This article was part of a series on
Procreation Ethics launched jointly by the
American Lutheran Church, the Association of Evangelical Lutheran
Churches, and the Lutheran Church in America in 1983. This article
does not represent official policy of the Evangelical Lutheran
Church in America.
[1] When couples find themselves childless because of male
infertility, they have several choices. They can remain childless
and learn to cope with their disappointment, or they can adopt
someone else's child. A third alternative is artificial
insemination.
[2] Artificial insemination is a relatively simple medical
procedure by which semen obtained by masturbation is deposited by
means of a syringe in or near the cervix of the woman's uterus.
Artificial insemination is of two basic types: homologous
insemination, when the semen is obtained from the husband
(AIH); and heterologous insemination, when the semen is
obtained from a donor (AID). AIH is used occasionally when for
physical or psychological reasons insemination through intercourse
is problematic, or in the case of oligospermia (deficient sperm
count) when sperm from several ejaculates are pooled for use in a
single insemination. Since AIH presents few legal, social, or
ethical problems, this paper will focus primarily on AID.
[3] Artificial insemination by donor (AID) is "medically
indicated" in cases of complete or virtually complete male
infertility, or in cases where the husband fears transmitting
genetic disease. AID is also utilized to provide natural children
to women who are not married or have no male partners.
[4] In the last several decades the demand for artificial
insemination has been increasing dramatically. While the nature of
legal and social problems surrounding the procedure has meant that
careful records have not been kept and therefore frequency cannot
be determined precisely, it has been estimated by responsible
researchers that from 6,000 to 20,000 AID children are born in the
U.S. each year.1
Psychological and Social Considerations
[5] AID offers certain potential psychological benefits
over the alternative of adoption. Both husband and wife can be
involved in the pregnancy from conception onward, sharing the
experience of delivery and the early days of the baby's life. There
is a greater chance that the child's physical appearance will at
least match that of the mother, and if there are several children
they are more likely to resemble one another. There need be no
subconscious fear of the sudden appearance of the natural mother,
as there may be in adoption. And, of course, the desire on the part
of the mother to carry a child is satisfied as it cannot be in
adoption.2
[6] However, AID also poses psychological dangers to the wife,
the husband, and the child. In the more usual situation of
procreation by husband and wife, the child can be understood to be
the joint issue of both parents. Both husband and wife fulfill for
the other the opportunity to become father and mother. Their love
for one another can be strengthened and deepened as a consequence
of this mutually shared experience.
[7] In the case of AID, however, the situation can be very
different. The wife may have a feeling of having been "cheated" by
the discovery of the husband's infertility. The desire to procreate
despite this discovery may become, in part, an act of revenge or
hostility toward the sterile husband.3 If AID is successful,
the wife may sense that the new life she bears within her has no
relation to the love she has for her husband.4 She may, in fact, secretly
yearn to meet the man who "helped" her when the husband could
not.5
[8] The husband, likewise, faces certain psychological dangers.
He may feel himself to be a stranger to the new life developing in
his wife's womb. His masculinity may be threatened, not only by his
infertility, but by the sense of inadequacy in comparison to the
donor who made possible his wife's pregnancy. "AID thus threatens
to evoke very deep-seated feelings of helpless dependence in
relationship to women and also feelings of inadequacy in relation
to other men." 6The husband may
psychologically withdraw from the home, investing his energy in his
work or other forms of self-achievement by which he may hope to
regain his sense of masculinity.7
[9] These psychological dangers for husband and wife also
threaten the psychological development of the child. The child may
become subtly aware of a family secret involving his or her father.
If the psychological dangers for husband and wife materialize, the
child may find him- or herself alienated from the father, creating
another set of psychological difficulties for the child.
[10] Closely aligned to this psychological danger is the matter
of dealing with the child's genealogy; Like adoption in an earlier
age, AID is usually maintained as a secret among the parties
involved. The doctor, the husband and wife, and the donor conspire
together to deceive the child and society regarding the child's
genetic identity;
[11] Several arguments can be offered in favor of disclosing his
or her true I genealogy to the child. In the first place, the risk
of accidental disclosure or I suspicion may cause parents to decide
that forthrightly telling the child at an I appropriate age would
contribute to a healthier relationship. This is similar to an
argument for disclosure of adoption. It recognizes the fundamental
impor- tance of truth for basic human relationships.
[12] An argument can also be made on the basis of the child's
right to know his or her genealogical heritage. Experience with
adopted children in recent years has shown the significance of this
knowledge of genealogical heritage for dealing with the problem of
identity as the child matures.
