The Principle of “Damage Exclusion” as a Benchmark in Catholic Discussions of Homologous Artificial Insemination

Abstract

The Catholic perspective rejects assisted human reproduction techniques, but the morality of artificial insemination (AI) is open for discussion. This article aims to analyze the morality of AI from a new angle, namely whether these interventions exclude all possibility of damaging the human embryo and the offspring’s health. The scientific evidence about the children’s health who are born through AI allows us to affirm that the procedures do not comply with the principle of damage exclusion: AI does not exclude all possibility of damaging the embryo and impacting the health and exposure to disease of the offspring born through these techniques.

This is a preview of subscription content, access via your institution.

Notes

  1. 1.

    Both these assisted reproduction techniques are termed “high-complexity” techniques, compared to the variants of artificial insemination, which are deemed “low-complexity” techniques.

  2. 2.

    Humanae Vitae (point 12): “The reason is that the fundamental nature of the marriage act, while uniting husband and wife in the closest intimacy, also renders them capable of generating new life—and this as a result of laws written into the actual nature of man and of woman. And if each of these essential qualities, the unitive and the procreative, is preserved, the use of marriage fully retains its sense of true mutual love and its ordination to the supreme responsibility of parenthood to which man is called.”

  3. 3.

    It is referred to as homologous because the gametes are from the same spouses.

  4. 4.

    It is important to note here the difference between “fertilization” (IVF) and “insemination” (AI); although both are artificial, they correspond to two different artificial reproductive technologies (ARTs), where the former includes embryonic manipulation, which is why it is considered illicit.

  5. 5.

    This last sentence is also mentioned in Donum Vitae (Ratzinger 1987).

  6. 6.

    In his dissertation on GIFT (Intrafallopian Insemination of Gametes, an AI variant), he comments: “Members of the Department of Bioethics of the Faculty of Medicine of the Università del Sacro Cuore in Rome, Monsignor Sgreccia with teachers Spagnolo and Di Pietro, they think that in the discussion of the morality of the ideal GIFT, there is no clear and definitive reason to reject the technique.” See “GIFT: Procedure and ethical assessments” (Gómez Cantero 1997).

  7. 7.

    For an explanation of the different arguments regarding AI, see “Different positions on the ethical assessment of insemination” (Páez 2012).

  8. 8.

    https://www.ncbcenter.org/resources/church-documents-bioethics/new-charter-health-care-workers/.

  9. 9.

    As clarified in Introduction, low-complexity techniques refer to AI variants.

  10. 10.

    See original source: https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d7513160fc3f&pitd=20180719&n=pt45.1.46&r=PART&ty=HTML#se45.1.46_1102 o bien https://www.law.cornell.edu/cfr/text/45/46.102.

  11. 11.

    This position is subtly different from the view of parenthood as a vocation—commonly espoused in the Catholic Church—for which a child is a gift given by God that fulfills this vocation (Padela and Clayville 2018). We agree with Martin Rhonheimer on this point: “The legitimate desire to have a child can only be simply a hope for the coming about of a new human life, and not a desire in the sense of an ‘ordaining,’ in which the desire in effect brings about (so to speak) the fulfillment” (Rhonheimer and Murphy 2010).

  12. 12.

    In an attempt to clarify or interpret the meaning of substitution or aid in a medical intervention with regard to the conjugal act’s dual unitive and procreative meaning.

References

  1. Akbari Sene, A., Ghorbani, S., & Ashrafi, M. (2018). Comparison of the pregnancy outcomes and the incidence of congenital fetal abnormalities in infertile women treated with letrozole and clomiphene citrate. Journal of Obstetrics and Gynaecology Research, 44(6), 1036–1041. https://doi.org/10.1111/jog.13644.

    CAS  Article  Google Scholar 

  2. Caffarra, M. C. (1988). The moral problem of artificial insemination. The Linacre Quarterly, 55(1), 37–43.

    Article  Google Scholar 

  3. Carlson, J. W. (1989). Donum Vitae on homologous interventions: Is IVF-ET a less acceptable gift than “gift”? The Journal of Medicine and Philosophy, 14(5), 523–540.

    CAS  Article  Google Scholar 

  4. Davies, M. J., Moore, V. M., Willson, K. J., Van Essen, P., Priest, K., Scott, H., et al. (2012). Reproductive technologies and the risk of birth defects. New England Journal of Medicine, 366(19), 1803–1813.

