Is it ethical to perform therapeutic procedures on human embryos?

As with all medical interventions on patients, one must uphold as licit procedures carried out on the human embryo which respect the life and integrity of the embryo and do not involve disproportionate risks for it but are directed towards its healing, the improvement of its condition of health, or its individual survival. Whatever the type of medical, surgical or other therapy, the free and informed consent of the parents is required, according to the deontological rules followed in the case of children. The application of this moral principle may call for delicate and particular precautions in the case of embryonic or fetal life. The legitimacy and criteria of such procedures have been clearly stated by Pope John Paul II: “A strictly therapeutic intervention whose explicit objective is the healing of various maladies such as those stemming from chromosomal defects will, in principle, be considered desirable, provided it is directed to the true promotion of the personal well-being of the individual without doing harm to his integrity or worsening his conditions of life. Such an intervention would indeed fall within the logic of the Christian moral tradition” (28)

Medical research must refrain from operations on live embryos, unless there is a moral certainty of not causing harm to the life or integrity of the unborn child and the mother, and on condition that the parents have givers their free and informed consent to the procedure. It follows that all research, even when limited to the simple observation of the embryo, would become illicit were it to involve risk to the embryo’s physical integrity or life by reason of the methods used or the effects induced. As regards experimentation, and presupposing the general distinction between experimentation for purposes which are not directly therapeutic and experimentation which is clearly therapeutic for the subject himself, in the case in point one must also distinguish between experimentation carried out on embryos which are still alive and experimentation carried out on embryos which are dead. If the embryos are living, whether viable or not, they must be respected just like any other human person; experimentation on embryos which is not directly therapeutic is illicit.(29) No objective, even though noble in itself, such as a foreseeable advantage to science, to other human beings or to society, can in any way justify experimentation on living human embryos or fetuses, whether viable or not, either inside or outside the mother’s womb. The informed consent ordinarily required for clinical experimentation on adults cannot be granted by the parents, who may not freely dispose of the physical integrity or life of the unborn child. Moreover, experimentation on embryos and fetuses always involves risk, and indeed in most cases it involves the certain expectation of harm to their physical integrity or even their death. To use human embryos or fetuses as the object or instrument of experimentation constitutes a crime against their dignity as human beings having a right to the same respect that is due to the child already born and to every human person.

The Charter of the Rights of the Family published by the Holy See affirms: “Respect for the dignity of the human being excludes all experimental manipulation or exploitation of the human embryo”.(30) The practice of keeping alive human embryos in vivo or in vitro for experimental or commercial purposes is totally opposed to human dignity. In the case of experimentation that is clearly therapeutic, namely, when it is a matter of experimental forms of therapy used for the benefit of the embryo itself in a final attempt to save its life, and in the absence of other reliable forms of therapy, recourse to drugs or procedures not yet fully tested can be licit (31)

What does the Catholic Church teach about contraception?

Contraception is “any action which, either in anticipation of the conjugal act [sexual intercourse], or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible” (Humanae Vitae 14).  The teachings of the Catholic Church on contraception are derived from Scripture, Natural law, Apostolic Tradition, The magisterium and human experience. Marriage is a sacrament with both unitive and procreative ends. Therefore, the fecundity of marriage is vital in the Church’s teaching about contraception. Pope Paul VI, in his 1968 encyclical, Humanae Vitae said this about marital love:  “Finally, this love is fecund. It is not confined wholly to the loving interchange of husband and wife; it also contrives to go beyond this to bring new life into being. ‘Marriage and conjugal love are by their nature ordained toward the procreation and education of children. Children are really the supreme gift of marriage and contribute in the highest degree to their parents’ welfare’” (Humanae Vitae 9). Similarly, the Catechism of the Catholic Church, # 2366 teaches that “Fecundity is a gift; an end of marriage, for conjugal love naturally tends to be fruitful. A child does not come from outside as something added on to the mutual love of the spouses, but springs from the very heart of that mutual giving, as its fruit and fulfillment. So the Church, which is on the side of life, teaches that it is necessary that each and every marriage act remain ordered per se to the procreation of human life. This particular doctrine, expounded on numerous occasions by the Magisterium, is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act.”

