Cross-posted at Civil Religion.
Last week the New York Times published a two–part series on artificial reproductive technologies. The series makes a riveting read, as writer Stephanie Saul narrates the joys and terrors of premature birth, high order multiples, NICU stays, and—finally, sometimes—the precious goal, a baby at home with a family. Although I have no first-hand experience with ARTs, I follow the topic with interest and so I was drawn into the story of the Stansel family, which anchors the second article.
Amanda Stansel underwent a common procedure called intrauterine insemination, in which her ovaries were stimulated with fertility drugs and her husband’s sperm was injected into her uterus. But something went terribly wrong, and Ms Stansel became pregnant with six babies. The chances of delivering healthy sextuplets are punishingly slim, and the Stansels’ doctors recommended selective reduction, the medical euphemism for the destruction of several embryos in hopes of improving the odds of survival for the remaining babies. Faced with this grievous dilemma, the Stansels decided to keep all six babies. Tragically, the babies were born prematurely, and four of the six have died. The two remaining baby girls face an uncertain future. The emotional drama of the Stansels’ path to parenthood passes through our most basic human hopes and fears.
I was drawn into this heartbreaking story for another reason: the Stansels are Latter-day Saints, as I am. Their Mormon faith is not prominently featured in the story, but nevertheless it was a key part of their decision to allow all six babies to be born. The article reports:
Many opponents criticize selective reduction as a form of abortion. And for many parents who elect to carry all of the fetuses, the decision often hinges on religious convictions. There is also a chance, up to 5 percent, that selective reduction will be followed by a miscarriage of all the fetuses, according to the American Society for Reproductive Medicine.
For the Stansels, the decision was influenced by their membership in the Church of Jesus Christ of Latter-day Saints. The church generally opposes abortion. After learning that Mrs. Stansel was carrying sextuplets, the Stansels decided to meet with church elders and consult with a reduction specialist.
“It just never felt right,” Mr. Stansel said. “We prayed many nights. A lot of sleepless nights. Originally we thought we might do the reduction. We chose to carry all six and, we believe, let God do what he’s going to do.”
I ache with sympathy for the Stansels’ loss; no compassionate reader could feel otherwise. I applaud their decision to keep all six babies—I hope that I would have the courage to do the same, were I ever in the same situation—and I have no wish to question their choices or their rationale. (I hope commenters will extend the same respect, and focus the discussion on general ideas rather than the Stansels’ particular case.)
But I can’t help wondering how the Stansels’ stated reason for rejecting the selective abortions—that is, their desire to allow God’s will to prevail—strikes non-religious readers. The article implies that the only reasons for opposing selective reduction are rooted in religion. Secular readers could come away with the impression that there is no ethical reason for non-believers to avoid “reducing” a high-order multiple pregnancy.
This raises a question: is it in the best interest of religious institutions and individuals to articulate secular arguments for their moral positions? If religion-minded people wish to persuade the non-religious to support one side of a thorny ethical question, then presumably they must do so with arguments that do not rely on explicitly religious claims. After all, an agnostic couple facing the Stansels’ excruciating choice is unlikely to be moved by an appeal to God’s will, but they might respond to a philosophical or scientific argument.
On the other hand, perhaps religious interests risk ceding the public square to secular voices if they voluntarily remove or recast religious discourse in debate. If it becomes unusual or unpopular to express religious points of view in public forums, then faith is effectively banished to the private sphere and religious citizens have difficulty finding the language to publicly speak their conscience. Perhaps, then, it is in the best interest of religious individuals to strongly insist on the relevance of religious claims to public debate.
Of course, this all assumes that it is possible to articulate secular arguments for religious positions. In some cases there simply may not be a secular route to the destination that religion has in view. In any case, this is a dilemma that has bedeviled religious citizens of modern states since the advent of religious pluralism. In our time, which sees such dizzying social and scientific change in matters close to the heart of religious claims, the dilemma is unlikely to be resolved.
Comments welcome here. I also wouldn’t mind comments over at the other site. By the way, I’m sure that plenty of people smarter than I have given the topic a lot of thought. References to relevant books, articles, blog posts, youtube videos or facebook status updates are welcome.