[13] A final argument in favor of disclosure, and the kind of
record-keeping that would make disclosure meaningful, is that
knowledge of one's genealogical heritage may be crucial if the
child suffers any genetic illness or needs a reliable family
medical history. Moreover, genetic counseling at some point in the
child's life - an increasingly useful tool in preventive medicine -
can be critically skewed if the child does not know his or her
paternal genealogy or, what is more likely, if the assumed paternal
genealogy is not the true one.
[14] There are, of course, a number of arguments against
disclosing either the fact of AID or the identity of the donor.
Some of these arguments pertain to the desire of maintaining
healthy family relationships which the stigma of AID might disrupt.
Disclosure might have a particularly devastating impact upon the
acting father's sense of fatherhood.
[15] Other arguments against disclosure are more concerned about
protecting the anonymity of the donor. The case for donor anonymity
is sometimes argued to protect the donor from legal involvement in
legitimacy and inheritance rights, and to encourage donors to
participate.
[16] It should be noted that a middle way exists, whereby
records containing pertinent genetic information could be kept and
made available to the child at an appropriate time and under
appropriate circumstances, while not disclosing the identity of the
donor. Such a procedure, of course, would meet only some of the
objections of those who argue the need for disclosure of the
child's genealogical heritage.
[17] Another social consideration closely related to the concern
for genealogical or genetic heritage has to do with the possibility
of unwitting incest between half-siblings. The concern is that AID
children of the same donor may fall in love and marry. Considering
the fact that semen from the same donor is often used with women
who live in the same geographic community and who may represent a
rather homogeneous ethnic or social group, the possibility of
incest, though small, is not farfetched.
[18] Another issue of social significance in considering the
practice of AID concerns the small but apparently growing numbers
of unmarried women who I are seeking artificial insemination as a
way of becoming mothers. One study indicated that at least 9.5
percent of the doctors responding had used AIDfor single
women.8 The
acceptance of "bachelor mothers" appears to be a growing trend in
our society The issue becomes even more complex, of course, when
AID is used by lesbian couples, and the resulting child grows up to
discover that both his or her "parents" are female. Such
developments clearly deal a serious blow to the child and to our
accepted understanding of the family as the basic unit of our
society.
[19] Eugenic considerations - the attempt to influence the
genetic quality of the human species by carefully selecting donors
- pose other questions beyond the scope of this paper.
Ethical Considerations
[20] None of the foregoing considerations are without ethical
significance. However, it is my contention that the chief ethical
issue, upon which hinges one's ultimate decision for or against
AID, has to do with the very nature of marriage and parenthood.
This is the issue that finally underlies our ethical assessment of
many of the other considerations discussed above. What is the
nature of the marriage bond, and what significance does this have
for our assessment of AID? What is the proper relationship between
this marriage bond and the procreation of children? These are the
crucial ethical questions in determining our decisions about
AID.
[21] Contemporary ethicists have taken widely different views of
these questions. Joseph Fletcher, the father of "situation ethics;'
takes a view that does not require of the marital bond a physical
monopoly. He stresses the "personal" character of the marriage
covenant, and goes on to assert that since no personal relationship
is entered into with the donor, AID is acceptable when mutually
agreed upon by husband and wife. In such a case there is no broken
faith, no infidelity, between them.
[22] Fletcher summarizes his views as follows:
We have asserted two things,
fundamentally: (1) 'that the fidelity of marriage is a
personal bond between husband and wife, not primarily a
legal contract, and (2) that parenthood is a moral
relationship with children, not a material or merely physical
relationship. The claim that AID is immoral rests upon the view
that marriage is an absolute generative, as well as sexual,
monopoly; and that parenthood is an essentially, if not solely,
physiological partnership. Neither of these ideas is compatible
with a morality that welcomes emancipation from natural necessity,
or with the Christian ethic which raises morality to the level of
love (a personal bond), above the determinism of nature and the
rigidities of law as distinguished from love?9
In characteristic fashion, Fletcher finds love and law
incompatible and insists that rules are less than Christian. And he
asserts that "to transcend natural restrictions, to seek ends by
means devised through choice rather than by physical determinism,
is a human and spiritual victory. With many of us it is a matter of
reasoned conviction that our march toward freedom and control is an
irreversible trend.10
[23] Thus Fletcher puts an emphasis on the "personal" character
of the marriage bond rather than on any notion of a physical bond.
He is unfettered by notions of the rightness or wrongness of given
physical acts apart from the meaning love assigns to them. And he
exalts the victory of the spiritual over the physical in the
opportunities for choice offered through the technology of AID. He
therefore celebrates this option when it is mutually agreed upon by
husband and wife.
[24] An altogether different view is set forth by Paul Ramsey.
Ramsey examines the nature of the marriage bond and argues that the
marriage bond and procreation are inseparable. He contends that Am
divides the sexual unity between husband and wife, and therefore
violates the covenant of marriage.