It follows therefore that contraceptive acts which include all forms of sterilization, male and female condoms and other barrier methods, spermicides, coitus interruptus (withdrawal method), the Pill, and all other related methods of birth control sever the unitive and procreative significance inherent in the marital act. Consequently in Catholic health institutions only procedures that do not separate the unitive and procreative dimensions of the marriage act may be employed to help couples conceive. The Ethical and Religious Directives for Catholic Health Care Services (5th edition) promulgated by the United States Conference of Catholic Bishops state that “Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning” (# 52). The Bishops also declare that “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available (#53).

 

What is the Catholic Church’s position on the use of medical remedies at the end of life?

 

According to the Congregation for the Doctrine of the Faith, Declaration on Euthanasia, 1980:

  1. DUE PROPORTION IN THE USE OF REMEDIES

Today it is very important to protect, at the moment of death, both the dignity of the human person and the Christian concept of life, against a technological attitude that threatens to become an abuse. Thus some people speak of a “right to die,” which is an expression that does not mean the right to procure death either by one’s own hand or by means of someone else, as one pleases, but rather the right to die peacefully with human and Christian dignity. From this point of view, the use of therapeutic means can sometimes pose problems.

In numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person’s name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case.

Everyone has the duty to care for his or her own health or to seek such care from others. Those whose task it is to care for the sick must do so conscientiously and administer the remedies that seem necessary or useful.

However, is it necessary in all circumstances to have recourse to all possible remedies?

In the past, moralists replied that one is never obliged to use “extraordinary” means. This reply, which as a principle still holds good, is perhaps less clear today, by reason of the imprecision of the term and the rapid progress made in the treatment of sickness. Thus some people prefer to speak of “proportionate” and “disproportionate” means. In any case, it will be possible to make a correct judgment as to the means by studying the type of treatment to be used, its degree of complexity or risk, its cost and the possibilities of using it, and comparing these elements with the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.

In order to facilitate the application of these general principles, the following clarifications can be added:

–If there are no other sufficient remedies, it is permitted, with the patient’s consent, to have recourse to the means provided by the most advanced medical techniques, even if these means are still at the experimental stage and are not without a certain risk. By accepting them, the patient can even show generosity in the service of humanity.

–It is also permitted, with the patient’s consent, to interrupt these means, where the results fall short of expectations. But for such a decision to be made, account will have to be taken of the reasonable wishes of the patient and the patient’s family, as also of the advice of the doctors who are specially competent in the matter. The latter may in particular judge that the investment in instruments and personnel is disproportionate to the results foreseen; they may also judge that the techniques applied impose on the patient strain or suffering out of proportion with the benefits which he or she may gain from such techniques.

–It is also permissible to make do with the normal means that medicine can offer. Therefore one cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected, or a desire not to impose excessive expense on the family or the community.

–When inevitable death is imminent in spite of the means used, it is permitted in conscience to take the decision to refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted. In such circumstances the doctor has no reason to reproach himself with failing to help the person in danger.

 

Does Preimplantation Genetic Diagnosis violate the Catholic Church’s teaching on the dignity of the human person?

 

According to CONGREGATION FOR THE DOCTRINE OF THE FAITH INSTRUCTION DIGNITAS PERSONAE ON CERTAIN BIOETHICAL QUESTIONS:

Preimplantation diagnosis is a form of prenatal diagnosis connected with techniques of artificial fertilization in which embryos formed in vitro undergo genetic diagnosis before being transferred into a woman’s womb. Such diagnosis is done in order to ensure that only embryos free from defects or having the desired  sex or other particular qualities are transferred.

Unlike other forms of prenatal diagnosis, in which the diagnostic phase is clearly separated from any possible later elimination and which provide therefore a period in which a couple would be free to accept a child with medical problems, in this case, the diagnosis before implantation is immediately followed by the elimination of an embryo suspected of having genetic or chromosomal defects, or not having the sex desired, or having other qualities that are not wanted. Preimplantation diagnosis – connected as it is with artificial fertilization, which is itself always intrinsically illicit – is directed toward the qualitative selection and consequent destruction of embryos, which constitutes an act of abortion. Preimplantation diagnosis is therefore the expression of a eugenic mentality that “accepts selective abortion in order to prevent the birth of children affected by various types of anomalies. Such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of a human life only within the parameters of ‘normality’ and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well”.[1]

