Interview | Sunday, 08 March 2009

Foetal philosophy

Theologian and bio-ethics expert Rev. Prof. Emanuel Agius this week advised Parliament on the ethical implications of assisted procreation. Is the Church trying to ban IVF? Not at all, he insists

When God told Noah to “go forth and multiply”, something must have gone terribly wrong. For despite the clarity of this commandment, an estimated 10% of couples are today unable to have children of their own through natural means; and since the 1980s, they have resorted in increasing numbers to various assisted procreation therapies: the best known being arguably in vitro fertilisation (IVF), whereby the female ovum is artificially fertilised in a laboratory, then re-implanted into the womb (where, if successful, natural gestation will take its full course).
Like many issues involving human reproduction, IVF has attracted its fair share of controversy over the years: not least in Malta, where there is palpable resistance to a treatment which is frowned upon by the Catholic Church.
Matters were not helped when, on 12 December 2008, the Vatican released ‘Dignitatis Personae’, an update to its ‘Donum Vitae’ (1987) which elaborates the Church’s position on assisted procreation.
With Dignitatis Personae, Pope Benedict does not mince his words about IVF. He concludes that: “all techniques of in vitro fertilisation proceed as if the human embryo were simply a mass of cells to be used, selected and discarded”; “in many cases the abandonment, destruction and loss of embryos are foreseen and willed”; and that “the blithe acceptance of the enormous number of abortions involved in the process... vividly illustrates how the replacement of the conjugal act with a technical procedure... leads to a weakening of the respect owed to every human being.”
And yet, Rev. Prof. Emanuel Agius this week accused parliament of “dragging its feet” on proposed legislation to regulate the provision of IVF services in Malta: where the treatment has been on offer, unregulated, since the mid-1990s.
Sitting in his office in the University’s theology faculty, I ask Rev. Prof. Agius to explain this apparent contradiction. On the one hand, the Church aggressively opposes IVF on moral grounds; on the other, he himself seems to be actively encouraging the State to recognise a practice deemed sinful by the Vatican. How does he account for the paradox?
“At a glance it may seem contradictory,” he admits, “but at the same time it is consistent with the Church’s position as laid out in Dignitatis Personae, which updated its previous position of 20 years ago in the light of new developments…”
Is it? On Tuesday, Prof. Agius himself told the parliamentary social affairs committee that “Man’s primary intention in IVF was to kill the embryos that remained unutilised, and this could never be acceptable…”
“Yes, but few people seem to realise that the last chapter of Dignitatis Personae also speaks of Church/State relations,” the theologian counters. “The Church does not expect the State to endorse its position on everything. Not everything that is immoral must also be illegal…”
This seems to fly in the face of the Church’s position on other moral controversies. What about divorce? Here we have a case where the Church opposes a practice, and also argues against its regulation by the State…
To my consternation, however, Prof. Agius simply raises his hand and refuses to be drawn into commenting on the analogy. “I will not comment on divorce,” is all he will answer when pressed. “You started with an interesting question, let’s stick to that...”
OK, I grumpily concede: but still, why make an exception for IVF? And how does he account for his apparent hurry to get the law passed through parliament?
Prof. Agius comes back with a surprisingly utilitarian argument: “Regardless of the Church’s opinion in the matter, there are people who will still choose to make use of these technologies. We must be realistic about this. And in a sensitive area like this, it doesn’t make sense to have a therapy like IVF completely unregulated. Better have a law than a vacuum…”
This sounds entirely reasonable; but in practice, wouldn’t the Church’s objections, if taken on board, effectively render any IVF regulation unworkable in practice?
Agius shakes his head. “No. Any law regulating bioethics would be acceptable in principle if it observes two fundamental principles: respect for human life from the very beginning; and protection for the institution of the family. These principles must be respected, not only because of what the Church teaches, but because they form the bedrock of the common good. You don’t have to be a Catholic to appreciate this. Can you imagine a society which does not agree to protect human life, or the family? With or without the Church, the State is already duty-bound to protect life anyway. This is enshrined in the Universal Charter of Human Rights.”
Nonetheless, the Church seems to be sending mixed messages on the subject. This emerged even from the parliamentary debate, where MP Michael Gonzi quoted Rev. Prof. Peter Serracino Inglott as saying that the freezing of embryos was approved by the Church. Perhaps unsurprisingly, Prof. Agius is reluctant to comment on this, too. But he does at least clarify the Vatican’s actual position.
“The moral position of the Church is critical of the whole process,” he explains. “IVF in general separates procreative from the unitive dimension of sexuality. It raises issues of concern to the rights of children, like surrogate motherhood or sperm or gamete donation. There is cryo-preservation – the technical term for freezing embryos; foetal reduction, or the loss of embryos…”
On the subject of cryo-preservation, Prof. Agius also raised a few eyebrows with his comment – subsequently used as a headline in The Times – that the US has “more frozen embryos than living people.” This claim does not stand to scrutiny – reliable estimates suggest there are in fact around half a million frozen embryos in the States: a far cry from the living population of 350 million…
Prof. Agius dismisses the point with a wave of his hand. “I was speaking metaphorically,” he explains, adding that it wasn’t his intention to be interpreted literally. “My concern was with the number of frozen embryos, and what happens to them. The same applies to when more embryos are implanted than are actually required. This is dangerous for two reasons: it can result in multiple births; and if it doesn’t, well, what will have happened to the remaining embryos?”
Prof. Agius seems to be arguing that IVF is wasteful because it results in the loss of a (sometimes large) number of fertilised ova. But this is also true of natural procreation. Nature, after all, aborts far more human embryos than humans do…
The theology professor acknowledges the argument, but with a proviso: the embryos aborted by Nature are not killed by human action. “It’s a philosophical concern,” he admits, “But the morality of an action is determined by intention. Besides, if Nature is wasteful, it does not follow that we should be wasteful, too…”
