Wednesday, May 20, 2015

When do we Truly Twin?

Many use twinning as an argument that life does not begin at conception/fertilitzation/gamete fusion.

Although what we do know of the inner workings of cells is tantalizing and beautiful, cells are still black boxes. The single-celled human zygote is the blackest (and most interesting) of these boxes. We have known for decades that there is early asymmetry in the zygote that later shows up in the division of the inner cell mass (ICM) and the trophectoderm.

We also know that intracellular components are moving as soon as sperm affects egg (cortical reaction, pronuclear migration events, etc). There is a great deal of mechanical action taking place, by which this tiny organism's body is quickly building infrastructure by which it will direct the rest of its development. Such organized activity promoting the development of a single organism is directed, like all operations of a living body, by a soul. This indicates (for those who don't realize this), that ensoulment occurs "at conception" (in non-scientific language), during fertilization, or at/around sperm-egg fusion.

But what about twinning? Complete twinning cracks an embryo into parts between days 0 and 13 of life. Depending on when the cleavage occurs, the twins share zero, one or more tissues.

Twinning is a natural and normal process. We can tell this because a) it occurs frequently, and b) there is a falling-short of it--conjoined twinning.

What causes twinning? I propose that infusion of two souls occurs at conception/fertilization/sperm-egg fusion. These two organizing principles begin directing development of a single zygotic body. There are too many cooks in the kitchen, leading to an unstable union, perhaps because the processes directed by the two new souls don't place adherent components (e.g. desmosomes) where single souls would. This results in fracturing of the conjoined body (a process disrupted by some defect in the material or some unfortunate accident, leading to conjoined twins).

Technology probably won't allow to see the difference between the intercellular workings of single-soul-driven and multiple-soul-driven zygotes for many years. Nevertheless, we can observe the end effect (what appeared to be a single body breaking in two parts and surviving, forming two complete sets of parts) and work back to the presence of two directing principles working from the outset on their completely totipotent cell.

Friday, May 15, 2015

Avoiding Eugenics: It's Easy!

I want to prevent inheritable disease. I think we should explore pre- and perinatal therapies as part of this. And not all the therapies I can imagine are approved by Church officials. Am I a eugenicist?

It the original sense of the word, no. I'm not a member of a "social movement claiming to improve the genetic features of human populations through selective breeding and sterilization." But more recently, the eugenics ideal has gone underground, and motivates some (not all) uses of prenatal diagnosis and abortion (related to race and mental disability). It creeps behind the language of "every child a wanted child," "working together for stronger healthier babies," and "healthy babies are worth the wait."

What if you could freeze oocytes (not morally illicit per se according to Dignitas Personae) and inject them later (e.g. after chemotherapy) in a woman's ampulla and allow conception to occur after natural intercourse? We'd need to learn more about construction of a zona pelucida and cumulus oophorous, but I bet we could do it.

What if you could CRISPR the ΔF508 out of all of a man's sperm, not only preventing this from being passed onto his sons, but also assisting the act of procreation, allowing him to build working sperm? This is germline gene therapy.

What if you could engineer a neo-ovary for a BRCA-positive woman, with her genome, minus the affected gene? That way, her offspring would not carry her genetic predisposition to breast and ovarian cancer. CRISPR would make it possible, and bioprinting would could make it real.

I don't think any of these things are eugenic in themselves (per se). Eugenics is marked by the erroneous equation between essential dignity and accidents like quality of life, health, beauty, intellect, usefulness, etc (paragraph 319 in the link). This error affects the intention behind the action, and the selection of means to the end of promoting those separable accidents.

None of the techniques I just listed are evil in themselves (malum in se). Printing tissue is not immoral, even printing tissue to replace reproductive organs. (Even though the reproductive system is set apart as half of a whole, meant to be used with a complementary system by a couple in a very sacred act, replacing an organ is a medical act that promotes the natural act of the human body.) Freezing cells, thawing them, and implanting them without IVF might be a roundabout way to assist fertility, but is not evil in itself. And germline therapy (I'm arguing something that not everyone agrees about now) is no different from somatic cell therapy, since it assists, rather than replaces or demeans, procreation and the health of offspring.

But any of those actions could be used with eugenic motives. A woman who wants to "clean up" her family tree or her society should re-examine her motives for neo-ovary creation. A woman who wants to freeze her eggs so that she doesn't use "the Down's duds" at the end of her reproductive life needs to re-think her intentions for egg freezing (and don't get me started on women who do this for their careers; that's a disaster of mixed priorities and apparent goods). A woman who plans to use germline therapy because she doesn't want to raise a child with mental retardation, or lose a child early, or pay for expensive drugs, needs to reconsider her reasons for germline gene therapy.