Rosalynde,
Very interesting post; you raise an important question about the way in which churches participate in the public sphere (of perhaps secondary to the question of whether and to what extent churches should participate in the public sphere).
In Elder Oaks recent foray into the subject, he said:
“As Latter-day Saints, we should never be reticent to declare and act upon the sure foundations of our faith. The call of conscience — whether religious or otherwise — requires no secular justification. At the same time, religious persons will often be most persuasive in political discourse by framing arguments and positions in ways that are respectful of those who do not share their religious beliefs and that contribute to the reasoned discussion and compromise that is essential in a pluralistic society.”
Also, I noticed you already linked to a book by Robert George. It seems that George made a similar argument as Elder Oaks at a recent BYU forum address, namely, that religious persons and institutions must rely on scientific and philosophical arguments to make their case in the public sphere.
One problem I’ve never been able to resolve with regards to reproductive technology is that forcibly creating fetuses is just as unnatural as forcibly destroying them. The argument against abortion largely hinges on the idea that it is a violation against a natural process.
Many people look the other way when someone violates the laws of nature because they want a baby so badly. IVF, for example, creates a lot of surplus embryos that are usually destroyed at the end of the process. But nobody wants to bring that up because it’s uncomfortable. These folks probably went with intrauterine insemination because you avoid the problem of what to do with the extra frozen embryos from IVF. But it’s still an unnatural and forced method of creating embryos.
I have no easy resolution for this. Artificial conception is a very difficult process and the people who go through it are usually very good parents because they wanted to be parents so badly that they went to great extremes. But I also can’t help but wonder if it’s hypocritical. It’s easy to justify violating nature when it creates an adorable little baby that parents are eager to love. But it’s not okay to violate nature after the first violation to create a better chance that the surviving babies would be healthy? So some kinds of thwarting nature are okay and others are not?
Sheldon, thanks for the response, and thanks especially for bringing out that passage of Elder Oaks’s speech. My overall impression of the talk was much less conciliatory, and I’m glad to be reminded of the qualifications he includes. And I hadn’t known that Robert George spoke at BYU. I’ll have to see if I can chase down the text. Thanks!
Molly, great response. The contradiction you point out is real, and it’s at the root of the Catholic position (as I understand it) against any kind of artificial reproductive technology. There’s a lot to recommend the coherence and elegance of Catholic theologies of life. But as you point out, the value that Mormon culture places on children will probably trump moral reasoning—no matter how elegant or coherent—in most cases for most LDS couples.
It does seem to me that one could make a different kind of argument against abortion that doesn’t necessarily rule out artificial conception. Rather than relying on a notion of “natural processes,” one could instead take as the fundamental assumption the value of human life. Thus any measure that prolongs, preserves, or propagates human life would be permissible, whether natural or artificial, and any action that destroys or shortens human life is not.
I’m sure this kind of theology has already been done by somebody—maybe by evangelical theologians?—does anybody have any references?
Veeeeryyy interesting post.
I’ve wondered about selective reduction as I hear it is a common practice and often times essential for the health of the mother. Often you are dooming the others when you choose not to reduce, and I’ve wondered if it feels like gray area to others as it often does to me. As someone mentioned before, during the IVF procedure the doctor will create as many embryos as possible before insertion, but will select only the strongest to go in. Is that the same thing? Or is it not?
I have no answers at all only infuriating questions, and I would put money down that we’re likely not to hear a definitive answer on this from the pulpit, so in the end it is between us and God. And, here comes a really out-there opinion, so don’t stone me or anything, but I feel in my gut that selective reduction is not the same as abortion. So, now it’s out there. Go easy on me!
I think the hardest part would be – how do you choose which embryos to “reduce”? They all have the same potential for life. I don’t think I could make that choice.
I have another question about this. Please don’t shoot me. Infertility has not been one of my challenges in life, so I do not know how it feels. But, it seems that a lot of couples I hear about are experiencing “infertility” fairly early. On their site, the Stansels mention that they got married in 2007 (and this is their second set of babies conceived with help. The first set died). I know another couple who wasn’t married very long before using clomid. They have multiples. Are we becoming impatient when it comes to having kids? Are we giving nature enough time to take its course before taking over?