[25] Ramsey argues that the very nature of sexual intercourse
combines a unitive (or unifying) and a procreative function:
An act of sexual intercourse
is at the same time an act of love and a procreative act. This does
not mean that sexual intercourse always in fact nourishes love
between the parties or always engenders a child. It simply means
that it tends, of its own nature, toward the strengthening of love
(the unitive or the communitive good), and toward the engendering
of children (the procreative good).11
Since God has placed the unitive good and the procreative good
together in sexual intercourse, they ought never to be put entirely
asunder:
An ethic (whether proposed
by nominal Christians or not) that in principle sunders these two
goods - regarding procreation as an aspect of biological nature to
be subjected merely to the requirements of technical control while
saying that the unitive purpose is the free, human, personal end of
the matter - pays disrespect to the nature of human
parenthood.12
It should be clearly stated that Ramsey does not argue against
contraception. People can practice responsible birth control
without separating the sphere or realm of their personal love from
the sphere or realm of their procreation. The person with whom the
bond of love is nourished and the person with whom procreation is
exercised remains the same. Though contraception is practiced with
regard to particular acts of sexual intercourse, the totality of
such sexual acts by a married couple holds together the unitive
good and the procreative good. "Where planned parenthood is not
planned unparenthood, the husband and wife clearly do not tear
their own one - flesh unity completely away from all positive
response and obedience to the mystery of procreation-a power by
which at a later time their own union originates the one flesh of a
child.13
[26] Even in a marriage where a responsible decision has been
made to have no children, the unitive and procreative functions of
sexual intercourse are honored. The marriage partners still accept
by the nature of their commitment that if either of the partners
has a child, it will be "within their marriage-covenant, from their
own one-flesh unity and not apart from it,14 Ramsey concludes that
practicing birth control, even lifelong birth control, does not
divide the unitive and procreative functions of sexual intercourse
for a married couple, because "they do not procreate from beyond
their marriage, or exercise love's one-flesh unity
elsewhere:'15
[27] Ramsey rejects AID because the personal and the physical
cannot be separated without dividing what God has put together in
the very nature of sexual intercourse. The very nature of human
parenthood is assaulted by putting the bodily transmission of life
completely asunder from bodily love- making, as in Am. Am is
therefore contrary to God's intention that children should be the
fruit of the loving gift of husband and wife to one another.
[28] Helmut Thielicke argues against AID on similar grounds. He
states that "the problem is presented by the fact that here a third
person enters into the exclusive psychophysical relationship of
marriage, even though it is only his sperm that 'represents'
him."16 The
introduction of donor semen therefore violates the
mysterium of marital fellowship, the psychophysical unity
of husband and wife. "This violation also manifests itself when the
fulfillment of motherhood which is not accompanied by the
fulfillment of fatherhood breaks down the personal solidarity ofthe
married couple."17 Even if the husband consents
to the procedure, psychic and physical realities are called into
play which have a life of their own, even apart from his initial
motivation. AID is therefore rejected.
[29] Roman Catholic theologians, in the main, have also rejected
AID. The official position of the Roman Catholic Church was stated
by Pope Pius XII in 1949. After condemning artificial insemination
outside of marriage, he went on to reject AID within marriage as
well:
Artificial insemination in
marriage with the use of an active element from a third person is
equally immoral and as such is to be rejected summarily. Only the
marriage partners have mutual rights over their bodies for the
procreation of a new life, and these are exclusive,
nontransferable, and inalienable rights. So it must be, out of
consideration for the child.
By virtue of this same bond,
nature imposes on whoever gives life to a small creature the task
of its preservation and education. Between the marriage partners,
however, and a child which is the fruit of the active element of a
third person - even though the husband consents - there is no bond
of origin, no moral or juridical bond of conjugal
procreation.18
AID is thus understood as contrary to the divine plan for
marriage and parenthood. It is an essentially disordered act.
Reflections/Conclusions
[30] On the basis of the foregoing discussion, what reflections can
be offered . and what conclusions drawn with respect to the
practice of AID? In my I opinion, AID is not an ethically
acceptable alternative to childlessness in the I case of male
infertility. Several fundamental considerations lead to this
conclusion.
[31] Though not absolutely determinative from an ethical
viewpoint, the psychological dangers described above weigh heavily
against a decision to employ AID. The radical asymmetry of the
parents' relationship to the AID child opens the door to a host of
psychological difficulties. It should be acknowledged that in
theory, of course, these psychological difficulties are not
insurmountable. But they appear sufficiently grave to compel
extreme caution.
