Life is filled with many things that we appreciate: health and children are among some of the most treasured things we enjoy. We all appreciate health, as sickness, disease and disorders can affect what we consider a “normal” life. There is also a desire in most of us to raise children.
But as good as health and children are, are they ends to be pursued at any means? Much in our modern health practice has evolved to accommodate these good ends. We have better care for pregnant women and unborn babies than ever before. But we also have many practices that remain unquestioned. In this episode of the CCL podcast, we consider ethical issues related to pre-pregnancy and pregnancy screening.
Links referred to:
- Watch Jonathan Morris speaking at our “Facing infertility as a church family” event in November 2020
- Our next event: Commanding the heart: Vengeance (Wednesday 19 October 2022)
- Support the work of the Centre
Runtime: 29:24 min.
Transcript
Please note: This transcript has been edited for readability.
Introduction
Chase Kuhn: Life is filled with many things that we appreciate: health and children are among some of the most treasured things we enjoy. We all appreciate health, as sickness, disease and disorders can affect what we consider a “normal” life. There is also a desire in most of us to raise children.
But as good as health and children are, are they ends to be pursued at any means? Much in our modern health practice has evolved to accommodate these good ends. We have better care for pregnant women and unborn babies than ever before. But we also have many practices that remain unquestioned. In today’s episode, we consider ethical issues related to pre-pregnancy and pregnancy screening.
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CK: Hello and welcome to the Centre for Christian Living podcast. My name is Chase Kuhn. I’m coming to you from Sydney, Australia, at Moore Theological College, where I’m joined by my guest today: Professor Jonathan Morris. Professor Morris has been looking after gynaecology and obstetrics at Sydney University for a long time now. He’s also been doing a lot of clinical research, caring for young mothers and young life. We’re very glad to have you here, Jonathan!
JM: Thanks, Chase! Great to be here.
CK: Did I get all of your titles and everything that you’ve been doing right?
JM: Yeah, that will do. [Laughter]
CK: I’ve tried before at other events, and I know there’s so much you’ve been involved in in your life. But really at the heart of it is caring for women in pregnancy—especially high-risk pregnancy—and young life. Is that correct?
JM: That’s right. I’m what’s known as a “maternal fetal medicine specialist”. That is a subspeciality of the discipline of obstetrics, which essentially cares for women who have high-risk pregnancies. The risk may be due to conditions they have themselves—such as women with medical disorders who become pregnant. But also I’m particularly caring for women who develop complications in pregnancy, which may either be complications in their own medical health or that of their baby’s.
Pre-pregnancy screening
CK: That’s part of the reason why I’ve asked you on today. We’ve had you before for events, and I’m grateful for the input you’ve given to us previously. But today I wanted to ask you about the kind of screening that happens—either during pre-pregnancy, before a woman might conceive a child, or even during pregnancy—the sort of screening happening today that’s seemingly more common. Speaking personally, I rang you at one point when my wife pregnant with one of our children, and said, “I’m being asked to do all these tests. Do I need to do this? Is it normal? Should I do it?” It seems that between my first child and my subsequent children, there were more and more things being asked of us and being normalised. I thought I’d get your input on this: tell us about the kinds of things parents expect these days as they go through pregnancy.
JM: That’s right, Chase. Over the last decade, we’ve seen an explosion of possibilities that relate to testing the unborn baby—not only in pregnancy, but now, increasingly, couples, before embarking on pregnancy, are being encouraged to undergo screening for both themselves and their partner for a whole range of possible genetic conditions.
This has been introduced now into clinical practice. It’s something that is widely offered. But I think the widespread offering is matched by widespread confusion among those who are planning pregnancy. So I think it really behoves us to consider, “What do we want?”, “What do we think?” and “What is the significance of the life we wish to nurture?”
CK: Yeah. Centuries ago, you got pregnant and then you had a child; that’s the way it goes. Now, increasingly, you have more and more appointments to check on health, which seems really good. Positively speaking, what’s the reason why these screenings have been introduced?