It takes two years now before a doctor will label you “infertile,” and IUI is the first step in the ART process that doctors will suggest, because it’s relatively low cost and low-intensity. I’ve been trying to get pregnant for 16 months, and so I appreciate your question Stephanie. I know if I had the cash I could go see a specialist and possibly walk away with a baby sooner, but I’m choosing to wait and let nature take its course. I think impatience is a hallmark of this generation for sure. I also think if adoption were more of a streamlined, less expensive process, we wouldn’t have as many couples running to science to conceive. I know the LDS adoption service is supposed to be wonderful but something about the way you have to “market” yourselves to prospective “baby ovens” is off-putting to me. My two cents.
“the value that Mormon culture places on children will probably trump moral reasoning”
Not only this but I would go as far to say that Mormon theology inadvertently encourages this kind of behavior. We tend to believe that there is a finite number of “spirit children” waiting for their chance at mortality. Why not draw as many as possible (by whatever means possible) into LDS families?
Whilst I wouldn’t say I agree with the statement 100% I’ve certainly heard it as a rationale for ART (at least that’s what some people told us).
Even if we frame selective reduction as abortion I wonder if the LDS position on abortion (potentially allowable in the case of the serious impact to the health of the mother or child) makes it a viable argument in favor of the procedure.
In any case, having gone though similar treatments, (fortunately without facing any of the moral dilemmas discussed), I have nothing but compassion and sympathy for all those who go through ART. The desires to be a parent can be very power desire that I do not think those who haven’t experienced infertility can truly understand.
Natalie, I’m not sure how you can distinguish between a straightforward elective abortion and the selective abortion of certain embryos in a multiple pregnancy. And I can’t think of any particular reason why we should do so; veiling the fact that we are destroying these small human organisms isn’t going to make anybody feel any better. That said, I absolutely recognize that the parents’ emotional trauma is of a different sort in a selective reduction situation, and my heart absolutely aches with sympathy for those parents. And the fact that some embryos are destroyed in order to improve the outcomes for others adds a dimension of dignity to those small lives that is missing in an elective abortion.
Stephanie, women’s fertility begins to decline at 25, and declines markedly after 30. Because of this, ARTs have greatest success rates among the youngest women. So the longer you wait, the lower your chances of conception. That’s why many couples (At their doctor’s advice) begin treatment fairly early.
mg, I agree that the Church’s official guidelines encourage a particularist approach to selective reduction—that is, there are no broad guidelines, but rather each case should be considered and prayerfully discussed individually. This is dissatisfying for people like me who are trying to discern the underlying philosophical or theological principle, but as a practical matter that approach probably works fairly well.
I too feel that the explanation for not implementing selective reduction being “we’ll let God do what he wills” does not work when you do not accept “God’s will” in infertility. Truly, I have a hard time with the “God’s will” argument in any reproductive choice: many LDS couples do not plan for example, instead allowing “God’s will” for successive Irish twins; are they willing to attribute the 13-year-old’s down the street pregnancy to God’s will, too? Of course not.
Let us use wisdom and personal revelation. While I personally would not likely participate in artificial reproduction, I think if it resulted in medically tenuous pregnancy, selective reproduction could be wise. Don’t we all make choices to protect our kids and give them the best chance at high-quality lives? Sure. Whether living in high-quality school districts or ensuring our kids are immunized, we make choices. We just don’t generally think of them as lethal. I wonder, though, if we could know the results of a pregnancy before it started, might we avoid some of them? Premature births with complications may be a gray area, but would any of us feel it sinful to avoid a pregnancy that resulted in miscarriage? I don’t know.
You pointed out that Mormons value children, but does artificially creating them make them more valuable? If we TRULY valued children, could we stand to have children living in foster or institutional institutions? Or do we just value the ones to whom we are genetically linked? I think if we “valued children” then we would earnestly work to improve the quality of the life children on earth are living rather than focusing on producing ones that look like us. Our theology is not just to pump out bodies for spirits, living conditions be darned; our theology is to assist heavenly father’s children to return to him, and we can hardly do that if we ignore the fact that they exist.