Another philosophical concern – inevitable, at this point – involves the precise origins of the human person. This in fact underpins the entire discussion; for Prof. Agius’ arguments depend entirely on the Church’s position that a human being, complete with rights and dignity, comes into being at the precise instant of fertilisation of the ovum. Needless to say this is not accepted by all alike, and is certainly not reflected in the various legislations adopted to date in Europe.
In a welcome break with tradition, Prof. Agius accepts that other institutions and countries see things differently, and even takes it upon himself to outline the alternative theories: “In Europe there are three general positions regarding the beginning of human life. The first is that the embryo is a fully-fledged human being from the moment of conception. The second is the opposite; i.e., that the embryo is just a bit of biological material; the third is that human life gradually assumes more importance as the foetus develops. The Church believes that life is a gift from God. From these three positions, the Church therefore favours the first.”
But at the same time, the blanket “life begins at conception” argument also creates anomalies outside the realm of assisted procreation. We’ve already discussed the fact that Nature herself aborts millions of fully-fledged human beings every day. But what about the issue of unviability? I invite Prof. Agius to consider the example of an ectopic pregnancy, when the fertilised egg occurs outside the womb, usually in the fallopian tube. For all our national hysteria about the unborn child, ectopic pregnancies are routinely aborted in Malta…
“There is a difference,” Prof. Agius replies. “What is the intention? To kill the child, or to remove a pathological organ?”
I point out that the same argument applies in reverse to IVF: what is the intention in multiple embryo implantation? To kill the remaining embryos, or to overcome a pathology (in this case, infertility)?
It seems like an afternoon destined for many philosophical contemplations, and I soon find myself confronted with St Thomas Aquinas’ “double effect” doctrine.
“The issue of whether an act is ‘good’ or ‘bad’ is determined by four basic principles,” Prof. Agius replies: “An action can be indifferent or morally good; the agent may intend to do good, but his actions result in unforeseen harm; there can be a good result not achieved by bad means; and the good result may outweigh the bad in certain circumstances…”
That may be the case, but at the same time the methods used by anti-IVF lobbies do not always seem to point in very “good” directions. I invite Prof. Agius to consider the arguments of well-known (and locally very influential) radical groups such as Human Life International… whose representative branch, Gift of Life, is very vocal in its local lobbying.
HLI’s website defines infertility as a “cross” some people have to bear: as though infertility is “God’s will”, and therefore should not be subject to medical treatment. Isn’t this a dangerous argument? By implication, doesn’t it also suggest that a child should be left to die of peritonitis, because God “willed” its appendix to burst?
“Of course I would object to that argument,” he replies without hesitation. “Any intelligent person would. But this is not the position of the Church. The Church distinguishes between natural and unnatural processes. If the therapy respects the two fundamental principles I mentioned earlier, there should be no objection on ethical grounds.”
Leaving aside the dignity of the human person, we turn instead to the protection of the family. Ancillary to all the medical and technical arguments, the IVF debate has also stirred controversy by proposing the treatment be limited only to married couples or “couples in a stable relationship”. Prof. Agius upheld this view during Thursday’s parliamentary hearing: but wouldn’t this be discriminatory?
“Every child has a right to an identity,” he replies. “Ideally – though of course this is not always the case – the child will be raised by its own mother and father. This is the model the Church tries to defend. Should IVF be allowed to a single mother…?”
The answer, I suppose, would depend on the interests of the child: as it already does with adoption. Is Prof. Agius suggesting that adoption should be denied to single parents?
His answer takes me by surprise: “I must say I find it difficult to understand that adoption is permitted in the case of single parents.”
No discussion on IVF would be complete without exchanging views on stem cell research: a medical technology which has been mired in controversy since it was first pioneered in the 1960s.
Supporters of the practice argue that the resultant treatments could have significant medical potential. Detractors – including the Catholic Church and all pro-life organisations – counter this on two main grounds: that the process inevitably destroys human embryos, and is therefore homicidal; and that the techniques involved might pave the way to reproductive cloning… the artificial “creation” of new life through asexual means.
The connection with IVF is inescapable, though not necessarily applicable to Malta (where no stem cell research currently takes place) Cryo-preservation of excess human embryos provides researchers with an almost inexhaustible supply of embryonic stem-cells to play with.
“There are three main arguments used to justify the technology,” Prof. Agius explains. “The first is research for its own sake. Then there is the argument that it will lead to the discovery of new cures; and finally, embryonic stem cell research is also used in toxicity testing.”
Prof. Agius argues that stem cell research is unnecessary on all three counts. “Therapy? So far there have been no results. If anything, there has been more success with adult stem cell research than embryonic. As for research, there are even lobby groups which argue that without embryos, the research would have to be carried out using animal testing. This is absurd: what they are suggesting is that it is acceptable to experiment on humans, but not on animals…!”
With regard to toxicity testing, the professor points out that this is no longer necessary since Shinya Yamanaka invented ‘induced pluri-potent stem cells’ (IPS cells) in 2007…”
IPS cells are extracted from adult cells through a process of “forced genetic expression” – too complex to be explained here – and initial indications suggest that these non-controversial variants may supersede embryonic stem cells for research and testing purposes. If borne out by results, the process could render embryonic stem cell research entirely redundant.
“In this respect the Church was prophetic,” Prof. Agius says with a glimmer of pride. “From the beginning its position was: let’s explore all possibilities, before settling on the present ones. The Church is after all not against science; it only wishes to direct science in a good direction. I am sure that, as with IPS technology, time will also prove the Church right on other issues, such as the sanctity of human life…”

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