Once upon a time, life was simple. Nobody had to debate when death had occurred. The doctor waited for breathing and heartbeat to cease and then pronounced that death had occurred.
As far as having children, if the Lord did not give you a family, you sought grace to accept it as His will, and either adopted children or were content to seek another avenue of serving Him. When organ failure occurred, there were no options other than renal dialysis which was in its infancy of development. Ethical issues were not complicated, and there were few gray areas.
The advent of technology and the rapid developments in medical science, however, have brought with them a host of ethical and moral questions which have necessitated the creation of Ethics Boards and confronted us with gray areas beyond number. We cannot rail against technology and advances. Men are simply, as Johannes Kepler said centuries ago, “thinking God’s thoughts after Him.” All that men have discovered is truth which God placed in His universe for us to discover. We need never fear discovering the secrets of God’s amazing creative design. What does create anxiety is how that knowledge is employed, and the issues which it can create. Whoever first discovered how to make a fire gave humanity a great gift – if used properly. But if allowed to go unchecked, fire is destructive.
While some might think that matters such as the prolongation of life, organ donation, genetic engineering, and fertility options are outside the realm of Scripture, this would call into question the very wisdom of God. Did He not know the dilemmas that believers would face in the 21st century? Was He unaware that medical science would place into the hands of men the tools for prolonging life, and even enabling life to occur in vitro? While we do not have clear precepts instructing us as to our choices (“thou shalt” and “thou shalt not”), we do have Scriptural principles to guide us. At times, there are principles which seem to be in conflict on some ethical issues. What is needed is a way to navigate through these difficult ethical issues, so that we might move with consciences “void of offense toward God.”
It is beyond the scope of this article to consider all the ethical issues which technology has introduced; we will look at a few of the most common facing believers.
There are two aspects of organ donation to consider: donating of an organ at death (cadaver donation), and donating of an organ from a living person (such as becoming a kidney donor). As I write, I am deeply conscious that if I, or a loved one, needed an organ for prolonging life, all that I write might well take on a different tone. So I write with both hesitation and with care. The gift of an organ to a young person to enable them to enjoy a normal life is of inestimable value. But there are other issues involved in the transplantation and donation science.
We live in a society where life must be prolonged at all costs. Death is feared and suffering is viewed as meaningless. The transplanting of organs received sanction and impetus in the USA by the Uniform Anatomical Gift Act passed in the 1960s, and then by the National Organ Transplantation Act, passed in 1984. The latter established a national registry for a donor-recipient matching system. Similar laws are in force in every developed country. All of this has helped immensely in the issue at hand, but it has also increased the pressure to find more available organs. This subtle pressure has spawned various attempts to define death by different criteria and then determine the optimal time to “harvest” organs from those deemed to be brain dead.
At one extreme, there are those who worry that every human being is viewed as a “pre-cadaver,” a candidate to be an organ donor. This demeans the value of life rather than honoring it. Balancing this, we must also bear in mind the principle of Scripture, “As we have therefore opportunity, let us do good unto all men, especially unto them who are of the household of faith” (Gal 6:10). The Galatians would have “gouged out [your] eyes and given them to me” (Gal 4:15, ESV), wrote Paul.
How then do we balance our Scriptural obligation to do good whenever possible, with the awareness that we are stewards of our bodies and not the owners (1Cor 6:19-20), that our bodies are “temples” and not a treasure trove of organs for someone to have?
Consider first the issue of being a live donor of an organ such as a kidney (obviously only paired organs can be donated by a living person). The discovery of a drug called cyclosporine in 1972 obviated the need for the donor to be a close match, likely a relative. The immune system could now be controlled to handle those not closely matched. For most Christians, however, the issue of being a kidney donor would likely arise only if a family member or close friend were in need. The ethical issue is not as black and white as it might seem. Am I potentially shortening my life by being a donor? Certainly, living with one kidney is possible. But in the event of an injury to that kidney from an accident, my life could be shortened. Yet, I am “doing good” for another and being willing to sacrifice to be a help to another. If, however, I do this under subtle coercion of some type (family, spousal, etc), I am not really doing it with the right and ethical motive. There must never be coercion by family or friends to be a donor. This negates the “doing good” injunction of Galatians 6. All this must be taken into consideration.
What of “cadaver” donation? You will not need your organs in the resurrection or eternity. Resurrection life will be maintained on an entirely different principle. Think of the benefit your lens could be, or your cornea. Think of how your heart could be given to a younger person with terminal heart disease, your liver to someone consigned to death apart from a transplant, your lungs given to someone to whom every breath is a struggle. If, for example, an autopsy is necessary at death, organs are removed from the body and frequently kept for evaluation. There is nothing unethical in this. Why not make them also available for someone in need, even when there is no autopsy? You are not sowing the body that is to be (1Cor 15:37-44).
