Journal of Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
REPRODUCTIVE HEALTH CARE POLICIES AROUND THE WORLD
Religious Views Regarding Treatment of Infertility by Assisted Reproductive Technologies J O S E P H G. S C H E N K E R x
and women. When evaluating an infertile couple according to the Halakha (Hebrew taw), one should first evaluate the female factor. If pathology is found, one may proceed to investigate the male factor: inadequate or abnormal production, ejaculation, or deposition of spermatozoa. According to the Christian view there is no absolute right to parenthood. It is very important, but a marriage does not have to include children to be valid. A Christian infertile couple should not indulge in behavior that undermines marriage or family, or that is unacceptable, in their efforts to become parents. According to the Islamic view, attempts to cure infertility are not only permissible but even a duty. The Koran, as well as the Old Testament, gives a record from Abraham and Zakariya that to have progeny is a great blessing from God. The pursuit of a remedy for infertility is therefore quite legitimate and should not be considered as rebellion against the fate decreed by God. The duty of the physician is to help the barren couple to achieve successful fertilization, conception, and delivery of a baby. Buddhism has never been organized around a central authority, therefore Buddhists of all types in various countries have been comparatively individualistic, and even their scriptures are not rigid. Traditionally, Buddhism has imposed strict ethics on priests, while it has taken relatively lenient attitudes toward laypeopte. This means that Buddhist priests allow laypeople to do whatever they want to do as long as they do others no harm in a concrete way. This leads to the idea that we do not have to accept infertility as it is. If medical treatment for infertility is available, we can make use of it. Generally speaking, having no children will be a greater threat to a marital relationship than the practice of modern infertility technology. According to Bud-
INTRODUCTION Religion and science have been interrelated since the beginning of human history. Nowadays, religious groups still exert influence on civil authorities in the field of reproduction, such as regarding prevention of procreation and issues such as abortion and infertility therapy. Recent developments in science and technology in the field of reproduction raise new religious questions that do not always have clear answers. The role of theology in bioethics is, first, to clarify for the different religious communities what their attitude to new developments in the new fields of reproduction should be. Since religious groups have been active in pressing their bioethical concepts on the public arena in different parts of the world, it is of importance to those who practice assisted reproduction to learn about the religious attitudes related to the problem of infertility and its therapeutic approach.
ATTITUDE OF RELIGIONS TO THE PROBLEM OF INFERTILITY AND THERAPY The Jewish attitude toward infertility can be learned from the fact that the first commandment of God to Adam was "Be fruitful and multiply" (Genesis 1:28). According to Hebrew law, the infertile couple should be diagnosed and treated as a single unit. The medical treatment is different for men The opinions presented in this column are those of its author(s) and do not necessarily reflect those of the journal and its editors, publisher, and advertisers. Department of Obstetrics & Gynecology, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israel.
3
1058-0468/92/0200-0003506.50/0 © 1992 Plenum Publishing Corporation
4
SCHENKER
dhism, treatment should be given to unmarried as well as to married couples. Hinduism exerts its influence through the power of its thought over society and not by formal institutional authority. The important concepts of the Hindu religion relating to the problem of infertility are as follows: (a) Marriage is considered sacred and permanent. (b) Male infertility is not a cause for divorce. (c) The emphasis in reproduction is not just on having children, but on having a male offspring. (d) It is a religious duty to provide a male offspring. Therefore, the wife of a sterile male could be authorized to have intercourse with a brother in-law or another member of the husband's family for the purpose of having a male offspring.