By treating the human embryo as mere “laboratory material”, the concept itself of human dignity is also subjected to alteration and discrimination. Dignity belongs equally to every single human being, irrespective of his parents’ desires, his social condition, educational formation or level of physical development. If at other times in history, while the concept and requirements of human dignity were accepted in general, discrimination was practiced on the basis of race, religion or social condition, today there is a no less serious and unjust form of discrimination which leads to the non-recognition of the ethical and legal status of human beings suffering from serious diseases or disabilities. It is forgotten that sick and disabled people are not some separate category of humanity; in fact, sickness and disability are part of the human condition and affect every individual, even when there is no direct experience of it. Such discrimination is immoral and must therefore be considered legally unacceptable, just as there is a duty to eliminate cultural, economic and social barriers which undermine the full recognition and protection of disabled or ill people.

[1] John Paul II, Encyclical Letter Evangelium vitae, 63: AAS 87 (1995), 473.

Physician Participation in Executions

Question: Should physicians participate in the execution of prisoners?

Answer:

A physician’s opinion on capital punishment is a personal opinion of that individual. However, as a physician he or she has the ethical responsibility to abide by the Code of Medical Ethics that governs the actions of those in the medical profession. The AMA’s position on physician participation in executions, which embodies the spirit of the Hippocratic Oath, is quite clear that “a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.”[i] The AMA sees its role in protecting values and services that may otherwise be vulnerable in society because of overshadowing by government, as is the case for executions, or by the private sector.[ii] Despite the fact that physician participation at executions violates the basic tenet of the Hippocratic Oath and the position of the AMA, not to mention similar positions of other medical societies, physicians continue to participate and it is expected that their involvement will only increase in the future. Their rationale ranges from it is a legal procedure approved by a democratic government, to participation minimizes pain and suffering and therefore is in the best interest of the prisoner. Personal and societal values seem to trump their professional values. However, these arguments fall apart when examined and scrutinized from an ethical perspective.

Some have argued that the way to circumvent the dilemma of physician participation is to train other medical personnel, such as physician assistants, nurses, etc., to perform the same task as the physician. This argument is clearly illogical. It assumes that other health care professionals are less dedicated to the ethical ideals of the medical profession. One might assume that all health care professionals are bound by the same basic ethical standards such as “first, do no harm.” In fact, the current professional oaths and position statements of both the American Nursing Association and the American Academy of Physician Assistants prohibit member participation in executions on ethical grounds.[iii] Logic and consistency would dictate that all medical professionals are bound by the same ethical arguments and constraints. Other physicians have tried to argue that their participation in executions is beneficent because it minimizes the risk of a botched procedure and thus minimizes pain and suffering. However, it has been shown that lethal injection, while on the surface may appear to be a painless way to die, in reality may be far more cruel and painful than anyone even imagined. How any physician, who is dedicated to “preserving life when there is hope,” can argue that taking the life of a healthy person because the state commands it is in the patient’s best interest and does not conflict with the goals of medicine is beyond comprehension. Physician participation in executions is unethical because it violates the four basic principles that govern medical ethics: respect for persons, beneficence, nonmaleficence, and justice.

The fear of many is that some physicians have been co-opted by the penal authorities and state legislatures in this country to believe that physician participation is a civic duty and one that is in the prisoner’s best interest. In reality, these physicians are being used as a means to an end. They are being used by certain states to medicalize executions in order to make them more palatable to the American public and to prevent capital punishment from being declared unconstitutional because it is “cruel and unusual punishment.” A basic tenet of the principle of respect for persons is that one may never use another person as a means to an end. Legislating that physicians must be present at executions uses these physicians as pawns or means in order to legitimize capital punishment. This not only violates the rights of these physicians but violates the basic ethical principles of the medical profession and distorts the physicians’ role in society. The AMA and other medical societies should take a strong position that participation of physicians in executions is grounds for revoking a physician’s license. “Even though state legislatures may attempt to subvert this position by guaranteeing anonymity to physicians who serve as executioners, the risk of losing one’s license should serve as a deterrent.”[iv] Until the AMA and other medical societies back up their positions with concrete actions, the image of a “white-coated healer” will continue to be confused with that of the “black-hooded executioner.” This does not bode well for the medical profession or society as a whole, “because when the healing hand becomes the hand inflicting the wound, the world is turned inside out.”[v]      

______________________________________________

 

 

[i] Council of Ethical and Judicial Affairs, American Medical Association,” Code of Medical Ethics, supra note 24, at 2.06, p.18.