    CAS  Article  Google Scholar 

  5. Doerfler, J. F. (1997). Is GIFT compatible with the teaching of Donum Vitae? The Linacre Quarterly, 64(1), 16–29.

    Article  Google Scholar 

  6. El-Chaar, D., Yang, Q., Gao, J., Bottomley, J., Leader, A., Wen, S. W., et al. (2009). Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertility and Sterility, 92(5), 1557–1561.

    Article  Google Scholar 

  7. Gaudoin, M., Dobbie, R., Finlayson, A., Chalmers, J., Cameron, I. T., & Fleming, R. (2003). Ovulation induction/intrauterine insemination in infertile couples is associated with low-birth-weight infants. American Journal of Obstetrics and Gynecology, 188(3), 611–616. https://doi.org/10.1067/mob.2003.5.

    Article  PubMed  Google Scholar 

  8. Gómez Cantero, Ó. (1997). Gift: Procedimiento y valoraciones eticas. Doctoral dissertation, Universidad de Navarra.

  9. Gutarra-Vilchez, R., Santamaria-Rubio, E., Salvador, J., Borrell, A., Santamariña-Rubio, E., Salvador, J., et al. (2014). Birth defects in medically assisted reproduction pregnancies in the city of Barcelona. Prenatal Diagnosis, 34(4), 327–334. https://doi.org/10.1002/pd.4286.

    Article  PubMed  Google Scholar 

  10. Hargreave, M., Jensen, A., Nielsen, T. S. S., Colov, E. P., Andersen, K. K., Pinborg, A., et al. (2015). Maternal use of fertility drugs and risk of cancer in children—A nationwide population-based cohort study in Denmark. International Journal of Cancer, 136(8), 1931–1939. https://doi.org/10.1002/ijc.29235.

    CAS  Article  PubMed  Google Scholar 

  11. Inhorn, M. C., & Tremayne, S. (2016). Islam, assisted reproduction, and the bioethical aftermath. Journal of Religion and Health, 55(2), 422–430. https://doi.org/10.1007/s10943-015-0151-1.

    Article  PubMed  Google Scholar 

  12. Klemetti, R., & Gissler, M., (2005). Children born after assisted fertilization have an increased rate of major congenital anomalies. Fertility and Sterility, 84(5). Retrieved from https://www.fertstert.org/article/S0015-0282(05)02926-2/pdf.

  13. Klemetti, R., Sevón, T., Gissler, M., & Hemminki, E. (2010). Health of children born after ovulation induction. Fertility and Sterility, 93(4), 1157–1168. https://doi.org/10.1016/j.fertnstert.2008.12.025.

    Article  PubMed  Google Scholar 

  14. Ombelet, W., & De Sutter, P. (2014). Perinatal outcome after IUI. In B. Cohlen & W. Ombelet (Eds.), Intra-uterine insemination: Evidence based guidelines for daily practice (pp. 139–144). Boca Raton, FL: Taylor and Francis Group.

    Google Scholar 

  15. Ombelet, W., Martens, G., De Sutter, P., Gerris, J., Bosmans, E., Ruyssinck, G., et al. (2006). Perinatal outcome of 12 021 singletons and 3108 twin births after non-IVF-assisted reproduction: A cohort study. Human Reproduction (Oxford, England), 21(4), 1025–1032. https://doi.org/10.1093/humrep/dei419.

    Article  Google Scholar 

  16. Ombelet, W., Peeraer, K., De Sutter, P., Gerris, J., Bosmans, E., Martens, G., et al. (2005). Perinatal outcome of ICSI pregnancies compared with a matched group of natural conception pregnancies in Flanders (Belgium): A cohort study. Reproductive BioMedicine Online, 11(2), 244–253. https://doi.org/10.1016/S1472-6483(10)60965-0.

    Article  PubMed  Google Scholar 

  17. Páez, G. (2012). Different views on the ethical evaluation of isemination. Persona y Bioética, 16(2), 137–148.

    Article  Google Scholar 

  18. Padela, A. L., & Clayville, K. (2018). Treating infertility with transplantation: Theological views on whether infertility is a disease. The American Journal of Bioethics, 18(7), 40–42. https://doi.org/10.1080/15265161.2018.1478031.

