Flowers in the Snow: When ART Clashes with Your Beliefs or Ethics

Advances in reproductive technology over the last 34 years have been spectacular. In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), tissue freezing that allows sperm, embryos and now ova to be preserved for long periods of time or the use of surrogate gestational carriers have all contributed to the ability of medicine to provide a wide range of family building possibilities to couples and individuals. It almost seems that these techniques will continue to improve and make it possible for anyone to have a child as long as they have the necessary access and resources.

What happens when these medical miracles come into conflict with religious beliefs, doctrine or personal ethics? How does a devout Catholic, a ritually observant Jew or Muslim cope with the contradiction created by the possibility of medical science and the constraints of belief?

Catholicism has taken a clear position on IVF and third party reproduction through papal pronouncements such as the Vatican's Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation which was issued in 1987. Shortly after its release Cardinal Joseph L. Bernardin of Chicago noted the difficulty that couples have with infertility. He said he wanted "to make one point very clear" regarding these couples and their struggle "…in the end, after careful and conscientious reflection on this teaching, they must make their own decision."

Similarly, Jewish authorities have noted that Jewish law shares the same concerns of the Roman Catholic Church when it comes to the use of third parties. At the same time Richard Grazi, M.D., a reproductive endocrinologist and Joel Wolowelsky, a professor of philosophy at the Yeshivah of Flatbush in Brooklyn, note the acceptability of "…artificial fertilization to the extent it is a therapeutic technique for a distraught woman (or couple) who cannot be reconciled to either a childless marriage or adoption" on a case by case basis.

Islam finds ART acceptable and commendable as long as it is practiced within the context of a marital contract between a husband and wife according to Musa ModdNordin, an Islamic Malaysian physician.

Without a doubt the first thing to do is have a conversation with your partner if you have one. Make sure that you are both on the same page. If you both believe that creating a child outside the womb, as in IVF or ICSI, is not acceptable because of the teachings of your faith you may be sad and distraught but will have the support of your partner. Secondly, and equally as important, make an appointment with a member of the clergy. Ideally this would be someone who knows you and whom you trust and respect. The focus of the meeting should be on your personal dilemma, the steps you have taken and your understanding of your faith's guidelines regarding procreation. Seek input with the appreciation that any decisions you make and their outcomes will be yours.

Andrew Dutney, professor of theology at Flinders University in Australia has written "…religious authorities are entirely aware that participants in the religions they represent commonly choose to decline the unreasonable burdens of pious childlessness….Religion is something they do themselves, albeit with the aid of established systems of religious practice and with the guidance of recognized leaders and authorities. When religion does not work one way, people tend to try it another way. It has always been so. While infertility is reported as a significant spiritual crisis by religious people, it is one through which the same people report spiritual growth and innovation."

Keeping these thoughts in mind and employing the guidance of thoughtful and knowledgeable advisors can help navigate the struggles when infertility and religious and ethical values clash. Ultimately decisions about treatment of infertility are personal and must be guided by one's one set of principles.

Dr. William Petok is a psychologist in private practice in Baltimore, Maryland, specializing in sexuality, infertility, and marital therapy. A past-chair of the Mental Health Professional Group of the American Society for Reproductive Medicine, he currently serves on the Board of Directors of Path2Parenthood. For further information, visit