ASSISTED REPRODUCTIVE TECHNOLOGIES
practice" regarding assisted reproductive technologies. It also advocates making it a crime. Eastern Orthodox View. The Eastern Orthodox Church supports medical and surgical treatments for infertility. Nevertheless, IVF and other assisted reproductive technologies are absolutely rejected. Protestant and Anglican View. The Protestant Church accepts traditional treatment of infertility. Assisted reproductive technologies are acceptable only if the gametes are from the married couple and the procedure avoids damage to the preembryo. Islamic View
The procedure of IVF and ET is acceptable according to Islam. It can be practiced only if it involves solely husband and wife and if it is performed during the span of their marriage. According to the Islamic view, the fusion of sperm and egg, a further step of sexual act, should take place only within the legal marriage contract. Buddhist and Hindu Views
Jewish View
The various aspects of the "test tube baby" are of considerable interest in the rabbinical literature (Responsa). The basic fact that allows in vitro fertilization (IVF) and embryo transfer lET) to be considered in the rabbinical literature at all is that the oocyte and the sperm originate from the wife and husband, respectively. The attitude favored by Jewish religious authorities, with regard to IVF and ET, is based on the commandment of procreation mentioned in the Bible.
lVF has been practiced in Japan since 1982 and is also practiced in other countries with Buddhist and Hindu populations. The practice of IVF raises another dilemma from the Buddhist and Hindu points of view, since it involves the procreation of more preembryos than are implanted in the uterus.
ARTIFICIAL INSEMINATION BY DONOR (AID)
Jewish View Christian View Roman Catholic View. The Vatican's statement on IVF is very clear. It does not accept IVF as a method for procreation. In 1959 Pope Plus XII declared that attempts at artificial human fecundation in vitro must be rejected as immoral and absolutely unlawful. The Vatican's instructions on respect for human life made a significant contribution to the discussion of the practice of new reproductive technologies. They state that noncoital technologies are morally illicit. The instructions call for the "reform of morally unacceptable civil laws for the correction of illicit
AID is indicated in cases of incurable male infertility or when the husband is a carrier of serious inherited disease or abnormality. It is used extensively throughout the world. The practice of AID is not morally acceptable to all infertile couples or their physicians, and it is unacceptable to various religious authorities. For many centuries Jewish religious authorities have discussed the principles involved in artificial insemination from a donor. The discussions are based on ancient sources in the Talmud and the codes of Jewish law. In the modern era rabbinical authorities have extensively discussed the practice of AID. The disJournal of Assisted Reproduction and Genetics, Vol. 9, No. I, 1992
RELIGIOUS VIEWS ON ASSISTED REPRODUCTIVE TECHNOLOGIES
cussions have focused on two issues: Is it permissible, according to Jewish law, to perform AID, or is the very act a transgression to adultery? and What is the status of the AID offspring? All Jewish legal experts agree that AID, using the semen of a Jewish donor, is forbidden. It is the severity of the prohibition that is debatable. The question is whether AID constitutes adultery, which is strictly forbidden by the Torah (the Pentateuch), or whether the injunction stems from other sourcesJmainly the legal complications of the birth of AID offspring--as most experts hold. Some rabbinical authorities permit AID when the donor is a non-Jew. This eliminates some of the legal complications with regard to the personal status of the offspring. If the semen donor is a gentile, the child is pagan (blemished); if the child is a female, she is forbidden to marry a Cohen (priest). AID, according to Jewish law, is prohibited for a variety of reasons: incest, lack of genealogy, and the problem of inheritance. Semen donors for AID, as well as physicians who use the semen, are violating the severe prohibition against masturbation. There are various views regarding the legal relationship that exists between the semen donor and the child born as a result of AID. Some rule that no relationship exists; others that the child should be regarded as the donor's child, with all the legal complications of incest, inheritance, levirate marriage, etc. The majority opinion is that the donor has not fulfilled the obligation of procreation by fathering an AID child. The practice of AID is accepted by part of the Jewish population in Israel, and according to the regulations of the Ministry of Health it is allowed in special circumstances.
