No aspect of medical practice has stirred more vigorous debate than interventions at the beginning of life. The vigor of the debate has stirred intellect, emotion, violence and prayer.

People taking diametrically opposing positions have evoked God on:

  • how to prevent egg and sperm from successfully mating (birth control)
  • when clusters of cells become people (personhood, abortion)
  • the morality of ending a pregnancy (abortion)
  • how to (if to) weigh the competing rights and needs of mother and fetus (abortion, serious illness of mother)
  • laboratory manipulation of egg and sperm (in vitro fertilization)
  • pre-birth and post-birth interventions to correct genetic anomalies (genetic and surgical interventions, valuing handicapped people)
  • treatment of severely compromised neonates (neo-natal ICU debates).

Since competing positions are strongly held on all these issues, the epitaph of “You are just playing God” is an equal opportunity charge. People on either pole or most of the space in between claim that others are choosing to over-extend moral human reach.

Perhaps there is no clearer picture of dependency than the developing human from conception through childhood. Just as all humans are ultimately dependent upon God, so the youngest are totally dependent upon parents and caregivers. Thus, the feeling of “playing God” is easily and quickly evoked.

In vitro fertilization (IVF) involves most of the competing positions. IVF, colloquially named “test tube babies,” is the process of fertilizing an egg with a sperm through a laboratory procedure. The fertilized egg is then treated so that cell division begins. When the embryo is formed, growth is halted, the embryo is stored (frozen), and transfer to a womb occurs at a later time. Most methods of IVF result in multiple embryos.
“Playing God” can then occur at several points.

In preparing for implantation, are embryos randomly selected or are they genetically screened for damaged or unique genetic characteristics?

Usually multiple embryos are implanted at one time. If more than one embryo implants, are all allowed to grow? Even for those opposed to abortion, the ethical issues (to say nothing of emotional and economic) involved in one family caring for six or eight babies at one time are recognized.

We have a growing capacity to genetically screen embryos. Is it permissible to select embryos for enhanced characteristics, for avoidance of inheritable diseases, for their usefulness to others?

A Real Situation
The issues were brought into focus in the case of the Hashmi family, residents of Great Britain.  Raj and Shahana’s three-year-old son, Zain, has thalassaemia—a rare, expensive to treat, and debilitating blood disorder that usually results in death by early adulthood. A bone marrow transplant is usually effective in curing the disease. However, they had not found a compatible donor for Zain.

Thus, they requested permission for IVF with embryos screened for not having thalassaemia, and for being genetically compatible to provide a bone marrow match for Zain. Blood from the baby’s umbilical cord would be used for the transplant. Would it be more virtuous for “the matched and generous stranger” to donate what Zain needs than for “a loved and selected sibling” to meet that need?

Is the Hashmi’s request morally repugnant? Morally questionable? Morally permissible? Morally obligatory? Since IVF is more closely regulated in Great Britain than in the United States, these questions are more publicly debated there, but the same questions exist here.

Here are some difficult questions to test your own convictions. What is the morality of:

  • Forming human embryos outside of sexual intercourse?
  • Creating embryos that will not be implanted, but will be destroyed?
  • Refusing (or choosing) to implant an embryo with a genetic marker for disease?
  • Selecting an embryo because it has desired characteristics? (Or failing to screen when one has the capacity?)
  • Selecting an embryo because the desired characteristics will benefit another? (Does “the other”‘ being an elder sibling change your response?)

Want more?

Is God more likely to be in the chance encounter of egg and sperm, or in the planned evaluation of already joined egg and sperm?

Does it change the family relationship if a sibling is born with knowledge that he/she will benefit a brother? Is the change necessarily “bad”?

Is it healthier (“holier”) for the Hashmis to naturally have more children hoping that one will be a match and none others will have the disease?

Are we “playing God” to intervene with science? Or, are we “playing God” if we deny science an opportunity to assist a suffering child?

The miracles of medical science have great power to transform suffering into health. But these same procedures raise deep questions about the nature of embodiment, community and our relationship to God. The church must find its voice for careful and caring conversations in response to the needs of our congregants and our communities.

Steve Ivy is vice president for values, ethics, social responsibility, and pastoral services of Clarian Health Partners in Indianapolis, Ind.

Also read the following articles by Steve Ivy:
21st-Century Medicine: ‘Playing God’ or ‘Playing for God’? 
Playing God at the End of Life

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