The Common Denominator: IVF, Prenatal testing, and Comfort Care

"As you do not know the way the spirit comes

to the bones in the womb of a woman with child, so you do not know

the work of God who makes everything.”

Ecclesiastes 11:5 ESV

by Dr. Patricia Lee June, PPL Board Member

What do IVF, prenatal testing and comfort care have in common?

All may be used for good or for evil.

Every living creature will die one day, whether on the day their life begins as a one-cell zygote, or whether over a century later. We all have a lethal condition. Therefore, describing an embryo/fetus/infant/child as having a lethal condition is saying no more than they are currently living and one day will die. Someone with a shorter than average life expectancy has a life-limiting condition, but their condition is not at present incompatible with life.

Some abnormalities are severe enough that the embryos involved live less than two weeks, and their parents or physicians may never know that the embryo existed. Less often, some abnormalities result in spontaneous abortions (miscarriages) prior to birth, but many children with severe abnormalities survive well in the intrauterine environment, including many with anencephaly. Although most infants with anencephaly die within half an hour of birth, there are some children (probably with less severe forms) that have lived for up to a couple of years after birth.

Increasingly and commonly, abnormalities can be treated that previously were incompatible with extrauterine life, although well compatible with life prior to birth. They include Potter Syndrome, trisomy 13 and trisomy 18, and some severe diaphragmatic hernias and tumors. Sometimes this requires prenatal surgery overseen by a Maternal-Fetal Medicine specialist. To call these children incompatible with life is a self-fulfilling prophecy. If you don’t repair cardiac defects or micrognathia or give amnio infusions prior to birth, these children will die within days to a few months; but if they are treated, many can survive to their teens and even beyond.

An overlapping category is that of function-limiting conditions. In Iceland, every child with Down Syndrome is prenatally diagnosed and killed prior to birth. In some countries, children with other chronic diseases and malformations, including Cystic Fibrosis, cleft palate/lip, clubfoot, are being killed prior to birth.

In-vitro fertilization (IVF) has resulted in many formerly childless parents having children. But it also involves both intrinsic and extrinsic moral dilemmas. The Christian Medical and Dental Associations (CMDA) has a well-thought-out paper on the ethics of IVF. (See below.)

Even when used between husband and wife, the usual practice with IVF is to hormonally cause super-ovulation, create more embryos than can safely be implanted at one time, dispose of embryos graded subpar or who failed genetic testing, and freeze any embryos that are not inserted in the uterus at the time. It is not clear why, but a higher percentage of embryos die, even when not frozen, than those conceived naturally, as do an even higher percentage of those who are frozen and thawed. Since all embryos are created in the image of God, this is inconsistent with Scripture.

Prenatal testing can be of value when it is used to provide improved treatment for the child, such as avoiding certain amino acids in some metabolic disorders, or if planning delivery in a hospital with a NICU for a child with complex cardiac malformations. But when used to diagnose children whose anticipated “quality of life” does not meet certain standards and kill them prior to birth through abortion, it is evil.

Comfort care has been promoted as a pro-life alternative for children diagnosed with severe anomalies. There are some conditions for which we have no treatment such as anencephaly, and allowing the parents to enjoy their child for all the days that God gives him or her is certainly a positive. However, using “comfort care” or “perinatal hospice” to allow the child to die of medical neglect is not consistent with God’s call to care for the least of these. Historically, some children with Down syndrome who had intestinal obstruction were starved rather than having surgical repair of the obstruction. Denying cardiac surgery to the children with Trisomy 13 and Trisomy 18 because of their trisomy is no longer justifiable. It will not cure their medical and intellectual disabilities, but it will allow them years to give and receive love and glorify God.

May God grant us the wisdom to know when medical procedures/medications are futile and should not be (further) pursued and when their use is to His glory.

https://cmda.org/president-trumps-executive-orderon-ivf/ (CMDA link) https://www.christianpost.com/voices/toevangelicals-ivf-bioethical-questions-to-grapplewith.html (The Center for Bioethics and Human Dignity)

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