It seems that most of us have multiple reasons for many of our decisions; we may marry for religious reasons, but we may have more carnal ones as well, and economic, too. I think (know) my midwives are pretty irreligious, but they absolutely understood my declining pre-natal testing for certain diseases–they knew that that would not alter my birth plans and I got the feeling that very few of their patients use those screenings. I realize that is several steps removed from selective reductions, but that is the closest I have experienced.
Fascinating discussion! Hope I haven’t said anything hurtful–I’m just thinking with my fingers. Dangerous, I am sure.
I think it is valid to ask what impact this might have on non-LDS readers’ perception of the church, but maybe it bears asking how it affects active LDS members’ views of their own church. I read this story last week and grieved for this family, but was also slightly horrified by the implication that selective reduction is considered equivalent to abortion by the LDS church. As an active member, I know that if I were in a similar position I would absolutely heed my doctor’s advice and do what was necessary to ensure my health and the health of however many babies I could realistically carry.
I don’t presume to judge this couple, I don’t know how their prayers were answered or how their decision was reached. I do however think the conflating selective reduction and abortion in this case is problematic and that to portray it as such could encourage reckless and irrational pregnancy decisions that are bound to lead to medical disasters and heartbreak.
Rosalynde #10 – your comment reminds me of this post on BCC. Your comment sounds like an argument for the early marriage culture of Mormons.
How can you discuss “ethical question[s]” without religion? Sure, sure, just don’t call it religion, then you trump all those praying nut-jobs.
Sorry, but a value set is a value set. Just because part of mine comes from the LDS church (and, presumably, God) and someone else’s comes from Al Gore doesn’t mean mine is inferior. (With all due respect to the guy who flies all over world in a private jet telling us to stop driving.)
So how do we talk about, say, laws against theft, murder, even speeding — or behavioral boundaries — without ultimately depending on a value set (that comes from…where?) to justify them?
I think it’s important to fight to keep a space for religious expression and religiously-rooted argument in the public square. If believers must always try to justify their positions in secular terms, they will almost always lose because they will always be trying to find post-hoc justifications for their preferences rather than coming to them through initial argument (like the secularists).
Indeed, the program of American secularism is generally to push religion as far into the private sphere as possible. In such a situation, the best that believers can hope for is a superficial “respect” for their beliefs and individual-level exceptions to more general policies–things which secularists often oppose, anyways. Although there has been significant “religious liberty” legislation and court decisions in recent years, most of it has taken this form. Paradoxically, then, the increase in religious liberty protection by statute and precedent in the recent past is the product of increasing pressure on religious practice and expression. In the absence of this pressure, there would be no need for formal individual-level protections.
FWIW, I am personally acquainted with a very devout LDS couple who has used IVF. They did not need to use “selective reduction”, but they were prepared to do so, and the husband told me he thought they would have been at peace if it had been medically necessary. (Whether, if confronted with the awful choice, they would have done so, or how they would have felt spiritually about such a choice, may never be known.)
My only point is that I do not know that there is a “one size fits all” principle with respect to artificial reproductive technologies and “selective reduction” among devout Latter-day Saints.
Thanks for the comments, all. Different people’s moral intuition seems to take them in very different directions on selective abortion in high-order multiple pregnancies. My intuition tells me that there is no defensible distinction from elective abortion (which itself can be undertaken to, say, ostensibly improve the quality of life of existing siblings), and I’m horrified at the thought of destroying the weakest embryos in order to improve the chances of the strongest. However, I recognize that other people’s intuition leads them in a different direction. Furthermore, I recognize that the emotional trauma facing parents in this situation is unique, and my heart truly breaks in sympathy for them.
TMD, fantastic comment, thanks. I agree that religious positions can be difficult to justify convincingly in secular terms. There’s a strong temptation to massage the data to support one’s view—and of course, evidence-based arguments are always vulnerable to new data. On the other hand, I’m not sure how else religious believers can find common ground with non-believers.
I do agree that the Rawlsian notion of a neutral secular public square (what you call the program of American secularism) is problematic. Liberal secular hegemony is not neutral. On this the religious conservatives and the post-modern academics can agree!