While the above is noble and selfless, it has led to attempts to both rush death in those who are dying, and to redefine death in those who might just be living, so that organs can be taken sooner. The window of time from death to harvesting of organs is very small. The harvested organs are far better if the heart and lungs are still functioning even if the brain is dead. All of this calls into question how we view our bodies and how we define death.
There is no black and white answer to the issue at this point in time. Believers must balance the obligation to “do good” with the stewardship of our bodies and an awareness of the issues surrounding the definition and timing of death.
Those who would like more information on the definition and determination of brain death can find it by going to www.aan.com (American Academy of Neurology) and searching under “brain death.”
Let me describe an extreme situation which could occur in society today, although it might never occur among believers. An infertile couple desperately wants a child. The infertility specialist suggests the use of a donor sperm and donor egg, with in vitro fertilization. She does not want to interfere with her career by having to have the fertilized ovum implanted into her womb, so they contract with a surrogate woman to carry the implanted fetus through to pregnancy. Notice several issues this raises: the child has potentially five parents. As well, the child becomes a “product” which has been produced by the technology of medicine and the contracts of business. Something seems totally wrong! Is this how the Creator designed life to be brought forth? Did God ever intend surrogacy and the production of children as a business?
There is nothing as heart-rending as the grief of those who would love to have children but are not able. Each month becomes a roller coaster ride of emotions. The desire for children is normal and God instilled it into women. Infertility can occur for many different reasons. Seeking available medical help and employing the wisdom of medical technology is not wrong. The ethical issues that surface are related to how far a Christian couple should go in attempting to manipulate a pregnancy.
Hannah’s barrenness was a reproach to her, it being viewed as a sign of divine displeasure. Likewise, in the New Testament, Zacharias and Elizabeth are introduced as barren and beyond years for bearing children. Yet Elizabeth owned that the Lord had taken away her “reproach among men” (Luke 1:25). So for these couples, infertility was linked with misunderstanding and even false accusations from the people of God.
It must be remembered that infertility does not indicate a failed marriage. The great design God had for marriage rises far above offspring. God’s intention in marriage is a picture of the truth of Christ and His Church. Nothing can hinder this purpose, and the presence or absence of children does not tarnish it in the least. Every husband and wife constitutes a family, not just a marriage.
So now you visit the infertility specialist and he discusses your options. You listen as he explains natural methods such as timing and basal body temperatures. But your mind begins to reel as he starts going over a list of possibilities which include drugs, in vivo and in vitro fertilization, donor sperms, donor eggs, surrogate mothers … each suggestion is met by a myriad of questions which rush to mind.
Is it Scriptural? How far do we go? Are we fighting against God? Are we falling short of what God wants? Are there any Scriptural guidelines to help in the sea of confusion in which the couple is engulfed? Principles are invaluable when faced with dilemmas.
All of the modern discoveries relating to conception are part of the present and eternal knowledge of God. God is the creator of all (Genesis 1) and all the laws which scientists discover are laws which He originated and placed into His creation. Neither the technology itself nor the information are evil. What we do with the knowledge is the ethical issue.
A principle which runs throughout Scripture is that knowledge brings with it increased responsibility. To know of a consequence to an act brings me into a sphere of greater responsibility for either doing that act (if evil) or being remiss in not performing it (if it is good). James 4:17 would confirm this to us.
Knowledge brings with it a choice: I must act based on the knowledge revealed. The fine line between trusting God and tempting God is something with which many believers have struggled. We are expected to use whatever means we can within the scope of the Word of God to carry out our responsibilities.
Paul made it clear in matters of conscience, that no one can legislate for another, and that to force a view on someone is to risk stumbling that believer. He issued the principle, “Let every man be fully persuaded in his own mind” (Rom 14:5). This principle is applicable here. Nothing and no one should preempt the conscience of the couple before the Lord. Both husband and wife together must have a sense of the Lord’s direction in the matter. In-laws, friends, and images of the “perfect family” must not legislate.
If there is reservation, then it is better to wait upon God. The “biologic clock” is a major concern. Decisions do need to be made within a timely manner. But the Lord is aware of all such and can guide.
Some would divide the various means of enhancing fertility into two categories: the natural versus the unnatural. The division does have a bit of overlap and perhaps some gray area, but it may be helpful for some. Under the title of natural are such methods as the best time for conception to occur, fertility enhancing medications, medications to control polycystic ovarian problems, and in vivo fertilization.
Under the category of unnatural are donor sperm, donor ovum, in vitro fertilization with re-implanting, and surrogate mothers. Stay tuned, as the list is certain to grow. In these methods, something foreign is being introduced into the equation. It is no longer the couple who is conceiving. Means of fertilization which involve a donor or surrogate seem to most to be unnatural and going beyond the specific couple. It is not really “their” child. No one can legislate for another couple in these very sensitive areas; but what has been offered are principles to help in the decision-making process.
For infertile couples who decide against unnatural means of conception and who still face the frustration of infertility, adoption is certainly a viable and God-honoring step to take.
What of genetic engineering and using embryos for harvesting? These will be addressed in a future article.