The Christian in Vocation: Ethical Consequences of In-vitro Fertilization

Amber Easton

Current Ethical Issue

There are many ethical dilemmas surrounding the protection of human life, and this protection must be established for all stages of them.  The issue arises due to the debate over when human life begins, but this information has been well known for over 75 years.  Human life begins at conception, from the moment the sperm meets the egg.  This fact is established in the 23 Carnegie Stages written by a branch of the National Institute of Health.  These embryonic stages are reviewed and verified annually by a global committee of expert human embryologists, known as the Federative International Programme for Anatomical Terminology (FIPAT) (Funk, 2028), and for over 75 years these stages have remained unchanged. Therefore, the same protection that is justly given to the most maturely developed individual, should also be given to the most delicate and youngest of humans.  Artificial reproductive technologies have been the cause of a growing ethical issue regarding the protection of hundreds of thousands of the most delicate of humankind.

 In Vitro fertilization (IVF) has become a successful alternative option for families and individuals who wish to have a child of their own but are experiencing infertility issues.  IVF is a procedure that is done by taking eggs from a woman and fertilizing the egg with a sperm cell in a petri dish.  This fertilization creates an embryo which is allowed to grow and develop in the dish for about 5 days, at which time it is either implanted into the mother’s uterus where it can continue to develop and grow or it is frozen in a process called cryopreserving (Boys and Walsh, 2017). According to the Center of Disease Control and Prevention, in 2018 there were 306,197 assistive reproductive cycles performed.  This resulted in 73,831 live births and 103,078 eggs or embryos cryopreserved for later use. It is estimated to be well over one million embryos currently frozen in the United States today (National Embryo Donation Center, n.d.). This number of frozen embryos is steadily growing with approximately one third of these being abandoned (Pflum, 2019).  This has created an ethical dilemma on what to do with the large number of abandoned embryos. 

There are several reasons for the large number of frozen embryos.  One, is that during the IVF process, the woman takes medications that cause her body to ovulate.  This stimulation of ovulation produces many eggs.  According to Staphanie Boys and Julie Walsh, the numbers  produced can range on average anywhere from 10 - 40 eggs. Due to the high cost of the medication to produce additional eggs and the uncertainty of the expensive procedures, many of the eggs are fertilized for use. This results in many embryos being left over from IVF procedures.  The parents of these embryos must then make decisions about what to do with the remaining embryos.  Their choices range from implanting them and having a larger family than first intended, keeping them cryopreserved indefinitely, adopting them to another family, donating them to research (stem cell, or training purposes), or thawing them (preventing further development and disposing of them) (Boys and Walsh, 2017).  Another option is known as “compassionate transferring” (Riggan and Allyse, 2019) this is a procedure in which the embryo is implanted into the mother’s infertile uterus or vagina which will lead to an intentional miscarriage of the embryo.

Reasons for abandonment of embryos range greatly due to family situations.   One scenario is that once a family has their desired number of children, the embryos that are not being used are frozen.  This costs patients anywhere from $500.00 and upwards to $1,200 annually to keep their embryos cryopreserved (Boys and Walsh, 2017).  Clients either choose to stop paying or can’t afford to continue to pay for the storage of their embryos leaving them abandoned. Others parents might move and neglect to forward their mailing address, so they no longer receive bills and information from the fertility clinics where their embryos are being stored.  These growing numbers of abandoned embryos leaves ethical decisions up to fertility clinics and healthcare workers.

So the ethical questions are; what to do with this high number of cryopreserved embryos? Whose decision is it to make when it comes to abandoned embryos?  What is the ethical action to take with them, and finally how to prevent these numbers from continuing to grow?

Relation to Nursing Code of Ethics Provisions 

American Nurses Association Code of Ethics provision 1 pertains greatly to this ethical dilemma.  Through showing compassion, respect and dignity to all patients from the very youngest to the oldest.  Nurses will be able to anticipate issues that may arise from certain decisions.  By having a knowledge base of what the client is dealing with, and the current situation of the great number of cryopreserved embryos, nursing staff will be able to better educate their patients on considerations for the future.  Through the expression of dignity and respect to the client, the client will feel as though they are being well cared for and will have more success in dealing with difficult decisions (American Nurses Association, 2015).

Additionally, the nursing code of ethics provision 8 also relates to this ethical concept.  It is imperative that nurses maintain universal rights of health for all (American Nurses Association, 2015).  Nurses and healthcare workers must practice by the non-malfeasance principle, which means to do no harm. By respecting the right of all humans, regardless of their developmental state, it will ensure that appropriate care is provided for all patients.  This includes the care for both the parents and the children, even if those children are immaturely developed and in an embryonic phase. It is important that nurses who are dealing with clients who are undergoing IVF consider the consequences of poorly educating patients resulting in further complications to families and the healthcare industry.