[ii] Emanuel & Bienen, supra note 3, at 922.

[iii] Baum, supra note 12, at 66. See also American Academy of Physician Assistants, Guidelines For Ethical Conduct For Physician Assistant Profession 8 (adopted May 2000), available
at http://www.aapa.org/images/GECIN-SERTATION.pdf. and American Nurses Association Position Statements: Nurses’ Participation in Capital Punishment (July 2001), available
at http://www.nursingworld.org/readroom/position/ethics/etcptl.htm.

[iv] Truog & Brennan, supra note 51, at 1349.

[v] Gordon, supra note 11, at 36.

Hospital Ethics Committees – Consultation Is Primary Function

Perhaps the most important function of Hospital Ethics Committees is to provide ethics consultation to the hospital community. When physician and patient/family cannot come to agreement about an important treatment decision, the Hospital Ethics Committee is consulted. One or more of its members, with formal training in bioethics, will make a thorough evaluation and then present her findings to the committee at large. The entire Committee will then meet to discuss the case and make a recommendation, which the physician and patient/family will then discuss. If disagreement still remains, referral is made to the Courts for final adjudication

WHO CAN BE AN ETHICS CONSULTANT?

An ethics consultant should be a professional (preferably MD, MSN, MSW or PhD, or JD) with clinical experience. Also the consultant should possess advanced understanding of Clinical Ethics (preferably: MA in Health Care Ethics or Ethics Fellowship Program).

 

WHAT ARE THE CORE COMPETENCIES FOR A CONSULTANT?[i]

  • Moral reasoning and ethical theory
  • Common bioethical issues and concepts
  • Health care systems
  • Clinical contact
  • The local health care institution
  • The local health care institution’s policies
  • Beliefs and perspectives of local patient and staff population
  • Relevant codes of ethics and professional conduct
  • Relevant health law

 

EXAMPLE SCRIPT FOR CONSULTANT’S FIRST ENCOUNTER WITH SURROGATE[ii]

“Hello, my name is ________. I am an ethics consultant and have been asked by your attending physician to come and talk with you. I routinely get involved in cases where difficult ethical decisions must be made about the best course of action to take. I want to assure you that I do not have an agenda of my own with preconceived answers about what’s right or wrong. My role is to talk with you and support you in considering the options that are available, and hopefully reach an outcome with which you are comfortable and that is in the best interests of your loved one. Is it ok if we talk?”

The primary characteristic of the facilitation approach is the open-ended way the ethics consultant approaches an ethics case with the attitude of assisting those involved in the conflict to arrive at an agreed-upon consensus.

 

GUIDELINES FOR EFFECTIVE BIOETHICS CONSULTATION[iii]

It is important that the Consultant understand the stated and latent interests of the participants. It is essential that the s(he) level the playing field to minimize disparities in power, knowledge, skill, and experience that separate the parties to the dispute. The Consultant should help the parties define their interests, search for common ground and maximize the options for conflict resolution. And the Consultant should ensure that the consensus can be justified as a “principled resolution”, compatible with the principles of bioethics and legal rights of patients and families.

 

ORR/SHELTON FORMAT FOR CONSULTATION REPORT[iv]

  • Demographic Data
  • Reason for Consultation Request
  • Informants
  • Systematic Description of Case
    • Medical Indications
    • Patient Preferences
    • Quality of Life
    • Contextual Features
  • Assessment
  • Discussion and Analysis
  • Recommendation

[i] American Society of Bioethics and Humanities (2011)

[ii] D. Micah Hester (2008), Ethics by Committee

[iii] Dubler N & Liebman C (2004), Bioethics Mediation: A Guide to Shaping Shared Solutions

[iv] Jonsen A et al (2010), Clinical Ethics: A Practical Approach

Hospital Ethics Committees – Preliminary Comments

Rapid advances in medical technologies in the 1960s presented society with ethical questions it was ill prepared to answer. For example, at the dawn of kidney dialysis technology, there were many more patients with end stage kidney disease than there were dialysis machines to treat them. What is the most ethical way to resolve this rationing dilemma? In the early 1960s, kidney dialysis selection committees were established to introduce community representatives into the process of deciding which patients would receive kidney dialysis. Thus the notion of ethics committees dawned in the field of bioethics. Once Medicare was expanded in 1965 to include coverage for kidney dialysis, this particular rationing problem was resolved.