About your #18–of course when you say it that way, it sounds terrible, Rosalynde! But would you have an objection to a family decided to stop having children to ensure the existing ones have a “good” (terrible subjective term, of course) life?
It seems that would not be a very controversial choice. Mommy can really only give full nurturing attention to so many little ones, so let’s go for a vasectomy. And of course, there are many non-emotional and actually physical needs which may be as pressing. Is that problematic? So it is really just a matter of timing? Choose pre-implantation and not after?
I am very much at ease with the Church’s abortion guidelines (although grateful I have never had to consider one), and suspect I would use said guideline of health for mother and babies for selective reduction if I had to.
But like I said, I would be much more inclined to foster to adopt than to wade into artificial fertilizations at all. I think there is something to be said for avoiding hard choices like this.
If life begins at the moment of fertilization, then doesn’t selective reduction/abortion occur when it is determined which embryos to implant? I.e., those that are never selected to be implanted are therefore “reduced” or “aborted”? Is that why the Roman Catholic Church opposes IVF, because it almost inevitably results in “elective” abortion of nonimplanted embyos?
Or does life begin at the moment of implantation? Thus justifying use of IUDs or morning after pills to the extent they function by preventing implantation of the embryo/zygote?
DavidH–I cannot answer your question. All I know is that I have successfully and selectively reduced the number of my eggs that could be fertilized, just like my YW leaders told me to.
But I believe the selective reduction discussed in this article is of already fertilized and implanted embryos; in fact they are fetuses, are they not?
DavidH –
The Church has remained deliberately uncommitted on the question of “when life begins” (i.e. when the spirit enters the body). Policy even extends to the point that stillborn children cannot be sealed to you (though can be listed on family group sheets as a courtesy). If a baby is not born live, even if it died during birth at full maturity, we don’t know 100% if a spirit was ever there. Such a wide open position offers significant wiggle room in this debate.
Yes, the Church is opposed to abortion in principle, but admits that there may be concerns of higher priority, particularly the health of the mother. After all, in the face of overwhelming complications, why should she risk her life if the fetus may not actually have become a living soul yet?
In the same vein, we might argue that risking the life of some/all of the multiple fetuses fits the same category, providing potential justification for selective reduction. I imagine a secular thinker might well find much logic in this stance too.
ESO—well, I’m not sure that it’s “merely” a matter of timing, but yes, once we’ve created a distinct human organism with its own life trajectory ahead, its own unfolding path and its own future interests, then the moral calculus changes drastically.
Where we can agree is on the desire to avoid these hard choices altogether. There’s a lot to be said in favor of regulating the fertility industry—for example, limiting the number of embryos to be transferred in IVF or banning IUI.
ESO #20, I don’t think that is a fair comparison. In one, life has not yet been created, and in the other, life has. Whether or not the Spirit has entered the fetus is debatable, but something alive and growing is in the body of the mother, and it would have to be destroyed. That is very different than choosing not to create an additional life.
Rosalynde–that kind of regulation makes so much sense–it seems odd that people have not created their own policies.
Stephanie–fair enough. I do think they are related issues, and just one or two generations ago, I think many Mormon women would have agonized over birth control and planning.
Oh–I thought of one sectarian argument against selective reduction: selection of the fittest. I don’t know how persuasive that would be, but rather than saying “we await God’s will” maybe “we want to see which of these embryos survive–only the strongest will, and we would be blindly guessing if we chose to reduce them ourselves.”
I wonder how many of us really appreciate how poor the prospects are for most higher order multiples, or the complex calculations that patients, doctors, and clergy undergo when making and advising these decisions. There are many personal characteristics (age, health, pregnancy history, height, weight, number of fetuses, etc.) that help doctors estimate the probability that a higher order multiple pregnancy will succeed. It is hard to know what data a particular individual has at hand, and I’m sure there is a lot of thought and prayer behind each choice.
That said, I find it hard to imagine that an informed doctor or priesthood leader would ever encourage or pressure anyone to carry sextuplets to term. Respect and support the decision, yes. Encourage, no.