Impact on Nursing and Patient Care 

There is great debate over when human life begins, and for individuals who understand that life begins at conception this is a terrible injustice to hundreds of thousands of individuals.  This will impact many patients who have IVF after they discover that they have to make an incredibly difficult moral decision with their remaining children. These decisions will impact these families for the remainder of their lives, either by increasing their family members or by choosing other fates for their children.  The decision may cause incredible joy, guilt or sadness for the parents of these embryos.

This may also impact nurses, through the care for families who have fertility problems. This ethical impact will be greatest for nurses who deal with women's health and fertility the most.  This is because they will be most responsible for properly informing their patients about these difficult choices, and it may cause great moral conflicts for nurses who feel a responsibility for the lives of the embryos.  For those families who get to adopt children through this process of IVF surplus. Nurses and families get the great privilege of aiding in the rescue of children who might have otherwise bleak endings, as well as being able to help with the correction of this growing ethical dilemma. 

Factors that Impact this Dilemma

The main factors that impact this dilemma are the views of when human life begins. These differing views and understandings will be the deciding factor of life or death for hundreds of thousands of frozen embryos.  Another important factor is how healthcare workers educate patients on future decision making and how to prevent this issue from growing.

Possible Solutions

Some possible solutions for this issue are better education for patients prior to the IVF process.  This will help clients to be better prepared in the event that they have to make a decision regarding a surplus of embryos. Embryonic adoption needs to be part of the education and options for  patients considering this alternative reproduction. Another solution is to limit the number of embryos created for clients and make it mandatory that all embryos that are created are implanted and given the right to full development. This would elicit more thought from parents and doctors who are undergoing or performing artificial reproductive technologies. As for the hundreds of thousands of frozen embryos, a time limit should be set on how long individuals may keep them frozen, indefinitely should not be an option.  This indefinite cryopreservation of embryos only passes the responsibility of care and decisions making onto the future generation. Once the allotted time for this is up, the embryos should be placed up for adoption. 

Impact on My Future Nursing Practice 

Before studying this ethical dilemma, I believed that artificial reproductive technologies were 100%  innocent and without any ethical fault.  Now that I have studied this it has come to my attention that even through the joy of becoming a parent, this procedure can leave individuals with feelings of loss and guilt.  This will impact my future nursing practice through better understanding of the loss and moral guilt that parents may experience through IVF.  It will also impact me to become more educated on technologies that seem to be completely innocent and without any negative consequences, so that I can make sure that if I am responsible for educating on that particular technology I have the ability to fully inform my patients about that procedure.

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References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/

Boys, S.  and Walsh, J. (2017). The dilemma of spare embryos after IVF success: Social workers’ in helping clients consider disposition options, 18(2). 583-594. DOI:10.18060/21551 

Centers for Disease Control and Prevention (CDC). (2020). Assisted reproductive technology (ART). https://www.cdc.gov/art/artdata/index.html#:~:text=Based%20on%20CDC's%202018%20Fertility,and%2081%2C478%20live%20born%20infants. 

Funk, C. (2018). Nonprofit works to fill the knowledge gap on human embryology.  https://lozierinstitute.org/nonprofit-works-to-fill-the-knowledge-gap-on-human-embryology/ 

National Embryo Donation Center. (n.d.) What we do. https://www.embryodonation.org/#:~:text=That%20surplus%20is%20estimated%20at,do%20with%20their%20remaining%20embryos. 

Pflum, M. (2019).  Nation’s fertility clinics struggle with a growing number of abandoned embryos.  https://www.nbcnews.com/health/features/nation-s-fertility-clinics-struggle-growing-number-abandoned-embryos-n1040806 

Riggan, K. A., Allyse, M. (2019).  ‘Compassionate transfer’: an alternative option for surplus embryo disposition.  Human Reproduction, 34(5), 791–794. https://doi.org/10.1093/humrep/dez038 

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Amber Easton  April 10, 2021

Nursing Program, Western Wyoming Community College

Ethics Paper--Nursing 1200

June 17-19 Lutheran Family Retreat in the Uintas

Headwaters Family Retreat

Date: 2pm June 17 through noon June 19

Place: Uinta County Youth Camp – southwest of Robertson, WY (Directions)

Theme: “Baptized for this Moment”

4 teaching sessions – aimed at all, including children

1. What is worldview and what does it matter?
2. Secular Humanist/Evolutionist worldview
3. Christian worldview
4. Where do we go from here?