JM: These tests are being introduced to prevent genetic conditions. Some of these conditions are undoubtedly very significant: some of them mean a child will potentially only live for a very short period after birth. Other conditions are relatively mild and are associated with long, productive lives, but are still conditions that require medical input. Traditionally, people would be very familiar with testing for Down syndrome. Testing for this has become very widespread and there are now countries in the world where Down syndrome has been eliminated through termination of pregnancy, once diagnosed. Iceland, for instance has very, very few babies born with Down syndrome.
We’ve progressed on from that, though—from chromosome problems, which, like Down syndrome, is a numeric issue: there’s either an extra chromosome—or for other conditions, there is a chromosome missing. We’re now going into single gene problems—of which there are many. The latest tests would screen for about 290 genetic conditions.
CK: Wow! Are they searching for those now to intervene? Maybe I should ask this instead: you’ve said a negative that comes out of this—that is, if there are complications detected, often this is leading to a termination of life. That is a very problematic thing for us in terms of a Christian worldview, where we want to value all life.
Are these to screen out a range of genetic issues before pregnancy happens? Are they just to terminate? Or are they ever to modify and have positive medical intervention during pregnancy that might lead to better life conditions?
JM: This is a really important question. What people need to understand is that the supposition and the basis for the testing for these conditions is very much to prevent a child being born with that condition. So for these conditions, it’s not a case that we will offer treatment in the course of the pregnancy to improve pregnancy outcomes; it very much is offering a termination of pregnancy if the condition exists.
If we consider it in the preconception, so many of these conditions are what is known as “autosomal recessive”—such that if each person in the couple carry this gene, they would have a one in four chance of having a baby who is affected. So the supposition is that should a couple be shown to be carrying one of these genes, they can be offered IVF. Then the embryos can be tested such that those embryos carrying the gene cannot be replaced and embryos that are gene-free can be transferred. Hence this is what is being sold as being a “healthy” pregnancy.
If you say yes to this screening, that’s really the value proposition. For instance, in pregnancy, a common condition would be cystic fibrosis. I’ve looked after women who have cystic fibrosis who have babies themselves. But at the moment, that’s one of the 289 conditions that would be screened for in pregnancy. If each person in the couple carries one of the genes for cystic fibrosis, the couple are offered an amniocentesis with a view to considering termination.
So it’s really important to realise that these conditions are screened for with the thinking that, should they be present in the baby, the prospect of continuing or not continuing with the pregnancy should be considered. In addition, in pregnancy and prior to pregnancy, the prospect of undergoing artificial reproduction technologies to choose embryos not affected also needs to be considered. That has profound implications for couples and for our society.
A life worth living?
CK: Yeah. That’s the way they’re marketing it, and it really is a marketplace, isn’t it: the way they’re marketing this is that it means a better quality of life for you and a better quality of life for the child you might raise. So there is a determination before birth that a certain kind of life may not be worth living. Is that correct?
JM: I think that’s the fundamental, foundational issue here: it’s about trying to determine what is the life that is worth living? Are there lives that shouldn’t be lived? How can technology contribute to parents, in terms of determining what characteristics their child should have? As I’ve said before, is it a child’s genetic sequence that determines its significance? It’s a deep question Christians need to ponder.
CK: Yes, absolutely. You raised something interesting a moment ago: we were talking about genetic screening before a pregnancy, and if there’s a recognition of a recessive gene, you might then intervene using artificial reproductive technology. In terms of helping people understand the process of IVF, what would happen if these genes are detected? Will life be created—sperm and an egg brought together to create an embryo in a laboratory? Is that correct? And is it right that once that embryo is formed, they will then do a genetic screening on that embryo?
JM: That’s right, Chase. If parents undergo this sort of screening for these 280-300 genes, if they both carry the same recessive gene, it is suggested to these couples that they undergo IVF. In that process, a woman—the mother—is stimulated to produce a large number of eggs. In one menstrual cycle, just a single egg is produced. IVF basically super-stimulates a woman such that many eggs can be retrieved.
Those eggs are then mixed with the partner’s sperm, and as many of the eggs as possible are fertilised. At that point, after the first few cell divisions—usually at about the eight-cell embryo stage—a cell is removed for embryo biopsy. That cell is tested to see whether this embryo carries the particular genetic condition or not. Obviously if it doesn’t, those embryos are frozen can be transferred. But those embryos that have the condition are discarded.