Christian View The Roman Catholic Church condemns AID for married, as well as unmarried, women. The Vatican's instructions demand a strict connection between procreation and intercourse. Artificial insemination involves separation between "the goods and meaning of marriage" (which means separation between unitive and procreative). Concerning AID the instructions suggest that the AID process damages personal family relations as well as the offspring. The practice of artificial insemination is also rejected on the grounds that it is based on masturbation and that the AID process is an adulterous act. Journal o f Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
5
The Greek Orthodox Church opposes the practice of AID on the basis that it is an adulterous act. For the Protestant Church AID is mortally illicit and, at best, morally questionable. The Anglican Church allows semen collection by masturbation for artificial insemination by husband and for IVF. Islamic View The practice of AID is strictly condemned by Islamic law. If the husband's infertility is beyond cure, the infertility should be accepted; according to Islamic law AID is considered adultery. The procedure also entails the lie of registering the offspring of a man who is not the real father and, therefore, leads to confusion of lines of genealogy, whose purity is of prime importance to Islam. Therefore AID is not practiced by the Moslem population. Hindu View According to the Hindu view, in the case of male infertility the wife can be authorized to have intercourse with a brother in-law or another member of the husband's family in order to conceive a male offspring (only after 8 years of infertility or after 11 years of delivering only female offspring). According to the above statement this may lead to the conclusion that sperm donation can be practiced according to the Hindu view, with the restriction that the sperm donor must be a close relative of the husband. Buddhist View According to Buddhism, donation of sperm is not prohibited, but it is suggested to refrain from this procedure as much as possible.
OVUM DONATION There should not be any ethical problems with oocyte donation in societies where AID is acceptable. Oocyte donation has the advantage over AID, as both parents contribute to the birth of the child. Jewish View In the case of egg donation or embryo donation, the problem that arises is who should be consid-
6
ered the mother: the donor of the oocyte or the one in whose uterus the embryo develops, the one who gives birth. In the case that one of the women is Jewish and the other is not, the problem of the status of the child--whether or not he is a Jew--will arise. Jewish law states that the child is related to the woman who finished its formation--the one who gave birth. Christian View According to Christianity, in reality the origin of a human is the "result of an act of giving." The Vatican's instructions do not accept the donation of gametes to an infertile couple as an act of generosity. They state that conception by gamete donation (oocyte) can damage personal family relations, as well as the offspring and society. Oocyte donation is forbidden by three main branches of Christianity: Roman Catholic, Eastern Orthodox, and Protestant. Islamic View Ovum donation is similar to sperm donation and it involves the intervention of a third party other than the husband and wife. Therefore it would not be permitted according to Islam. Hindu and Buddhist Views According to Hinduism and Buddhism, it is suggested that oocyte donation can be practiced on the same grounds as sperm donation.
SCHENKER
sperm and, therefore, donates her oocyte and leases her uterus. Following birth the child is given to the infertile couple for adoption. Jewish View. The Jewish religion does not forbid the practice of surrogate motherhood. According to Jewish law, if partial surrogacy is practiced--a strange woman is inseminated with the sperm of a man and she completes the pregnancy on agreement--the child born should be handed over to the owner of the sperm. In the case of full surrogacy, when the embryo is transplanted into another woman, the question is not resolved, as discussed in the case of ovum donation. From the religious point of view, the child will belong to the father who gave the sperm and to the mother who gave birth. Christian View, The practice of surrogate motherhood is not accepted by the Christian religion, i.e., Roman Catholic, Protestant, or Anglican. The objection is on the basis that surrogate motherhood is contrary to the unity of marriage and to the dignity of the procreation of the human. Buddhist View. There is no Buddhist prohibition of the practice of surrogacy, but it may raise complications regarding the family ties and legal and moral aspects. Hindu View. According to Hinduism, there is no prohibition of the practice of surrogacy, but as in Buddhism, it may raise dilemmas regarding family ties and legal and moral issues. Special problems can arise when the surrogate mother delivers a female offspring, since according to Buddhism, there is an obligation to provide a male offspring.