I appreciate Rosalynde’s post, but I worry just a bit that her language (“I applaud their decision to keep all six babies—I hope that I would have the courage to do the same”) threatens to move beyond heartfelt support for the Stansels into a more vague and general cheerleading of what is (in at least some cases) extremely ill-advised medical behavior. Doctors who advise selective reduction are not always wrong. Heeding their advice takes courage too.
On the other hand, I fully agree with Rosalynde on the need for fertility industry regulation. The fact that these terrible choices have to be made at all is tragic evidence that, conversely, doctors are not always right. Maybe the government should mandate that insurance fully fund single-embryo transfers and forbid multiple-embryo transfers and IUI altogether. Given the millions of dollars that one sextuplet pregnancy can cost, we might even save some money this way.
well, the far more obvious question raised by their stated desire “to allow God’s will to prevail” is why they then chose to undergo the artificial procedure to begin with.
but with regard to your question — should people offer secular rationales for their faith-based decisions? — the answer is clearly no.
it’s disingenuous, it betrays a lack of confidence in one’s religious convictions, and the secular rationales offered are usually bogus anyway.
the example before us is a case in point. there is no secular rationale for not selectively reducing a six embryeo pregnancy during the first trimester. that’s why her doctor recommended it.
witness also: Ross Douthat on gay marriage.
quoting Douthat, from the link in my comment above:
and of course, not only is “institutional support for reproduction” not persuasive, it’s intellectually dishonest. if a hetero-only marriage policy is meant to support reproduction then the policy is, as one justice so well put it, at the same time too inclusive and too exclusive.
there’s nothing wrong with opposing a certain public policy for religious reasons. why not just be up front about it?
TMD #16,
as a secularist myself, i could not agree more with your first paragraph.
but your second begins with a misunderstanding.
it is not the aim of secularists to push religion out of debates on public policy. indeed, it would be counter to our interests to do so. we welcome religious arguments in such debates because the american people are, in the spirit of the founders, inherently wary of them!
31: The wariness you describe is actually the product of a multi-decade process of delegitimization rather than a historic tendency reaching back through two centuries.
palerobber, it’s not the case that there are no secular arguments against the destruction of human embryos. I linked in the post to Robert George’s _Embryo_, which is an extended instance of precisely such. Maybe you think the argument fails, and fair enough, but it is there.
Tim, your criticism is well taken. It’s difficult to overstate the medical catastrophe that is a high-order multiple pregnancy.
Excellent discussion, Rosalynde W.
The pitfalls of being open about purely religious motivations are as you say. One pitfall of recasting ones’ views in secular terms is that our culture values authenticity (too much, probably, but that’s another discussion).
But I can’t help wondering how the Stansels’ stated reason for rejecting the selective abortions—that is, their desire to allow God’s will to prevail
I wonder about this stated reason too, though in a different way than you. If by ‘God’s will’ we mean letting events take their natural course, then one wouldn’t be doing repro procedures. I wonder if what the Stansel’s meant by God’s will was something more like God’s will in their specific situation (i.e., some kind of personal revelation directing them to proceed) or God’s will with respect to abortion.
Also, as has already been pointed out, those of us who are moral cowards, or at least who don’t have a taste for complex morally-freighted life and death decisions, would be well-advised to avoid procedures that can result in these kinds of multiple pregnancies.
I don’t think so. I think people of secular persuasion need to understand that religion isn’t going anywhere and it’s awfully selfish to expect people of faith to apologize for their choices all the time. We have nothing for which we must apologize to them. We do have, however, a very REAL responsibility to follow Christ at all times. He taught us to carry our crosses, to disengage with those who would not be dissuaded from their ways. We’re supposed to be His followers, and He has made it clear that He believes in the sanctity of life.
By appealing to philosophy or science in order to avoid contention, we present both falsely as our motivations and bring people to a false understanding of what it means to be advocates of morality. We must, as a people, come to understand that to stand by principle, even to the point of contention, was His way. If you don’t believe that, have a closer look at the New Testament Gospels some time. When we bear the cross of discipleship, we need to be willing to pay that price. If He did so, being perfect, why shouldn’t we?