Activities: hiking, fishing the camp pond, shooting (on a range with a certified range master), canoeing on Meeks Cabin Reservoir, campfire, horseshoes, playground,  basketball, volleyball, stargazing, and watching the clouds roll by...

Cost: $100.00 per family regardless of size and inclusive of lodging and food

Lodging: 12 cabins are reserved. Each contains 6 bunk beds. The cabins are rustic, toilet and shower facility are in a separate but close building. People will need to bring their own bedding – sleeping bag, pillow, blankets etc. Families will share cabins to accommodate the number of people in attendance. 

Go here to register: https://www.wylcms.org/familyretreat/

Schedule: 

Thursday 6/17

2:00pm Check in

2:30pm Welcome & Opening devotion

3:00pm Session 1 - Rev. Patrick Baldwin

4:00pm Family time

5:30pm Supper hour

6:30pm Session 2 - Rev. Kevin Rose

7:30pm Family time

9:00pm Campfire devotions

Friday 6/18

8:00am Breakfast

9:00am Matins - Rev. Jonathan Lange

10:00am Session 3 - Rev. Jim Martin

11:00am Break

11:15am Session 4 - Rev. David Bott

12:15noon Lunch hour

1:15pm Family time

5:30pm Supper hour

6:30pm Family time

9:00pm Campfire devotions

Saturday 6/19

8:00am Breakfast

9:00am Panel discussion / Closing Devotion - Rev. Mark Mumme

10:30am Check out (reservation expires at noon)

Lutheran Laymen’s Declaration and Petition

This document, authored by Lutheran Church-Canada (LC-C) laymen from Waterloo, Ontario, requests our spiritual fathers to continue to celebrate weekly Divine Services uninterrupted during the pandemic. We believe that the weekly physical gathering of God’s people around His Word and Sacrament is crucial at all times. Our petition is chiefly supported by a series of theological statements, but we also present supporting scientific and sociopolitical statements.

This document has been sent to LC-C churches and to our Synodical leaders. Because there are sharp divisions among us regarding these issues, we hope to foster biblically-based unity within our Synod.

We ask that you prayerfully consider this document and cause it to be circulated among the laymen in your congregation. We encourage laymen to support the petition by signing their names to it at the following website (the document is also available for download at the website): www.sdnp2020.com

Your Brothers in Christ,

Paul Gyger, Bruno Korst, Topias Nieminen, Daniel Smilek, Marinus Veenman, 

Sine Dominico Non Possumus / (Advent 2020 AD) 

Read the document here.

CrossTalk: In the cross of Christ I glory

Crosses are everywhere you look. You see them not only on and in church buildings. You see them at hospitals, in cemeteries, on bumper stickers, tattoos, billboards, and jewelry. Crosses are so ubiquitous that we hardly even notice them.

But a visitor from ancient Rome would be aghast. In pre-Christian Rome, references to crucifixion were vulgarities of the highest order. The cross was not referenced in polite company. Among the most disgusting insults a foul-mouthed Roman could hurl was, “go get yourself crucified.”

Against this backdrop, St. Paul, the apostle to the gentiles and first missionary to the Roman world, must have struck his hearers as some sort of kook. He said things like, “far be it from me to boast except in the cross of our Lord Jesus Christ, by which the world has been crucified to me, and I to the world” (Gal 6:14). To the Corinthians he wrote, “I decided to know nothing among you, except Jesus Christ and Him crucified.”

The crucifixion of Jesus Christ is the single most important event in the history of the world. It changed everything—absolutely everything. Unless God Himself became a man and suffered the penalty for all sins, the penalty would still remain unpaid. But God the Father did offer up His only begotten Son. The only begotten Son of God did give His life for the sins of the world. As a result, everyone who repents can truly be forgiven every sin he has ever committed. The blood of Christ does that!

Jesus’ death was the one human sacrifice that counts. But it was not just a sacrifice by any means at all. Jesus was not thrown off a cliff—although they tried (Luke 4:29-30). He was not stabbed with knives, like Julius Caesar, or poisoned like Socrates. He wasn’t even stoned to death—although they tried that, too (John 8:59). 

God Himself tells us the reason why He wasn’t stoned. “This was to fulfill the word that Jesus had spoken to show by what kind of death Jesus would die” (John 18:32). On multiple occasions Jesus had said, “See, we are going up to Jerusalem. And the Son of Man will be delivered over to the chief priests and scribes, and they will condemn him to death and deliver him over to the Gentiles to be mocked and flogged and crucified, and he will be raised on the third day” (Matthew 20:18-19). 