SURROGACY CRYOPRESERVATION OF PREEMBRYOS Complete Surrogacy In cases of infertility due to uterine factors, when the woman is unable to carry the embryo, the ovum is fertilized with the sperm of her husband, after which it is implanted in the uterus of another woman, who gives birth as a "surrogate mother." Partial Surrogacy Partial surrogacy is when the surrogate mother is inseminated with another woman's husband's
Cryopreservation of preembryos is at present nearly routinely practiced in IVF programs. Jewish View The freezing of the preembryo raises the basic question of whether cryopreservation, which stops the development and growth of the embryo, cancels all rights of the preembryo's father. With regard to the mother, the problem is simplified, since the embryo is transferred into her uterus later and will Journal of Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
7
RELIGIOUS VIEWS ON ASSISTED REPRODUCTIVE TECHNOLOGIES
renew the mother-embryo relationship. With regard to the relationship to the father, whose main function is to fertilize the oocyte in order to form the preembryo, the period of freezing may cause a severing of the relationship between the child and his father. Freezing of sperm and preembryo is permitted only when all measures are taken to ensure that the father's identity will not be lost.
(b)
(c)
(d) Christian View
The freezing of embryos, even when carried out in order to preserve the life of the embryos, constitutes an offense against the respect due to humans, by exposing the embryos to great risks of death or harm to their physical integrity and depriving then, at least temporarily, of maternal shelter and gestation. Islamic View
According to islamic law, freezing of preembryos is acceptable. Buddhist View
Buddhism accepts cryopreservation of preembryos.
PREEMBRYO RESEARCH
Benefits from human preembryo and embryo research may be achieved in the following medical areas: (a) improving clinical results of assisted reproductive technologies, (b) diagnosing genetic aberrations and possible therapy, (c) contraceptive research, and (d) using embryonal tissue therapeutically for transplantation to adults with life-threatening medical conditions. Jewish View
(a) Creating and inducing a preimplantation embryo in vitro for fertility research should be allowed if there is a real chance that the Journal o f Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
(e)
sperm owner may benefit and have a child as a result of this research. Jewish law forbids destruction and use of a preembryo as long as it has a potential implantation ability. An in vitro blastocyst that hatches from its zona pellucida and loses its implantation potential may be kept for continuous research. Using a postimplantation preembryo for research is prohibited, unless the research is essential for saving the embryo's life. The arbitrary limit of 14 days approved for research on preembryos by some ethical committees is not recognized by Jewish law.
Christian View
Christianity recognizes the preembryo as a human from the stage of conception. Any research on the preembryo is forbidden. Islamic View
Some Islamic scholars may accept performing research on excess embryos resulting from IVF in order to increase their "ILM" (knowledge). It may be permissible in cases when it is for the sake of the individual embryo. Buddhist View
Buddhists believe that there is a continuity from life to life through many reappearances. According to many Buddhist scholars experimentation on preembryos is acceptable. Hindu View
Hinduism does not view the soul atman as having a specific beginning or specific end. Research on preembryos may be permissible when it is to help the infertile couple and it serves the dharma of the physician.
CONCLUSION
Nowadays, assisted reproductive technology is a common practice in the treatment of infertility. The
8
clinical achievements of this technology are due to the scientific progress in the field of human reproduction. Different religious arguments of the world's main religious impose limitations on the therapeutic approach to infertility. The prolonged conflict between religion and science is based on the difference in religious belief and scientific theory. The universal declaration of human rights has recognized the right of each individual to make decisions regarding his or her reproduction. Religious
SCHENKER
authorities, despite the powerful influence they exercise on public minds, should not prohibit a therapeutic approach to infertility, which would limit the area within which individuals are free to decide. Religious authorities, in order to maintain their strength, power, and efficiency, should undergo continual development, and change in the same way that science does. While religious principles may be unchangeable, they may, nevertheless, undergo significant changes in their implementation.