[32] More serious from an ethical standpoint is the moral
assessment of the role played by the donor. Though not explicitly
dealt with in the ethical considerations discussed above, that
discussion does bear implicitly on the donor's responsibility for
his actions. The donor clearly exercises his procreative powers
apart from any marital bond or commitment. He remains anonymously
hidden from both the mother and the child, refusing his
responsibility as father. His function remains that of a sperm
salesman, failing to take full responsibility for his biological
offspring. Even though it may be argued that he does what he does
as an act of love to provide a child for a childless couple,
nevertheless love can never oblige one to perform an action which
by its nature violates the fundamental unity of the personal and
biological dimensions of sexual intercourse within the covenant of
marriage.
[33] It is the nature of the marital covenant and the meaning of
parenthood that provide the critical norm for judging the
fundamental ethical stance toward AID. I argue that marriage is a
deeply personal commitment in which husband and wife mutually
confer exclusive fidelity to one another, including the mutual
commitment of procreative powers. By the introduction of donor
semen, AID separates procreation from marriage and thereby violates
the marriage covenant.
[34] Those who offer contrary arguments in favor of AID
explicitly or implicitly separate the personal from the physical,
the unitive from the procreative function of the sex act. They thus
fall prey to the destructive dualism which has plagued Western
culture, whereby the personal or spiritual is understood as the
specifically human, and the physical or bodily is frequently
depreciated. The personal is too readily understood as a
disembodied spiritual reality.
[35] I would argue that we cannot separate the meaning of
"personal" and "human" from physical, bodily processes. Ramsey is
right when he contends, "We need rather the biblical comprehension
that man is as much the body of his soul as he is the soul of his
body.19
[36] The "one-flesh unity" of marriage holds together in a unity
the love-making and life-giving dimensions of sexual intercourse.
Only when this unity is maintained can children be understood in
the full sense as the visible fruit and I extension of conjugal
love.
[37] AID cannot be ethically accepted merely because, like other
good technologies, it "works" - that is, because it gives a child
to a childless couple. From the standpoint of ethics, we need to be
concerned not only about right ends, but also about correct means.
And in this case, the means violate the fundamental meaning of
sexual intercourse within the covenant of marriage. Even when the
husband consents, "AID signifies less than an unreserved commitment
to share another's life 'for better or worse, in sickness and in
health.'"
[38] None of these ethical objections should be construed, of
course, in such a way as to cast a moral shadow on the child who
has been so conceived. Nor does AID fall into the category of some
unforgivable sin. But on the basis of the above considerations, a
couple who find themselves childless because of male infertility
are better advised either to come to terms with their childlessness
or to seek children through adoption.
1 Martin Curie-Cohen, Leslie Luttrell, and Sander Shapiro,
"Current Practice of Artificial Insemination by Donor in the United
States;' The New England Journal of Medicine (Vol. 300, No. II),
March 15, 1979, 588; and Lucinda Ann Smith, 'Artificial
Insemination: Disclosure Issues;' Columbia Human Rights Law Review
(Vol. II, No. 63), Spring/Summer, 1979, 89-90. See also S.J. Berman
and Robert W Kistner (editors), Progress in Infertility (Boston:
Little, Brown and Company, 1968).718.
2 Berman and Kistner (editors), Progress in Infertility.
719.
3 Karl Ostrom, "Psychological Considerations in Evaluating
AID," Soundings (Vol. 54, No.3), Fall, 1971, 293.
4 Bernard Haring, Ethics of Manipulation (New York: The
Seabury Press, 1975), 197.
5 Editor's Introduction, "Artificial Insemination: A
Simple Medical Technique, a Complex Human Problem," Soundings (Vol.
54, No.3), Fall, 1971, 288. See also Robert L Francoeur, Utopian
Motherhood: New Trends in Human Reproduction (South Brunswick and
New York: A.S. Barnes and Co., 1970),37.
6 Ostrom, "Psychological Considerations in Evaluating
AID;' 296. 7. Ibid.
7 Ibid.
8 Curie-Cohen, et al, "Current Practice of
Artificial Insemination by Donor in the United States;' 585.
9 Joseph Fletcher, Morals and Medicine (Princeton, NJ:
Princeton University Press, 1954), 139
10 Ibid., 117
11 Paul Ramsey, Fabricated Man: The Ethics of Genetic
Control (New Haven and London: Yale University Press, 1970),
32.
12 Ibid., 33.
13 Ibid., 34.
14 Ibid., 41.
15 Ibid., 44.
16 Helmut Thielicke, The Ethics of Sex. trans. John W
Doberstein (New York: Harper & Row, 1964),259.
17 Ibid., 262.
18 Pope Pius XU, "To Catholic Doctors," The Catholic Mind
(Vol. 48, No. 1048), April, 1950, 252.
19 Ramsey, Fabricated Man, 133.