There is something so special about this kind of death that God wanted to accomplish the single sacrifice for the sins of the world in that way and in that way only.

That is why the cross—and no other symbol—has become synonymous with Christianity from ancient times. Let us ponder that fact. Let us appreciate that God specifically chose it. Let us learn to rejoice in the cross of Christ like St. Paul and all the apostles did.

Jesus’ passion on the cross does not only refer to the pain that he endured. It also refers to the fact that it happened to him. “Passion” is derived from the word, “passive.” It is the opposite of active doing. It is passive receiving. 

From this we learn a great truth: Unless God Himself is actively working, we can accomplish nothing. Unless we are passively receiving the gifts of God, we are not being saved. That’s why St. Paul said, “I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me” (2 Corinthians 12:9).

In the cross of Christ I glory, 

Tow’ring o’er the wrecks of time. 

All the light of sacred story 

Gathers round its head sublime.

Cross Talk: The Divine Gift of Self Control

“What happens in Vegas stays in Vegas,” is one of the most well-known ad campaigns of all time. Despite its popularity, it is really a horrible slogan. It invites a person to ask what evil he would do if no one would ever find out.

How far would you go if you knew you would never be caught? Would you lie, steal, cheat, and commit adultery? Would you murder and take advantage of helpless people? What evil things might you do anonymously if you weren’t worried about your reputation?

As exercises in self-examination, such questions are terribly uncomfortable. If you turn them around and ask what your enemy might do to you if no one would ever find out, the world can become a very frightening place.

Imagine an enemy who has no restraints whatsoever. Imagine an enemy who sees everything you do and hears every word you say. Then imagine that this enemy is willing to do absolutely anything to harm you without any moral restraints at all.

You may be thinking about the CIA, FBI or some other three-letter agency that has the power to ruin your life. But these are small potatoes compared to Satan. If big government scares you, Satan should scare you far more. He is far more powerful than any human agency, and he has no humanity at all that might tug at his conscience.

Of course, there is One—and only One—who is more powerful than Satan. God is all-powerful and all-knowing. But, unlike Satan, God has self-restraint. The fundamental difference between God’s character and Satan’s is that there are certain things that God will not do.

The self-restraint of God is what we call goodness. And, as Jesus makes plain, “No one is good except God alone” (Luke 18:19 ESV). This is why the fear of God is not at all like the fear of Satan. We have reason to fear the devil because he is unbounded evil. We both fear and love God because He is unbounded goodness.

The most amazing thing about God’s goodness is that He maintains His self-control and goodness even in His confrontation with the devil. Even when faced with Satan, who will stop at nothing in his pursuit of evil, God never stoops to do evil.

Rather, He sacrifices Himself on the cross to defeat Satan with all his power and willingness to do evil. In fact, Jesus’ own self-control is the way that He defeats the unrestrained evil of Satan. In so doing, He proves once and for all that goodness is not a hindrance in fighting evil. Rather, it is the only way.

That brings us back to the Christian ethos. Rather than saying, “What happens in Vegas stays in Vegas,” Jesus says, “everyone who does wicked things hates the light and does not come to the light, lest his works should be exposed. But whoever does what is true comes to the light, so that it may be clearly seen that his works have been carried out in God” (John 3:20-21).

In this world we see evil men who are willing to do and say anything and who desperately hide their actions. They do not restrain themselves, but do whatever they can get away with. This should not make us envious. It should arouse our pity.

Here we see the demonic consequences of the loss of self-control. These frightful displays give opportunity to repent of our own lack of self-restraint and to pray. We should pray both for forgiveness and for the fruits of the Holy Spirit: “Love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control” (Galatians 5:22-23).

Cross Talk: Choices

Life is a series of choices. Some of them, you make. Most are made for you. Starting with your conception, God chose for you which one of myriad eggs would be released and which of millions of gametes would fertilize that egg to make a zygote. That choice determined your DNA for life.

But God’s choice of your DNA was only the beginning. Choices that your mother made while you were growing in her womb, choices that your father made and choices that community and national leaders made without your input, all determined uncounted aspects of your life. All of this happened without your choice or approval.

Embryologists have yet to learn when you made your first choice. When did you first do something that was not determined from outside of you—and what was it? Was it a thought? Was it the voluntary movement of an arm? Was it at two weeks’ gestation, or eight weeks? Whatever and whenever it was, it was a choice within strict limitations. Choice to clench your fist—is only possible if you have a fist to clench. A choice to swing it at something is limited by the reach of your arm.

That is the thing about choice. It is always the result of God’s prior choice. Because we are His creatures, no one of our choices is fully free. Some of the limits placed on your choice are direct limits from God. Others come through other people.