Journal of Assisted Reproduction and Genetics, Vol. 9, No. I, 1992
REPRODUCTIVE HEALTH CARE POLICIES AROUND THE WORLD
Religious Views Regarding Treatment of Infertility by Assisted Reproductive Technologies J O S E P H G. S C H E N K E R x
and women. When evaluating an infertile couple according to the Halakha (Hebrew taw), one should first evaluate the female factor. If pathology is found, one may proceed to investigate the male factor: inadequate or abnormal production, ejaculation, or deposition of spermatozoa. According to the Christian view there is no absolute right to parenthood. It is very important, but a marriage does not have to include children to be valid. A Christian infertile couple should not indulge in behavior that undermines marriage or family, or that is unacceptable, in their efforts to become parents. According to the Islamic view, attempts to cure infertility are not only permissible but even a duty. The Koran, as well as the Old Testament, gives a record from Abraham and Zakariya that to have progeny is a great blessing from God. The pursuit of a remedy for infertility is therefore quite legitimate and should not be considered as rebellion against the fate decreed by God. The duty of the physician is to help the barren couple to achieve successful fertilization, conception, and delivery of a baby. Buddhism has never been organized around a central authority, therefore Buddhists of all types in various countries have been comparatively individualistic, and even their scriptures are not rigid. Traditionally, Buddhism has imposed strict ethics on priests, while it has taken relatively lenient attitudes toward laypeopte. This means that Buddhist priests allow laypeople to do whatever they want to do as long as they do others no harm in a concrete way. This leads to the idea that we do not have to accept infertility as it is. If medical treatment for infertility is available, we can make use of it. Generally speaking, having no children will be a greater threat to a marital relationship than the practice of modern infertility technology. According to Bud-
INTRODUCTION Religion and science have been interrelated since the beginning of human history. Nowadays, religious groups still exert influence on civil authorities in the field of reproduction, such as regarding prevention of procreation and issues such as abortion and infertility therapy. Recent developments in science and technology in the field of reproduction raise new religious questions that do not always have clear answers. The role of theology in bioethics is, first, to clarify for the different religious communities what their attitude to new developments in the new fields of reproduction should be. Since religious groups have been active in pressing their bioethical concepts on the public arena in different parts of the world, it is of importance to those who practice assisted reproduction to learn about the religious attitudes related to the problem of infertility and its therapeutic approach.
ATTITUDE OF RELIGIONS TO THE PROBLEM OF INFERTILITY AND THERAPY The Jewish attitude toward infertility can be learned from the fact that the first commandment of God to Adam was "Be fruitful and multiply" (Genesis 1:28). According to Hebrew law, the infertile couple should be diagnosed and treated as a single unit. The medical treatment is different for men The opinions presented in this column are those of its author(s) and do not necessarily reflect those of the journal and its editors, publisher, and advertisers. Department of Obstetrics & Gynecology, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israel.
3
1058-0468/92/0200-0003506.50/0 © 1992 Plenum Publishing Corporation
4
SCHENKER
dhism, treatment should be given to unmarried as well as to married couples. Hinduism exerts its influence through the power of its thought over society and not by formal institutional authority. The important concepts of the Hindu religion relating to the problem of infertility are as follows: (a) Marriage is considered sacred and permanent. (b) Male infertility is not a cause for divorce. (c) The emphasis in reproduction is not just on having children, but on having a male offspring. (d) It is a religious duty to provide a male offspring. Therefore, the wife of a sterile male could be authorized to have intercourse with a brother in-law or another member of the husband's family for the purpose of having a male offspring.
