Dr Byron C. Calhoun, MD, FACOG, FACS, MBA

“Ladies and gentlemen, do you know what people in modernist circles think of one who remains true to the old traditions, yet is not stupid? They consider him a monomaniac, three-quarters insane, and openly declare to everyone within earshot that they cannot understand such a weird product of nature.”¹

I begin with a quote from 1871 from Holland’s very own champion of traditional and family values: Abraham Kuyper. From Dr Kuyper we see how the liberal-modernist sees those of us with the temerity to question materialistic-utilitarian ethics. Out meeting demonstrates we will not be silenced, we will influence our societies, we will be heard, and truth will win. We paint with a broad brush stroke on the topic of How Biotechnology and Ethics Affects the Family. Our discussion simply cannot be exhaustive in the time allotted but will seek to be instructive and motivational. We will begin with examples of biotechology’s influence on ethics, move to the divergent view of ethics by modernist-utilitarian from traditional morality, discuss the impact on science, and finally offer insights how we as the traditional family may influence the society around us for good.

Let me address my topic How Biotechnology and Ethics Affects the Family with 3 instructive examples from my own experience and tie them to developments in biotechnology and ethics. My first story involves my family with the care my father received. My father suffered early heart attacks beginning at age 48 years of age in 1963. Lifestyle changes were all that were available at that time. My father diligently applied the changes of quitting smoking, losing weight, dietary changes, and exercise. He did well until 1973 when he suffered his 2^nd heart attack. However, by the time he suffered his 2^nd heart attack in 1973 advances moved forward. This was the beginning of cardiac bypass surgery and by 1982 it was routine. My father had his bypass surgery and did well but contracted hepatitis from the blood transfusion and ended up dying from liver failure in 1991. Science has advanced since 1991 and now routinely screens for non-A/non-B hepatitis so this is now rare. Further, open-heart surgery has largely been replaced with interventional cardiology with the placement of coronary artery stents to open blockages and provide therapy. What was once rare now has become common place as science advances. These represent moral and good advances in science with appropriate application of new technology to better humanity. Because of his age (at that time 76 years), he was not offered any further therapy in the form of liver transplant even though the remainder of his health (including his heart) was excellent. Age ought not preclude possible therapies in the traditional family. However, even this discussion would never have come to light without the advances in transplant care.

The second story involves prenatal diagnosis of a fetal anomaly. Ultrasound arrived in medicine in the 1950’s through Ian McDonald but was not really in general practice in obstetrics & gynecology until the 1990’s when microcircuits made possible huge advances in computing and scanning power. A young couple came to me for an ultrasound and consult due to a positive screening test (maternal serum alphafetoprotein) that looked for open spine defects. On the ultrasound we found a baby with anencephaly which is a lethal anomaly in which the baby has no brain above its brainstem. Since they were a devout Christian family we provided perinatal hospice care and their baby ended born as a stillbirth. This conundrum would never have come about without the ability to screen and diagnose in the womb these serious anomalies.

The final case to illustrate how biotechnology and ethics affect the family involves a dear family friend’s daughter. She suffered from infertility and sought to become pregnant with the use of in vitro fertilization. Unfortunately, she and her partner received poor information and did not realize how horrible the infertility world practices its services. She and her husband were not told about what would happen to the “excess embryos=babies”. They knew they would be “frozen” but no one told them that upward of 35% of the embryos would not survive the re-thawing process to try to use them for implantation.² The were also not informed that “selective reduction” of multiples (twins-triplets) would be offered to them to kill the “extra” babies to a single baby. Sadly, she ended up with twins, early preterm labor, and loss of both her babies at 22 weeks. Now, she and her husband face the daunting ethical dilemma of what to do with the frozen embryos. Their situation worsens since the doctors froze the embryos in sets of 2 and now she is placed again at the agonizing risk for twins again with preterm delivery and loss or the prospect of trying to “re-freeze” an embryo and risk another 35% loss rate.

So, biotechnology runs directly against the ethic of the family in end of life issues, pregnancy, and even in the conception of life. Further, modern ethics ends up as C.S. Lewis presciently notes 1947 (over 60 years ago) in the Abolition of Man,

And all the time-such is the tragic-comedy of our situation-we continue to calmour for those very qualities were are rendering impossible. You can hardly open a periodical without coming across a statement that what our civilization needs is more ‘drive,’ or dynamism, or self-sacrifice, or ‘creativity.’ In a sort of ghastly simplicity we remove the organ and demand the function. We make men without chests and expect of them virtue and enterprise. (my emphasis). We laugh at honour and are shocked to find traitors in our midst. We castrate and bid the geldings be fruitful.³