Now, in any IVF cycle, by nature, there’s always a large number of embryos that don’t survive. So essentially, both through the IVF process and through the selection of embryos, a lot of wastage is created in the embryo space.
The beginning of life
CK: Help us to get clear on this issue as a moral issue: where life is created in that embryonic form, as Christians, we really believe that that is a life. That is a child that is being formed in that moment. Is that correct?
JM: The beginning of life has huge implications for our theology and our thinking. I think every Christian needs to wrestle with the issue of “When does life begin?” Over the years, there have been debates about that.
It’s interesting to reflect on it biblically: consider Jesus, who came into this earth as a man. His conception is announced in the Bible. So it seems—both theologically, with scientific backing—that life begins at fertilisation. If that’s the case, it means those embryos—be they two, four or eight cells—are life. If Christians land on that point of view, it shapes your whole worldview about this issue.
CK: Yes. Then the termination of an embryo or the discarding of an embryo is then a discarding and a termination of life.
JM: That really becomes what Christians do need to wrestle with. Having a family—reproduction—is such an integral part of human flourishing. These are difficult issues, but they are ones I am concerned that Christians do really think through, prior to being in situations in which these tests are being offered or suggestions are being made. Like all things in our lives, putting down strong foundations before we encounter difficulties is much easier.
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CK: As we take a break from our program, I want to tell you about some more resources for your Christian life. First, I encourage you to browse the Centre for Christian Living website, where you’ll discover a wealth of resources, including past podcast episodes, videos from our events, and essays on important topics. Head over to ccl.moore.edu.au to find out more.
While you’re on our website, I encourage you to register for our final live event in 2022. As we conclude our series of events looking at “Commanding the heart” in Matthew 5, we’ll look at the topic of vengeance. From the dawn of time, systems of justice have demanded recompense for wrongs. The most fundamental systems have been kind for kind—that is, an eye for an eye, a tooth for a tooth, a life for a life, and so on. In fact, this sort of rudimentary justice system is biblical and lies at the foundation of much of the law in Scripture. But in the Kingdom, Jesus tells us that there is no room for vengeance. Indeed, life in the Kingdom demands forbearance and forgiveness.
What does this mean for us practically? Is there any justice? I invite you to join us on October 19 as Dr Andrew Errington leads us to discover how Jesus transforms our expectations and pursuits of justice, and leads us away from vengeance. Head over to ccl.moore.edu.au to register.
Now let’s get back to our program.
Early pregnancy
CK: We’ve been asking you about a lot of the science behind pregnancy. But I would like to shift for a moment in the conversation and talk about the kinds of experience that people have these days and what might drive some decisions. It seems to me that this industry is now playing to what typically has been a patient and is now a consumer. There are things that can be offered to you to make your life the way you hope for. That is, if you would like a child, we will try to facilitate a child. If you would like a healthy child, we could facilitate a healthy child. In places, there are bans on screening for the sex of the child, but if you would like a girl, you could have a girl. If you would like a boy, you could have a boy. Is that correct? Is that a right representation of some of the shifts that make it more complicated for Christians? Or is that too crude a painting?
JM: I think your crude painting is very accurate. I often reflect that in early pregnancy, we no longer congratulate people; we often just tell them about all the things that may go wrong. Have they considered this? I think the whole approach and emphasis in early pregnancy is one of screening for risks of this and that. It is heavily driven—particularly in those countries where these tests are available, often at the parents’ own expense—by a market that seeks to promote them, without necessarily emphasising some of the deep societal issues that this raises. Some of these conditions are of variable severity: you can’t always predict their severity, according to what the genetic sequence is. Some of them are highly controversial—for example, congenital deafness.
As Christians, we need to think about our responsibility as parents for caring for our child, regardless of the condition or nature of that child. This is in a world that’s getting increasingly complex. As Christians, although we can share and justify our worldview, I recognise we necessarily can’t impose it on those who don’t share that worldview. But I think it still behoves us to talk and to give a reason for the thinking we have.