ASSISTED REPRODUCTIVE TECHNOLOGIES
practice" regarding assisted reproductive technologies. It also advocates making it a crime. Eastern Orthodox View. The Eastern Orthodox Church supports medical and surgical treatments for infertility. Nevertheless, IVF and other assisted reproductive technologies are absolutely rejected. Protestant and Anglican View. The Protestant Church accepts traditional treatment of infertility. Assisted reproductive technologies are acceptable only if the gametes are from the married couple and the procedure avoids damage to the preembryo. Islamic View
The procedure of IVF and ET is acceptable according to Islam. It can be practiced only if it involves solely husband and wife and if it is performed during the span of their marriage. According to the Islamic view, the fusion of sperm and egg, a further step of sexual act, should take place only within the legal marriage contract. Buddhist and Hindu Views
Jewish View
The various aspects of the "test tube baby" are of considerable interest in the rabbinical literature (Responsa). The basic fact that allows in vitro fertilization (IVF) and embryo transfer lET) to be considered in the rabbinical literature at all is that the oocyte and the sperm originate from the wife and husband, respectively. The attitude favored by Jewish religious authorities, with regard to IVF and ET, is based on the commandment of procreation mentioned in the Bible.
lVF has been practiced in Japan since 1982 and is also practiced in other countries with Buddhist and Hindu populations. The practice of IVF raises another dilemma from the Buddhist and Hindu points of view, since it involves the procreation of more preembryos than are implanted in the uterus.
ARTIFICIAL INSEMINATION BY DONOR (AID)
Jewish View Christian View Roman Catholic View. The Vatican's statement on IVF is very clear. It does not accept IVF as a method for procreation. In 1959 Pope Plus XII declared that attempts at artificial human fecundation in vitro must be rejected as immoral and absolutely unlawful. The Vatican's instructions on respect for human life made a significant contribution to the discussion of the practice of new reproductive technologies. They state that noncoital technologies are morally illicit. The instructions call for the "reform of morally unacceptable civil laws for the correction of illicit
AID is indicated in cases of incurable male infertility or when the husband is a carrier of serious inherited disease or abnormality. It is used extensively throughout the world. The practice of AID is not morally acceptable to all infertile couples or their physicians, and it is unacceptable to various religious authorities. For many centuries Jewish religious authorities have discussed the principles involved in artificial insemination from a donor. The discussions are based on ancient sources in the Talmud and the codes of Jewish law. In the modern era rabbinical authorities have extensively discussed the practice of AID. The disJournal of Assisted Reproduction and Genetics, Vol. 9, No. I, 1992
RELIGIOUS VIEWS ON ASSISTED REPRODUCTIVE TECHNOLOGIES
cussions have focused on two issues: Is it permissible, according to Jewish law, to perform AID, or is the very act a transgression to adultery? and What is the status of the AID offspring? All Jewish legal experts agree that AID, using the semen of a Jewish donor, is forbidden. It is the severity of the prohibition that is debatable. The question is whether AID constitutes adultery, which is strictly forbidden by the Torah (the Pentateuch), or whether the injunction stems from other sourcesJmainly the legal complications of the birth of AID offspring--as most experts hold. Some rabbinical authorities permit AID when the donor is a non-Jew. This eliminates some of the legal complications with regard to the personal status of the offspring. If the semen donor is a gentile, the child is pagan (blemished); if the child is a female, she is forbidden to marry a Cohen (priest). AID, according to Jewish law, is prohibited for a variety of reasons: incest, lack of genealogy, and the problem of inheritance. Semen donors for AID, as well as physicians who use the semen, are violating the severe prohibition against masturbation. There are various views regarding the legal relationship that exists between the semen donor and the child born as a result of AID. Some rule that no relationship exists; others that the child should be regarded as the donor's child, with all the legal complications of incest, inheritance, levirate marriage, etc. The majority opinion is that the donor has not fulfilled the obligation of procreation by fathering an AID child. The practice of AID is accepted by part of the Jewish population in Israel, and according to the regulations of the Ministry of Health it is allowed in special circumstances.