God alone determines how tall you are and how high you can jump. By physical training, you can strengthen your body to get closer to that God-imposed limit, but you can never exceed it. But there are other limits that God imposes by way of command. God’s “thou shalt not” requires your agreement. Unlike the law of gravity, you are not forced to obey. But those who don’t obey bring all sorts of trouble and misery into their lives.

The judgment of God lies at the intersection of these two sorts of choices. He first makes choices for you that equip you to do things. Then, He tells you how you ought to use these things. For instance, he gives you legs to walk, arms to carry, eyes to see your brother in need, and more food than you need for yourself. Only after giving you all these gifts does he say, “go feed your hungry brother.”

You can either obey his command because He enabled you, or you can defy Him. The choice is yours. But one choice is right and the other is wrong. God is the judge. God is the judge because He gave you the choice in the first place. He is not an intruder into your choices, He is the giver of choices.

God gave us our lives, our bodies, our choices and then taught us how to use all these great gifts. Not only do you have no reason to resent His loving guidance to those who keep His commandments, you learn by experience that God’s will is always better than your own ideas. His ways are sheer delight, wholly human, and fully satisfying.

Best of all, God became a man just like you. He, and He alone, made all the right choices. He lived the perfect life of love. He could do anything He wanted—with unlimited power and sovereignty. But He chose to use His human body—the body of the Word made flesh—to live for you and to die for you.

That’s why it is such a comfort to know that, on the Day of Judgment, God will sit on the judgment seat in the body of Jesus. Your judge will be one who lived the human life. Your judge will also be the One who died that you might live.

Believe in Him and you will have no need to be afraid in the Day of Judgment. Believe in Him and your life, already now, will begin to look like His life. And that’s a beautiful choice.

Cross Talk: Christians honor authorities

In recent months, Romans 13 has received a great deal of attention. While this chapter is too great to cover completely, let’s walk through a few of its most important teachings.  

Paul begins, “Let every soul be subject unto the governing authorities. For there is no authority except from God, and the authorities that exist are appointed by God. Therefore whosoever resists the authority, resists the ordinance of God. and those who resist will bring judgment on themselves.” (Romans 13:1-2).

We should notice, first, that Paul puts submission to authority as the first priority. It is the foundation stone of a godly life. God himself has created human beings to live in hierarchies. To be godly people requires recognition that God puts us in relationships of authority and humility. To live in insubordination brings harm (judgment) to ourselves.

Second, know that authorities are not only presidents and governors. God-ordained relationships also include parents and children, husbands and wives, teachers and students, police and citizens. Authority is not oppression, and subordination is not being oppressed. On the contrary, humbling ourselves before authority that has been ordained by God is empowering. And authorities that recognize the source of their power are necessarily humble.

Third, St. Paul reminds us that God gives authority for our good. “For rulers are not a terror to good works, but to evil. Do you want to be unafraid of authority? Do what is good, and you will have praise from the same. For he is God’s minister to you for good. But if you do evil, be afraid; for he does not bear the sword in vain; for he is God’s minister, an avenger to execute wrath on him who practices evil” (Romans 13:3-4).

Government is not merely a “necessary evil.” It is a divine and blessed gift. That’s why Christians thank God for presidents, governors, husbands, parents, teachers and police. We don’t only thank God when they do what we want. We thank him for their very existence.

Fourth, we also recognize that they have a God-given responsibility. When they execute their office according to God’s command, it not only benefits us, it benefits them. Christians pray, “May all that receive the sword as Thy ministers bear it according to Thy commandment.” We do this not only for our own sake, but also for their benefit. We ask God’s blessing upon them as persons.

Fifth, authorities are persons. We must never lose sight of that. The great evil of vitriolic “identity politics” is that people seek to dehumanize political opponents. Those who get caught up in this evil, never succeed in dehumanizing their targets. They do, however, dehumanize themselves. Christians must fight against this evil by praying constantly for all those in authority.

Sixth, the current political ugliness has another consequence as well. Those under our own authority learn from our attitudes toward others. That is why we see—across the board—a widespread disrespect for authority. Students are rude and disobedient toward teachers. Children disrespect parents. This will not be reversed unless we learn to treat state and national authorities with honor and dignity.

“Therefore you must be subject, not only because of wrath, but also for conscience’ sake” (Rom. 13:5). The unbelieving world grudgingly submits to authority only as much as necessary to escape punishment. Christians have a completely different attitude. We consider authorities as gifts from God. We help and support them with kindly advice, patience, deference, and fervent prayer.

We know that they are crowned by Jesus Christ, the One who Himself was crowned with thorns and rules over all the kingdoms of this world.