (Braintree, MA: The Pope John XXIII Medical Moral Center, 1988), pp. 55-56. See also John M. Haas, president of National Catholic Bioethics Center, "Begotten, not Made: A Catholic View of Reproductive Technology," http://www.usccb.org/prolife/programs/rlp/98rlphaa.shtml.
[2] On this see Rev. Donald G. McCarthy, "Catholic Medical Teaching and TOT/GIFT: Response: A Response to Donald DeMarco," in McCarthy (ed.), Reproductive Technologies, Marriage and the Church (St. Louis: Pope John XXIII Medical Moral Center, 1988) p. 144.
[3] The 2008 Congregation for the Doctrine of the Faith Dignitas Personae, a sequel to Donum Vitae, does not consider the morality of GIFT. The 2009 edition (5th edition) of Ethical Directives for Catholic Health Care Services, directive No. 38, declares: "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".
[4] GIFT? Yes! Ethics & Medics 18/9 (Sept. 1993): 3-4 at 4.
[5] "Reproductive Technologies," Ethics & Medics 21/1 (Jan. 1996): 1-3 at 2.
[6] Ibid.
[7] See Grisez's Difficult Moral Questions, Vol. 3 of his The Way of the Lord Jesus, Question 52, pp. 242-249 (originally published by Franciscan Herald Press, 1997; reprinted 2007 Alba House).
[8] See DeMarco, "Catholic Moral Teaching and TOT/GIFT," in Reproductive Technologies. (see footnote 2 above), pp. 47-49.
[9] See the 4th edition of their Health Care Ethics (Washington, D.C. Georgetown University Press, 2002), pp. 47-49.
[10] See my Catholic Bioethics and the Gift of Human Life (Second Ed. Huntington, IN: Our Sunday Visitor, 2008), p. 93.
* * *
William E. May, is a Senior Fellow at the Culture of Life Foundation and retired Michael J. McGivney Professor of Moral Theology at the John Paul II Institute for Studies on Marriage and Family at The Catholic University of America in Washington, D.C.
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