With a loving intention to contribute to the health of children conceived, and an attitude of acceptance of whatever children are conceived, we can avoid becoming eugenicists when we use morally neutral means to achieve a good.

Friday, May 8, 2015

Summa Snowflake: A Thomistic Approach to Frozen Embryo Adoption

Is it morally acceptable to place a previously cryopreserved ("frozen") embryo in a married woman's uterus by embryo transfer (ET) when she and her husband jointly desire to raise him as their adopted child?

Objection One. It would seem that the question is closed, since the Congregation for the Doctrine of the Faith released an instruction, Dignitas Personae, which participates in the ordinary magisterium of the successor of Peter and as a consequence is received with the religious assent of their spirit. This instruction states:
It has also been proposed, solely in order to allow human beings to be born who are otherwise condemned to destruction, that there could be a form of ‘prenatal adoption’. This proposal, praiseworthy with regard to the intention of respecting and defending human life, presents however various problems not dissimilar to those mentioned above [ET, surrogacy, and in vitro fertilization (IVF)].
And concludes that "the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved" (emphasis added). This continues the teaching of Donum Vitae, which taught that these embryos are "exposed to an absurd fate, with no possibility of their being offered safe means of survival which can be licitly pursued."

Objection Two. The Catechism states that 
Techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral. These techniques (heterologous artificial insemination and fertilization) infringe the child's right to be born of a father and mother known to him and bound to each other by marriage. They betray the spouses' "right to become a father and a mother only through each other" (CCC 2376).
But the embryo in consideration was conceived of gametes of persons other than the couple adopting them, by the process of in vitro fertilization, which replaces the natural act of intercourse. This betrays the spouses' "right to become a father and a mother only through each other," which is related to the virtue of chastity, that promise of immortality (cf CCC 2337, 2347).

Accidentally, a frozen embryo implanted in a woman's uterus may (and in most cases of embryo abandonment will) not know his biological mother and father, who may not have been joined in marriage.

Objection Three. Frozen embryo adoption fractures marital fecundity in a way that conventional adoption does not. A wife's reproductive organs are not solely her own, but rather belong to her husband and herself, for "the two shall be one flesh" (Gen 2:24) and
[T]he marriage contract is not a mere promise, but a transfer of right, by which the man actually yields the dominion of his body to the woman, the woman the dominion of her body to the man... (Catechism of Trent, cf CCC 1631).
Dominion over two complementary reproductive systems creates marital fecundity. (For this reason, a woman may not use her uterus (or ovaries) as her own part, to be used independently as in surrogacy (nor may a man donate semen). Such acts employ reproductive organs independently of marital fecundity, which is the only place for their proper function.)

However, even should a couple jointly use the power of their wills to adopt a frozen embryo, this adoption does not require the bodily function of the male part of the couple's fertility, nor essential parts of the woman's fertility. This differentiates adoption of frozen embryos from more conventional forms of adoption, which do not partially use (and therefore break up) the marital fecundity of a couple.

Objection Four. Such adoption is not the best way to protect the lives of frozen embryos. A human has a right to life "from the moment of conception until death" (cf Ex 20:13 and Donum Vitae). A child conceived naturally is rightly sheltered in a mother's uterus, for it is impossible to remove him from the uterus without an abortafacient effect. This cannot be generalized to frozen embryos, who have from conception been denied their proper dignity and who have never been inside a uterus.

A frozen embryo has a right to life, but this is not a right to be gestated in a uterus. In fact, the right of life of a frozen embryo is best preserved by continued cryopreservation. For thawing embryos and inserting them into a uterus is not of clear medical benefit to life over continued freezing.

Objection Five. Donum Vitae explains that embryo transfer (ET), which is required to adopt a frozen embryo, is morally illicit:
[A] homologous [in vitro fertilization] and ET procedure that is free of any compromise with the abortive practice of destroying embryos and with masturbation, remains a technique which is morally illicit because it deprives human procreation of the dignity which is proper and connatural to it.
A fortiori, the ET required by embryo adoption, which is always associated with non-homologous in IVF, is also morally illicit. Moreover, even if ET be regarded as morally licit, is may be easily considered extraordinary surgical treatment for the preservation of a life, classing it as morally unnecessary.

Objection Six. This robs a man of his capacity to connect with his progeny, a capacity in need of protection especially in cultures which undervalue fatherhood.

Objection Seven. Adoption of frozen embryos predisposes a culture to the error that a child is an object or product, and that reproductive tissues are ingredients and incubators. Thus, such an adoption is an occasion of scandal, denegrating the dignity of children and procreation, and indirectly the Sacrament of marriage, God's Trinitarian nature, and His supreme goodness.