Christian View The Roman Catholic Church condemns AID for married, as well as unmarried, women. The Vatican's instructions demand a strict connection between procreation and intercourse. Artificial insemination involves separation between "the goods and meaning of marriage" (which means separation between unitive and procreative). Concerning AID the instructions suggest that the AID process damages personal family relations as well as the offspring. The practice of artificial insemination is also rejected on the grounds that it is based on masturbation and that the AID process is an adulterous act. Journal o f Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
5
The Greek Orthodox Church opposes the practice of AID on the basis that it is an adulterous act. For the Protestant Church AID is mortally illicit and, at best, morally questionable. The Anglican Church allows semen collection by masturbation for artificial insemination by husband and for IVF. Islamic View The practice of AID is strictly condemned by Islamic law. If the husband's infertility is beyond cure, the infertility should be accepted; according to Islamic law AID is considered adultery. The procedure also entails the lie of registering the offspring of a man who is not the real father and, therefore, leads to confusion of lines of genealogy, whose purity is of prime importance to Islam. Therefore AID is not practiced by the Moslem population. Hindu View According to the Hindu view, in the case of male infertility the wife can be authorized to have intercourse with a brother in-law or another member of the husband's family in order to conceive a male offspring (only after 8 years of infertility or after 11 years of delivering only female offspring). According to the above statement this may lead to the conclusion that sperm donation can be practiced according to the Hindu view, with the restriction that the sperm donor must be a close relative of the husband. Buddhist View According to Buddhism, donation of sperm is not prohibited, but it is suggested to refrain from this procedure as much as possible.
OVUM DONATION There should not be any ethical problems with oocyte donation in societies where AID is acceptable. Oocyte donation has the advantage over AID, as both parents contribute to the birth of the child. Jewish View In the case of egg donation or embryo donation, the problem that arises is who should be consid-
6
ered the mother: the donor of the oocyte or the one in whose uterus the embryo develops, the one who gives birth. In the case that one of the women is Jewish and the other is not, the problem of the status of the child--whether or not he is a Jew--will arise. Jewish law states that the child is related to the woman who finished its formation--the one who gave birth. Christian View According to Christianity, in reality the origin of a human is the "result of an act of giving." The Vatican's instructions do not accept the donation of gametes to an infertile couple as an act of generosity. They state that conception by gamete donation (oocyte) can damage personal family relations, as well as the offspring and society. Oocyte donation is forbidden by three main branches of Christianity: Roman Catholic, Eastern Orthodox, and Protestant. Islamic View Ovum donation is similar to sperm donation and it involves the intervention of a third party other than the husband and wife. Therefore it would not be permitted according to Islam. Hindu and Buddhist Views According to Hinduism and Buddhism, it is suggested that oocyte donation can be practiced on the same grounds as sperm donation.
SCHENKER
sperm and, therefore, donates her oocyte and leases her uterus. Following birth the child is given to the infertile couple for adoption. Jewish View. The Jewish religion does not forbid the practice of surrogate motherhood. According to Jewish law, if partial surrogacy is practiced--a strange woman is inseminated with the sperm of a man and she completes the pregnancy on agreement--the child born should be handed over to the owner of the sperm. In the case of full surrogacy, when the embryo is transplanted into another woman, the question is not resolved, as discussed in the case of ovum donation. From the religious point of view, the child will belong to the father who gave the sperm and to the mother who gave birth. Christian View, The practice of surrogate motherhood is not accepted by the Christian religion, i.e., Roman Catholic, Protestant, or Anglican. The objection is on the basis that surrogate motherhood is contrary to the unity of marriage and to the dignity of the procreation of the human. Buddhist View. There is no Buddhist prohibition of the practice of surrogacy, but it may raise complications regarding the family ties and legal and moral aspects. Hindu View. According to Hinduism, there is no prohibition of the practice of surrogacy, but as in Buddhism, it may raise dilemmas regarding family ties and legal and moral issues. Special problems can arise when the surrogate mother delivers a female offspring, since according to Buddhism, there is an obligation to provide a male offspring.