In the late 1960s, some states called for abortion review committees to determine which requests for therapeutic abortions were legitimate. The US Supreme Court Decision Roe v. Wade settled the issue in 1983 with the legalization of abortion. In the early 1980s, infant care review committees were established in some states to satisfy the federal mandate that intensive care nurseries be prevented from engaging in discriminatory practices against critically ill newborns. The Baby Doe Law in 1984 made such discrimination illegal. Drawing on these experiences, the 1976 New Jersey Supreme Court decision in the Karen Quinlin case was interpreted by many as giving credence to the importance of ethics committees for end-of-life cases.

The 1991 Patient Self-Determination Act required that every health care organization in the United States receiving Medicare or Medicaid payments convene meetings of a committee to assure compliance with the requirements of the Act regarding “advance health care directives”. And in 1992, the Joint Commission on the Accreditation of Healthcare Organizations passed a mandate that all JCAHO approved hospitals must put in place a means for discerning ethical concerns. Numerous examples were tried but most settled upon the health care ethics committee model. The 1991 Law and 1992 JCAHO regulation spawned a rapid increase in number of Ethics Committees in hospitals of all sizes.

The Hospital Ethics Committee promotes shared decision-making between patient/surrogate and the clinician. It enhances the ethical tenor of health care professionals and health care institutions. And it promotes fair policies and procedures that maximize the likelihood of achieving good, patient-centered outcomes.

WHAT DO HOSPITAL ETHICS COMMITTEES DO?

  1. CONSULTATION

Perhaps the most important function of Hospital Ethics Committees is to provide ethics consultation to the hospital community. When physician and patient/family cannot come to agreement about an important treatment decision, the Hospital Ethics Committee is consulted. One or more of its members, with formal training in bioethics, will make a thorough evaluation and then present her findings to the committee at large. The entire Committee will then meet to discuss the case and make a recommendation, which the physician and patient/family will then discuss. If disagreement still remains, referral is made to the Courts for final adjudication.

  1. EDUCATION

Another important function is ongoing ethical formation of committee members through self-study, lectures, and conferences. They will become grounded in ethical theory and learn how to apply theory to clinical decision making. As the committee grows in competency, it will develop an ethics education program for the entire hospital community. Questions to be addressed are:

  • What ethical issues are currently relevant at your institution?
  • What individuals in the institution or in the area possess ethics expertise and the ability to put theory and language of ethics into practice?
  • What is the most appropriate teaching forum?
  1. POLICY

The third function is to develop and/or revise select policies pertaining to clinical ethics, e.g. advance directives, DNR and Comfort Care Policies, withholding and withdrawing life-sustaining treatments, informed consent, organ procurement, etc. Hospital Administration may request ethical review of new or updated hospital policies. And new issues requiring policy review may surface during ethical consultations

COMMITTEE MEMBERSHIP

Typically the Hospital Ethics Committee has representation from the following areas:

  • Physician Medical Staff
  • Hospital Administrator
  • Bioethicist
  • Nurses
  • Other Clinical Specialists
  • Social Services
  • Community Representative
  • Pastoral Care
  • Legal Counsel
  • Quality Improvement

RESPONSIBILITIES OF MEMBERS

  • Commit to the Mission and Values of the Institution.
  • Understand role and function of Ethics Committee
    • Orientation Program for new members
  • Competent in their own areas of expertise and generally knowledgeable about issues in health care ethics
  • Familiar with institutional policies related to clinical and organizational ethics.

TYPICAL AGENDA FOR MEETING

  • An established leader who structures the meeting dates and topics, and leads the session
  • Presentation of the particular issue or topic by Consultation Sub-Committee.
  • A brief didactic overview of literature, ethical principles, or pertinent factors
  • Review of facility policy or previous management
  • Group discussion related to the issue
  • Summary via policy or facility understanding
  • Consensus Recommendation for Clinical Team

WHO MAY REQUEST ETHICS CONSULTATION?

