Questions about assisted reproductive technologies (ARTs) have been making major headlines with the California octuplets.  Without sifting through the particularities of this woman's family story, a pressing problem surfaces:  the development and use of these technologies has outstripped our ethical and regulatory response.  As the Religious Institute's just-released Open Letter to Religious Leaders on Assisted Reproductive Technologies states, "The use of ARTs is always a serious moral and medical decision."   Ethical deliberation is desperately needed!   

Since the advent of these technologies 30 years ago, millions of women and men have used ARTs to try to have children.  It is not a new story (although eight at once is a rare occasion).  Yet the use of ARTs is a largely unregulated practice in the United States.  Are they safe enough, effective enough, affordable enough?  What are the ethical considerations that should govern their use?  Moral judgments that take into consideration medical, economic, and religious concerns will come to different conclusions about artificial insemination than they might about in-vitro fertilization.  There is no easy answer, nor a single answer. 

We urgently need a public dialogue - involving physicians, theologians, ethicists, clergy, health advocates and the scientific community - that responds to the social, religious and medical issues raised by the use of ARTs.  We need to assess individual choice within a larger social context, so that we do not divorce moral choices from moral responsibilities to one's self, family or the larger community.   In other words, the moral questions not only involve the individual -- health risk to self and potential child(ren), ability to care for child(ren), religious belief/teaching, partner's desires, and personal motive.  But there are social justice issues we as a community must weigh -- medical effectiveness, cost, and equal access.  We also must consider how ARTs reinforce biological children as superior and women as valued only for childbearing.  

Medical Effectiveness and Economic Cost

Not all ARTs are the same; they vary in their cost and medical risk.  Some procedures have unknown long-term health implications, not to mention high financial cost and limited success.  There is a need for increased regulation to safeguard health, additional research to determine the risks, and caution on the use of high-risk, low-success technologies.  Medically effective practices must be part of what determines the use of available technologies.  With regard to in-vitro fertilization (IVF), for example, it is not statistically effective to implant an excess of embryos - and it could increase health risks for the mother and children if multiple births occur.  The high-financial cost also creates a class system of those with access and those without. 

Equal Access and Non-Discriminatory Practices.

While religious and other cultural beliefs will affect individual decisions about ARTs, no single religious viewpoint should determine public policy or medical practice.  We know from history that, when moral agency over reproductive choice has been denied, marginalized persons and communities have been harmed by forced sterilization, eugenics and medical experimentation in the name of progress.  The right to make personal decisions about reproduction should not be limited on the basis of marital status, sexual orientation, gender identity, disability, class or race.   

‘Fruitfulness' and Personal Desire

I do not deny that many women and men experience a yearning for biological children, or that women in particular suffer in cultural and religious contexts that value them primarily for childbearing.  Religious traditions have contributed to this suffering.  From Jewish and Christian traditions, the Open Letter calls for broader interpretations of texts such as "be fruitful and multiply" and those that present infertility as a penalty for sin or unfaithfulness.  Simultaneously, we must mine our religious traditions' rich sources of spiritual and moral support for various understandings of creativity, generativity and family formation.    

As a society, and as faith communities, we must commit to an ongoing conversation that respects an individual's desire to have biological children, holds medical professionals accountable to nondiscriminatory and medically effective practices, and supports reproductive justice for generations to come.    

The Religious Institute convened a group of clergy, theologians, ethicists and health professionals to create the Open Letter to Religious Leaders on Assisted Reproductive Technologies. Our intent was to help prepare religious leaders to assist women and men seeking to become parents and to counsel individuals and couples considering ARTs. I invite you into a discussion of the moral and religious implications of these technologies.  The Open Letter is available on our web site.  An accompanying guidebook, A Time to Be Born, will be published in May.