SURROGACY CRYOPRESERVATION OF PREEMBRYOS Complete Surrogacy In cases of infertility due to uterine factors, when the woman is unable to carry the embryo, the ovum is fertilized with the sperm of her husband, after which it is implanted in the uterus of another woman, who gives birth as a "surrogate mother." Partial Surrogacy Partial surrogacy is when the surrogate mother is inseminated with another woman's husband's
Cryopreservation of preembryos is at present nearly routinely practiced in IVF programs. Jewish View The freezing of the preembryo raises the basic question of whether cryopreservation, which stops the development and growth of the embryo, cancels all rights of the preembryo's father. With regard to the mother, the problem is simplified, since the embryo is transferred into her uterus later and will Journal of Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
7
RELIGIOUS VIEWS ON ASSISTED REPRODUCTIVE TECHNOLOGIES
renew the mother-embryo relationship. With regard to the relationship to the father, whose main function is to fertilize the oocyte in order to form the preembryo, the period of freezing may cause a severing of the relationship between the child and his father. Freezing of sperm and preembryo is permitted only when all measures are taken to ensure that the father's identity will not be lost.
(b)
(c)
(d) Christian View
The freezing of embryos, even when carried out in order to preserve the life of the embryos, constitutes an offense against the respect due to humans, by exposing the embryos to great risks of death or harm to their physical integrity and depriving then, at least temporarily, of maternal shelter and gestation. Islamic View
According to islamic law, freezing of preembryos is acceptable. Buddhist View
Buddhism accepts cryopreservation of preembryos.
PREEMBRYO RESEARCH
Benefits from human preembryo and embryo research may be achieved in the following medical areas: (a) improving clinical results of assisted reproductive technologies, (b) diagnosing genetic aberrations and possible therapy, (c) contraceptive research, and (d) using embryonal tissue therapeutically for transplantation to adults with life-threatening medical conditions. Jewish View
(a) Creating and inducing a preimplantation embryo in vitro for fertility research should be allowed if there is a real chance that the Journal o f Assisted Reproduction and Genetics, Vol. 9, No. 1, 1992
(e)
sperm owner may benefit and have a child as a result of this research. Jewish law forbids destruction and use of a preembryo as long as it has a potential implantation ability. An in vitro blastocyst that hatches from its zona pellucida and loses its implantation potential may be kept for continuous research. Using a postimplantation preembryo for research is prohibited, unless the research is essential for saving the embryo's life. The arbitrary limit of 14 days approved for research on preembryos by some ethical committees is not recognized by Jewish law.
Christian View
Christianity recognizes the preembryo as a human from the stage of conception. Any research on the preembryo is forbidden. Islamic View
Some Islamic scholars may accept performing research on excess embryos resulting from IVF in order to increase their "ILM" (knowledge). It may be permissible in cases when it is for the sake of the individual embryo. Buddhist View
Buddhists believe that there is a continuity from life to life through many reappearances. According to many Buddhist scholars experimentation on preembryos is acceptable. Hindu View
Hinduism does not view the soul atman as having a specific beginning or specific end. Research on preembryos may be permissible when it is to help the infertile couple and it serves the dharma of the physician.
CONCLUSION
Nowadays, assisted reproductive technology is a common practice in the treatment of infertility. The
8
clinical achievements of this technology are due to the scientific progress in the field of human reproduction. Different religious arguments of the world's main religious impose limitations on the therapeutic approach to infertility. The prolonged conflict between religion and science is based on the difference in religious belief and scientific theory. The universal declaration of human rights has recognized the right of each individual to make decisions regarding his or her reproduction. Religious
SCHENKER
authorities, despite the powerful influence they exercise on public minds, should not prohibit a therapeutic approach to infertility, which would limit the area within which individuals are free to decide. Religious authorities, in order to maintain their strength, power, and efficiency, should undergo continual development, and change in the same way that science does. While religious principles may be unchangeable, they may, nevertheless, undergo significant changes in their implementation.
Journal of Assisted Reproduction and Genetics, Vol. 9, No. I, 1992