Caring for parents
CK: Yeah. This is one of the things I really like about talking to you, Jonathan. You’ve been a friend of mine for a long time now, and I’ve found that you’re really patient in this process. You try to really care for people in what they might be feeling.
Not putting it so crudely that a parent might be a consumer, you know that there are couples out there who are desperate for a child. You know that there are couples who worry about the prospect of their child suffering from something that may make life more difficult for them, and who therefore want to protect them from that. You know that there are couples who would love for their child not to have similar things that they might have suffered themselves. So when these services are made available, we ought to be understanding about why people find them attractive. It’s not that they are wanting a designer lifestyle; they’re seeking after good things—life, health, etcetera—good gifts from God. And yet that is not the whole sum total of what makes for a good life, is it.
JM: That’s right. I entirely agree. The allure of some of these technologies—the promise that they offer—obviously it is something that, understandably, people wrestle with, because these are deep issues.
But having said that, the counterbalance is a community that cares—a community that can offer support. A community that cares is one where these challenges shouldn’t just be those of the parents. A community that cares is one that sees that there are wider support agencies. I think that many of the debates we have lose the fact that God gives us many things, but he also gives us the capacity to care. That counter argument is one we don’t hear.
For instance, all have seen babies with Down syndrome who have brought much joy to people’s lives. For a long time, those children were institutionalised and were denied education. We now have babies with Down syndrome that grow up to study tertiary education, and who know the Lord Jesus.
I just think that we need to be very careful. If it’s technology that rules our reproductive lives, there’s so much more to it than that.
CK: Yes, and I think you’ve just said something helpful: should we have a child with a severe disability or even a minor disability, the church community itself has so much to offer in the way that it can welcome, receive, love, support and care for those families. I’ve seen that in churches I’ve been involved with. I’ve seen it in family members who have children with varying disabilities, who have been loved, nurtured, cared for and been supported by the whole community.
Likewise, I’ve known couples who are infertile and who have continued to persist with naturally seeking children, and who have been loved and cared for in the community. I’ve also known couples who have really suffered through that and found it very difficult, because of churches placing such a high value on family.
All of these things come into the way we think about what kind of community we’re fostering as a church, and how we’re actually considering one another.
JM: Oh, absolutely! I think this is something our churches need to self-assess. Where are those families? Where are those children with these sorts of needs? Are they in our church congregations? Are these families made welcome? It’s so important to be both theologically truthful, on the one hand, and socially engaged and welcoming, on the other.
CK: Yeah, absolutely. Again, I just want to encourage you: I love the way you’ve patiently nurtured relationships and cared for people as they wrestle with these issues, helping to lead them towards truth, and yet also recognising that these are decisions they have to make on their own.
During pregnancy
CK: Let’s say a couple pregnant and that this is their first pregnancy. How would you imagine that pregnancy progressing? What kinds of advice would you give to couples about screening and what they must do or mustn’t do, and how they might go? At various stages along the way, they get ultrasounds. Is that normal? Should you get ultrasounds?
JM: Childbirth, generally, is so much safer now. As you know, I’ve spent some time in Africa where women still die of complications in pregnancy. Ultrasound has a real place in pregnancy: it has an application in ensuring that the mother is kept safe. Determining the position of the placenta, for instance, is very important. In addition, there are some conditions for the baby where it’s really helpful for these to be identified beforehand, as they may require some sort of intervention that can, at times, be life-saving. Babies sometimes have heart conditions. Sometimes babies have growth abnormalities, where the timing of the birth is really important. I think ultrasound, when it’s used to help guide management, is really important.
The next issue, though, is when sometimes those ultrasounds find things that can be concerning. Sometimes it’s clear from an ultrasound that a baby has a condition that means it won’t survive the pregnancy. But over my career, I’ve become alarmed at the readiness at which my profession will often advocate terminating the pregnancy, rather than let a pregnancy run its natural course.
I think if one looks at life, it’s interesting: if one accepts the thesis that life begins at birth, there are some babies who live just a few weeks and there’s a miscarriage; there are those who die late in pregnancy; and there are some who die soon after birth. If we see life as a continuum from fertilisation to 80-100 years, we will see that lives last across that continuum. It’s important, therefore, that if these tests do show any concerns, there must be deep discussion and thoughtfulness about any action that should be taken.