Objection Eight. This is an use of a woman's uterus excludes the possibility of gestating her own children, which is its natural and primary use. This difficulty arises most clearly for fertile women choosing to adopt.

It has been argued that frozen embryo adoption may be used with impunity by fertile couples, because their motivation is generosity and love of the child, without the danger of admixture of desire to experience the natural delights of gestation. However, it is in fertile women that this objection most clearly applies.

Objection Nine. Adoption of frozen embryos directly or indirectly increases demand for frozen embryos, especially when the couple adopting is infertile. As a bishop said, "a systematic organization of prenatal adoption of frozen embryos would, in fact, end up...legitimizing the the root of the whole problem" (The London Tablet, August 1996). As long as in vitro fertilization is legal, such an increase in demand causes occasion for grave sins within the medical profession, for infertile patients, and for those preyed upon for gamete donation.

Sed contra, Janet Smith summarizes the opinion of many saying, "[I]t may be a good thing, much like any kind of adoption. Couples adopt babies. Sometimes that calls for nursing a child, so [the mother is] offering her body to this child. [O]utside the context of in vitro fertilization, we might not be so opposed to it."

I answer that a thing may be said to morally acceptable in two ways. It may be called acceptable per se (considered in itself), and it may be acceptable in a given circumstance.

Many have found frozen embryo adoption to be morally unacceptable in the set of circumstances in which they live (or lived). This is for good reason: as of their writing, and as of this writing, conditions exist that make this action illicit. IVF is legal, corporations make embryo adoption available regardless of partners' marital status (civil or sacramental), embryo transfer is likely to result in embryo demise, and long-term effects of cryopreservation are not known.

However, instructions may change with changing technology, as they are applications of general principles and such applications change with circumstances (explanation of types of Church documents). This means that Donum Vitae's instruction that frozen embryo adoption cannot be "licitly pursued" could change if circumstances improve. Dignitas Personae, in fact, softened the language surrounding frozen embryo adoption, stating that it "presents problems" similar to illicit technologies and cannot now be "resolved."

Considered in itself, adoption of frozen embryos is morally neutral. Its only essential component is passive locomotion of a human being in an early stage of development (from cryopreservation unit to uterus). Passive locomotion of a human being unable to consent, per se, is not objectionable.

Other accidental components of this act include civil (legal) adoption of the embryo, the thawing and ET techniques employed, and the marital status and intention of the adopting party. Clearly, embryo adoption can be considered illegal theft if civil adoption does not occur. It can be considered unnecessarily dangerous to embryos if improper or unsafe thawing procedures or ET is used. It is certainly morally illicit if the adopting party has as part of their intention the selfish desire to have a child, aversion to conventional adoption, the upbringing of a child outside a faithful sacramental marriage (understood as a irrevocable, mutual self-gift of a man and woman), the use of the uterus as a rentable space (or children as products, or procreation as fabrication), or any other intention to sin.

Moreover, in a country where IVF (and any other artificial creation of embryos) is legal, any adoption of frozen embryos will have the unfortunate effect of enabling embryo creation and abandonment. This is an unprecedented situation in history; in the past and currently, no encouragement of conventional adoption has been shown to increase promiscuity or child abandonment. Rather, the generosity of couples who adopt is an example of selfless charity and a sign of God's adoption of us. Should IVF become illegal and a supply of abandoned embryos be left over, adoption of frozen embryos may become morally licit to married couples (of normal and abnormal fertility) with joint intention to raise the child as their adopted son or daughter.

Response to One. This document has the authority of an instruction, so there is no doctrine contained in it, but is the well-intentioned and nobly opined teaching of eminent theologians. With additional scientific information, these teachings may legitimately be changed by those who are faithful, submissive children of the Church.

There is much discussion on this issue among faithful theologians; such discussion, while emotionally charged, is a good to be encouraged, not a worry to be tolerated. This is for two reasons: this discussion is 1) the process of fruitful discernment which allows the Holy Spirit to work in the Church to find a true answer and 2) a mark of the beauty of the Church, which is the only environment in which true scientific freedom can exist.

Response to Two. The Church teaches that life begins at conception. This is most consistently taken to mean "at sperm-egg fusion," since "conception" is not a scientific term and "fertilization" is actually a series of events. In embryo adoption, the events of procreation have already occurred, so no procedures performed can dissociate or replace the marital act. ET, the only procedure involved, assists or replaces implantation, which is rightly held to be a step in development, not procreation.