    Article  PubMed  Google Scholar 

  19. Pío, XII. (1949). Discurso a los participantes en el IV Congreso Internacional de los Médicos Católicos, 29 de septiembre de 1949: AAS 41.

  20. Poon, W. B., & Lian, W. Bin. (2013). Perinatal outcomes of intrauterine insemination/clomiphene pregnancies represent an intermediate risk group compared with in vitro fertilization/intracytoplasmic sperm injection and naturally conceived pregnancies. Journal of Paediatrics and Child Health, 49(9), 733–740. https://doi.org/10.1111/jpc.12257.

    Article  PubMed  Google Scholar 

  21. Ratzinger, J. (1987). Donum Vitae. Instruction on respect for human life in its origin and on the dignity of procreation, February 22. Retrieved February 19, 2019 from http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html.

  22. Ratzinger, J. C., & Bovone, A. (1987). Instruction on respect for human life in its origin and on the dignity of procreation. The Linacre Quarterly, 54(2), 24–49. https://doi.org/10.1080/00243639.1987.11877891

    Article  Google Scholar 

  23. Reefhuis, J., Honein, M. A., Schieve, L. A., & Rasmussen, S. A. (2011). Use of clomiphene citrate and birth defects, National Birth Defects Prevention Study, 1997–2005. Human Reproduction, 26(2), 451–457. https://doi.org/10.1093/humrep/deq313.

    CAS  Article  PubMed  Google Scholar 

  24. Rhonheimer, M., & Murphy, W. F. (2010). Ethics of procreation and the defense of human life: Contraception, artificial fertilization, and abortion. Washington, DC: Catholic University of America Press.

    Google Scholar 

  25. Rosner, F. (1983). In vitro fertilization and surrogate motherhood: The Jewish view. Journal of Religion and Health, 22(2), 139–160. https://doi.org/10.1007/BF02296394.

    Article  PubMed  Google Scholar 

  26. Sarmiento, A. (1990). Aspectos éticos de la Gift. Scripta theologica: revista de la Facultad de Teología de la Universidad de Navarra, 22(3), 907–915.

    Google Scholar 

  27. Schenker, J. G. (2005). Assisted reproduction practice: Religious perspectives. Reproductive Biomedicine Online, 10(3), 310–319.

    Article  Google Scholar 

  28. Schenker, J. G. (2008). Assisted reproductive technology: Perspectives in Halakha (Jewish religious law). Reproductive BioMedicine Online, 17(SUPPL. 3), 17–24. https://doi.org/10.1016/S1472-6483(10)60326-4.

    Article  PubMed  Google Scholar 

  29. Sgreccia, E. (2009). Manual de Bioética, tomo I. Fundamentos y ética biomédica, 4(1), 615–620.

    Google Scholar 

  30. Stanford, J. B., Simonsen, S. E., & Baksh, L. (2016). Fertility treatments and adverse perinatal outcomes in a population-based sampling of births in Florida, Maryland, and Utah: A cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology, 123(5), 718–729. https://doi.org/10.1111/1471-0528.13510.

    CAS  Article  Google Scholar 

  31. Yeprem, M. S. (2007). Current assisted reproduction treatment practices from an Islamic perspective. Reproductive BioMedicine Online, 14, 44–47.

    Article  Google Scholar 

  32. Zhu, J. L., Basso, O., Obel, C., Bille, C., & Olsen, J. (2006). Infertility, infertility treatment, and congenital malformations: Danish national birth cohort. BMJ, 333(7570), 679.

    Article  Google Scholar 

  33. Zhu, J. L., Basso, O., Obel, C., Hvidtjørn, D., & Olsen, J. (2009). Infertility, infertility treatment and psychomotor development: the Danish National Birth Cohort. Paediatric and Perinatal Epidemiology, 23(2), 98–106.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Francisco Güell.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Navarro-Rubio, S., Güell, F. The Principle of “Damage Exclusion” as a Benchmark in Catholic Discussions of Homologous Artificial Insemination. J Relig Health 60, 268–281 (2021). https://doi.org/10.1007/s10943-019-00913-8

Download citation

Keywords

  • Assisted human reproduction
  • Offspring’s health
  • Catholic morality
  • Human embryo
  • Gamete manipulation