At most hospitals, anyone may request an ethics consultation including the patient or family. Need to check the hospital’s policies to learn how to request an ethics consultation

WHEN TO ASK FOR AN ETHICS CONSULT

Consider asking for a consult when two conditions are met:

  • You perceive that there is an ethical problem in the care of patients.
  • Resolution does not occur after bringing this to the attention of the attending physician.

Most “ethical problems” are caused by lack of communication. However, sometimes a true ethical dilemma occurs, frequently because there is a conflict between principles (autonomy, beneficence, and justice) or between principles and outcomes.

The Catholic Church’s position on GIFT seems unclear. Can a Catholic couple having problems getting pregnant start the GIFT procedure?

Gamete Intrafallopian Transfer (GIFT) is a technique of intracorporeal artificial fertilization that involves the simultaneous but separate transfer of the male and female gametes into the fallopian tube. This technique is the recommended treatment for some forms of female infertility or male infertility, provided that the woman has at least one pervious tube. Following induction of ovulation and egg cell procurement by means of laparoscopy and procurement of sperm from within the vagina or by means of a perforated condom, the gametes, separated by an air bubble, are transferred into the fallopian tube by means of a small catheter. In this case fertilization occurs only when the egg cells and spermatozoa come in contact with each other inside the fallopian tube. Unfortunately, only 20 to 27% of the total number of gamete transfers result in completed pregnancies, due to a high incidence of miscarriage.

The instruction Donum Vitae makes no pronouncement with regard to GIFT, either implicitly or explicitly. However, the instruction does not proscribe “those cases in which the technical means is not a substitute for the conjugal act but serves to facilitate and to help so that the act attains its natural purpose”. Therefore, the CDF instruction confirms a traditional position of the Catholic Magisterium that acknowledges the physical and spiritual unity of the conjugal act as the indispensable moral requisite for generating to a new individual. In light of this tradition the intention of treating infertility does not justify any method and any process whatsoever in order to achieve conception.

From the Catholic moral standpoint the ethical dilemma associated with GIFT revolves around the question whether the intervention of the physician or the technician should be considered an assisting act of or a substantive one for the natural marital act. The facts that few oocytes are needed, that they are introduced into the fallopian tube after a short interval of time together with the spermatozoa obtained during or immediately after a conjugal act and that fertilization is inter-corporeal without any embryo manipulation reasonably classify that technique as a form of assistance and not a substitute for the conjugal act. In that case, the GIFT technique is morally acceptable.

However, not all Catholic ethicists agree with this interpretation: some consider that reproductive technology as a substitute for the conjugal act that, like the homologous and heterologous in vitro fertilization, is morally unacceptable.
———————————————————————————————————————–
1 Congregation for the Doctrine of Faith (CDF), Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae). February 22, 1987. Accessed on December 1, 2013 http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

2 Catechism of the Catholic Church, nn 2270-1.

3 United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 2009: n 49.

4 Nelson KE, Hexem KR, Fudtner C. Inpatient Hospital Care of Children with Trisomy 13 and Trisomy 18 in the United States, Pediatrics, 2012:129(5):869-76. doi: 10.1542/peds.2011-    2139. Epub 2012 Apr 9. http://www.ncbi.nlm.nih.gov/pubmed/22492767 (Accessed on August 9, 2013).

5 Janvier A, Farlow B., Wilfond B, The Experience of Families with Children
with Trisomy 13 and 18 in Social Networks Pediatrics 2012 Aug;130(2):293-8. doi: 10.1542/peds.2012-0151. Epub 2012 Jul 23.
http://www.ncbi.nlm.nih.gov/pubmed/22826570 (Accessed on August 12, 2013).

6 Koogler TK, Wilfond BS, Friedman Ross L. Lethal Language, Lethal Decisions Hasting Center Report. 2003:33, 37-41.

7 CDF, Donum Vitae, 1987: II, n.6.

8 May W.E, Catholic Bioethics and the Gift of Human Life, Our Sunday Visitor Publishing Division: Huntinghton, IN: 2008, 93-94.

My wife was told that her fetus in the 16th week of pregnancy has Trisomy 18. The Ob/Gyn is recommending an elective abortion because the condition of Trisomy 18 is not compatible with life. What is your opinion?