Further, this section calls illicit the abuse of reproductive tissues as if they were ingredients or rentable spaces, and the attitude of producing progeny as if they were products. However, no reproductive tissues are being inserted in embryo adoption; instead, it is a human being who is being moved into the uterus. Moreover, use of the uterus in embryo adoption need not have the same status as that of surrogacy, since the species-making difference of surrogacy (gestational and traditional, paid or unpaid) is the intention of the surrogate to temporarily use her organ for another couple's child. Use of a uterus by a married woman adopting an embryo as her own can have a wide variety of legitimate intentions, such as the desire to rescue the child. When this intention is shared by her husband, her uterus is used as it should be in marital fecundity--in conjunction with the will of her husband to nourish a member of the family. And in this, the third is also addressed.

Finally, this section of the Catechism discusses that spouses must become parents only through each other. The most important determination of parenthood is not shared genetics, gestation, lactation, or monetary support. Rather, the most important determination of parenthood is the formation of a parental relationship with the child, which is initiated by an act of the will by the parent to take the child as a child. In this way, biological parents are always called parents, since their act of the will occurred in the act sexual intercourse, whether knowingly or unknowingly. But also in this way, parents of conventionally adopted children are rightly called parents. (Clarification of their status by adding the word "adoptive" to the word "parent" is often done to help explain the child's origins, but is also often left out to emphasize the reality of the child's identity as a member of their family). This act of the will is preserved in adoption of embryos.

This text is not irrelevant, however. It highlights how much the Church values the God-given, primary way of becoming parents. Men and women were made become fathers and mothers by the natural act of fertile intercourse within marriage. Since the Fall and the mission of redemption, legitimate, reparative forms of parenthood have been introduced. These forms of adoption, although not original to our nature, are intrinsically good (as is seen by their analogy to our adoption by God in salvation history).

Reply to accident: This is unimportant. Conventional adoption is the same way--children adopted may never know their biological parents, their culture of origin, or whether their biological parents were joined in marriage. What seems more essential is that they know an adoptive mother and father who are joined in marriage, so that they may be raised in an intact family.

Response to Four. This argument does not address embryo adoption per se, but discusses current circumstances. It also neglects to consider the basic duties of parents (and any human being) to shelter children. A child conceived naturally is rightly sheltered in utero not only because of his right to life, but also because charity demands that we love each other as God loves. Thus a zygote, blastocyst, and embryos are lovingly gestated out of hospitable love, not protection of the right to life.

It is true that this cannot be perfectly generalized to frozen embryos. Their current environment is an eerie mean between a induced protective coma and a wintry exile. This does not constitute or resemble "shelter," as befits a person who does not medically require such a state for therapeutic reasons. Placing these displaced persons in the best shelter for them (implanted in human endometrium, in situ) is currently difficult and dangerous. Whether Pope St. Paul VI's injunction in Humana Vitae ("to tolerate a lesser moral evil in order to avoid a greater evil or in order to promote a greater good") applies is still being debated. Is the death of the embryo during attempted transfer a greater evil than continued cryopreservation? The answer must come from more information from medical science, which is not interested in knowing the answer.

It can be said for certain that if safer transfer procedures existed, this objection would not stand; perhaps future advances could create safer transfer procedures or bridge environments that improve the safety of transfer.

Response to Five. The text explicitly says the act of artificial fertilization is immoral, but does not address the transfer separately:
the Church remain opposed from the moral point of view to homologous ‘in vitro’ fertilization. Such fertilization is in itself illicit and in opposition to the dignity of procreation and of the conjugal union (emphasis added).
More is detailed by Jeff Mirus.

Response to Six. In all cases of parenting, men cannot gestate. In cases of conventional adoption, he does not contribute to genetic content of the embryo. As discussed above, the act of the will to become a father and the formation of a relationship with the son or daughter is the defining characteristic of a father. All men who make this choice create the capacity to be a father and to "connect" with their progeny, and such capacity is widened and fulfilled with continual, unconditional love. These acts of the will are not impeded or altered by the process of embryo adoption.

Response to Seven. What is received is received according to the mode of the receiver. A morally neutral act which is done with good intention may nevertheless buttress an erroneous idea of human dignity or procreation if the culture surrounding the action cannot appreciate truths of moral theology. However, an action must not be considered based on these effects. Rather, the receiver needs evangelization, first in the form of lived exemplary charity.

Response to Eight. The inability to gestate one's own children (as in pathological infertility or any normal pregnancy) is not an absolute evil. Further, the gift of adoption is precisely the gift of equivalent worth with genetically-related children. This can be seen by analogy to God's adoption of souls which, while so unworthy of equality with Christ, were nevertheless made so by the loving act of adoption (cf Ephesians 1:3 and John 3:16). In the same way, an adopted embryo is by definition not less worthy of intrauterine shelter than genetically-related embryos.

Response to Nine. This is a valid objection, as stated in the Answer.