We then come to the sort of tests that are advocated—like blood tests to screen for Down syndrome and other conditions. Again, I think people really need to think carefully about whether the result of that test would alter their decision to continue with the pregnancy. I would caution against undergoing tests just to provide reassurance, because although these tests are relatively accurate, they still do throw out possibilities that subsequently are shown to be erroneous. So you may be adding to your anxiety, and that sometimes leads to other testing.
So ultrasounds, I would advocate. I perform ultrasound myself and I think they’ve got a very useful place. But for tests that seek to establish or screen for genetic abnormalities, or tests that screen for the possibility of carrying genetic abnormalities or otherwise, I’d encourage couples to think really deeply about those. Are they tests that, should they indicate a problem, change a particular course of action?
Asking the right questions
CK: If a couple is talking to their medical practitioner, how many of these things have become just routine, and must you then go through these steps? Or how many of these things do you opt into or out of? I realise we’re in the state of New South Wales and that that might be different from other states, and different from other nations. We have listeners from all over the world. I’m just talking about being in a developed, western context like our own. What sorts of things have become routine now that may not be necessary?
I always take the advice of my medical practitioner, so I’m not saying people should be questioning their medical practitioner. What would you say as a doctor?
JM: There is now very much a situation where there is an assumed view that’s adopted by people caring for women in pregnancy. These tests are seen as something that people would like. They’re often not discussed; often in general practice, people are given just a referral form.
I do think these things have been introduced without the necessary societal awareness being raised, or societal debate carried out about whether our society wishes to offer tests to do away with congenital deafness, for instance. These are big issues for our society. I think they’ve been introduced without the necessary discussions. So certainly, as with any medical test, I’d encourage people to ask: is this something I have to have? Is this something I need? What are my options? What would happen if I don’t do this test?
CK: That’s very, very helpful.
Talking in Christian community
CK: As we wrap up our conversation, how can we talk about this well in our churches? I find that this is one of the most sensitive areas to talk about, because often people have history. Maybe they’ve done something that they might have changed their mind about and feel judged for. Maybe they’re in a desperate situation and are making decisions because of that. Maybe they’re just thinking ahead towards the future. Maybe they’re aware of their own genetic conditions from their family line. How can we begin to talk about these things? You and I are talking together in a room right now. But it’s a very sensitive topic when you’re in a situation like in a church. What do you encourage people to do?
JM: I think it’s really important that churches have forums where these issues are discussed. They need to be thoughtful. They need to be purposeful. But they need to be sensitive to all those possibilities you mentioned. There are obviously people who wrestle with these issues—who have made decisions in the past or who are struggling with decisions in the present. Obviously those discussions need to be in an appropriately safe setting, where people are reassured that there is a God who loves them, and that they are loved and forgiven through Christ.
But I do think these discussions need to be had. We need to recognise that they will raise further questions. We need to provide resources, expertise, and personnel to counsel and support people. But that doesn’t necessarily mean shying away from some of the truths that, as Christians, we hold dear.
Ultimately, I think we need to care for each other, and in that caring, we need to offer a society and a community that shares these burdens, whatever they are.
CK: That’s lovely. Jonathan, thank you so much for coming in today and talking with me. I’m grateful for the work you’ve done and the ministry you have. Thank you so much.
JM: Thanks, Chase!
Conclusion
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CK: To benefit from more resources from the Centre for Christian Living, please visit ccl.moore.edu.au, where you’ll find a host of resources, including past podcast episodes, videos from our live events and articles published through the Centre. We’d love for you to subscribe to our podcast and for you to leave us a review so more people can discover our resources.
On our website, we also have an opportunity for you to make a tax deductible donation to support the ongoing work of the Centre.
We always benefit from receiving questions and feedback from our listeners, so if you’d like to get in touch, you can email us at ccl@moore.edu.au.
As always, I would like to thank Moore College for its support of the Centre for Christian Living, and to thank to my assistant, Karen Beilharz, for her work in editing and transcribing the episodes. The music for our podcast was generously provided by James West.
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