Trisomy 18, also known as Edwards’ syndrome, is a chromosomal abnormality associated with severe developmental abnormalities affecting multiple organs. Because of those anomalies the majority of the fetuses do not survive to term or die within their first months of life. However, 5% to 10% of infants with trisomy 18, most of whom possess an extra copy of chromosome 18 only in few cells of the body, live longer than one year and survive to the teenage years in spite of serious medical and development problems.

Elective abortion or early induction of labor constitutes the currently most common medical recommendation provided to a pregnant woman carrying a fetus with trisomy 18, on the ground that this chromosomal abnormality is a lethal and incompatible with life. According to the Catechism of the Catholic Church it is gravely immoral to support a couple’s decision to end the pregnancy through an early induction of labor when the developmental stage of the fetus is incompatible with life outside the uterus and when neither the mother’s health nor the fetal life are in danger [1]. In those circumstances, the early induction of labor configures an act of elective abortion that is morally unacceptable. That moral stance has been confirmed by the US Conference of Bishops in the Ethics and Directive for Catholic Health Care Services. In particular, paragraph 49 of that document states “For a proportionate reason, labor may be induced after the fetus is viable”.[2] Since the threshold for fetal survival in the US has been set up at 24 weeks of gestation, the early delivery of a 16 week fetus is an act of elective abortion that is utterly immoral. Furthermore, the scenario depicted in the question reveals the incorrectness of the provided medical counseling that failed to take into consideration both the improvement of survival of those infants with trisomy 13 and 18 submitted to multiple surgeries [3] as well the reports of the rewarding experience of families living with a child with trisomy 18.[4] It is highly advisable that obstetricians, genetic counselors and ethicist abandon the ‘lethal language’ leading to ‘lethal decisions’ and be more respectful of the parents’ decisions and preferences of not terminating the life of a baby with trisomy 18.[5]


[1] Catechism of the Catholic Church, nn 2270-1.

[2] United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 2009: n 49.

[3] Nelson KE, Hexem KR, Fudtner C. Inpatient Hospital Care of Children with Trisomy 13 and Trisomy 18 in the United States, Pediatrics, 2012:129(5):869-76. doi: 10.1542/peds.2011-2139. Epub 2012 Apr 9. http://www.ncbi.nlm.nih.gov/pubmed/22492767 (Accessed on August 9, 2013).

[4] Janvier A, Farlow B., Wilfond B, The Experience of Families with Children
with Trisomy 13 and 18 in Social Networks Pediatrics 2012 Aug;130(2):293-8. doi: 10.1542/peds.2012-0151. Epub 2012 Jul 23.

http://www.ncbi.nlm.nih.gov/pubmed/22826570 (Accessed on August 12, 2013).

[5] Koogler TK, Wilfond BS, Friedman Ross L. Lethal Language, Lethal Decisions Hasting Center Report. 2003:33, 37-41.

Is pre-implantation genetic diagnosis (PGD) acceptable for Catholics?

The official position of the Catholic Magisterium on prenatal diagnosis has been articulated in the instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae) issued by the Congregation for the Doctrine of the Faith (CDF). In that document it has been stated that prenatal diagnosis is “ permissible if the methods used, with the consent of the parents who have been adequately instructed, safeguard the life and integrity of the embryo and its mother and does not subject them to disproportionate risks. But this diagnosis is gravely opposed to the moral law when it is done with the thought of possibly inducing an abortion depending upon the result…”.

Although the document does not address explicitly the moral acceptability of pre-implantation genetic diagnosis (PDG) it is reasonable to infer that genetic testing performed on early, pre-implantation embryos obtained by uterine lavage with the aim to identify a suspect genetic abnormality and eventually to correct it through somatic gene therapy is morally licit. PGD can be performed either through noninvasive blastocyst culture or by splitting the 4 to 8 cell embryo in two. By virtue of the totipotency of the embryonic cells even the implantation of a ‘half’ of the embryo can develop into a whole individual. Unfortunately, this diagnostic technique has been increasingly used as a means of selecting those embryos carrying genetic abnormalities and eliminating them.  In that case PDG is manifestly contrary to the respect of every human life from the very moment of conception defended by the Catholic Magisterium and, thus, morally unacceptable.