From the very beginning the struggle raged between those who sought to obey God and those who sought to become God. “For God doth know that in the day you eat thereof, then your eyes shall be opened, and ye shall be as gods, knowing good and evil.”⁴ Thus, the debate continued so that the very essence of good and evil became the linch-pin of the arguments. Further, these “gods” believed the ancient lie for violating truth and reaching for evil, “Ye shall surely not die.”⁵

Into the fray for mastery of biotechnology and ethics came another shining light from Dutch extraction: Cornelius Van Til. His exposition and careful elaboration of presuppositional ethics blew apart any ability to compromise with evil. His division of ethical discussion into covenant-keepers and covenant-breakers brilliantly outlined the failure of past ethical arguments for the traditional family and its ethics. Van Til stated in essence that there are only 2 views of life-man-family possible: you believe in the Jehovah God who is who He says He is, He is immanent, His word is operative today, and is infallible-so your ethics flow from a an external God-given inviolate truth; or you do not believe the Jehovah God who cannot and does not exist, is not operative in the world today, we are our own ‘god”-so your ethic flows from each of us individually, as utilitarian exercises, and may change on a whim or depending how we “feel” about an issue.

Unfortunately, these beliefs spill over into the bioscience world. Science represents, in its purest form, observable and repeatable experiments or events. It has nothing to say about ethical approaches or truth. Therefore, experiments on Jews in concentration camps or on vulnerable prisoners are perfectly acceptable in the utilitarian world since good comes these heinous acts on people who will die anyway. Science without an underlying external ethic only trades on truth Science presumes truth is knowable, i.e. 2+2 always will equal 4 and not 5. Finally, your view of mankind and truth (external or internal) drives your view of how you will interpret the scientific facts. We find experts solemnly opining “abortion is 10 times safer than childbirth”. This of course is nonsense. It is only “true” if you don’t include all the associated and delayed maternal deaths caused by: abortions not reported, improperly compare a 9 week abortion to-all obstetrical deliveries including cesarean sections, medically complicated patients, and all patients. The real truth is abortion is far deadlier than child birth if you compare the two by controlling for medical factors, suicide, homicide, all cause deaths, etc.^6-12 Hence we see the perversion of biotechnology, science, and scientific truth.

The new biotechnologies created a huge dilemma for the scientific community at large. They needed a means to dismantle the external God-given ethic to allow them to do whatever “science” they desired to do. Unfortunately, traditional values and the family stood in the way. Scientists needed a counterfeit ethic. Therefore, in the United States then President Nixon formed a task force to try and deal with these burgeoning issues. From this committee of ethicists came the brain child of Albert Jonsen, PhD: the new discipline of “bioethics” and the now trendy “4-box model” of how to “do ethics.” The ethic is a forced, utilitarian, and materialistic moral model. It consists of 4 parts divided into “boxes” to be used in every ethical decision making process. These consist of autonomy, beneficence, fairness, and non-malfeasance. The obvious question comes to mind as why these were chosen? These 4 concepts were chosen so you could justify any decision as “ethical”. The real problem comes when you attempt to resolve a conflict between views. What is more important? Patient autonomy or fairness? Who decides what is “fair”? In fact the most telling commentary on the total failure of this ethical model came at a conference that I attended in 2001. It was a conference on ethical research with Dr Albert Jonsen as one of the main organizers and speakers. Dr Jonsen was directly questioned about this problem of the conflict between the “4-box” principles. His answer spoke volumes. He essentially noted, “The model doesn’t really work since there is no way to resolve conflict between principles.” So much for bioethics. From this unworkable ethical paradigm, biotechnology brought to the family

-the IVF debacle with some 400,000+ “fetal-cicles” (or embryos) in suspended animation¹³

-the conundrum of maternal genetic testing to “search and destroy” Down’s babies and others “unfit to live”

-the creation of impersonal, autocratic and ethically bankrupt “ethics committees” at each hospital to force families to allow their family members to die (Karen Ann Quinlinn)

-set the stage to allow euthanasia of elderly who could benefit from routine and simple therapy (like the “high tech” administration of antibiotics for pneumonia)

-brought forth increased pre-term deliveries for patients unwise enough to believe abortion lies^14-24

The traditional and natural family response must echo Dr Kuyper’s bold vision of common grace. The traditional (here Christian) must provide the positive response to materialistic-utilitarian science. Kuyper excels in his radical framework of how we in the traditional family need to engage the modernist-liberal in the defense of the family. In Common Grace Kuyper notes:

This institute (national-church) does not cover everything that is Christian. Though the lamp of the Christian religion only burns within that institute’s walls, its light shines out through its windows to areas beyond, illumining all the sectors and associations that appear across the business, vocation, public opinion, and literature, art and science (my emphasis), and so much more are all illuminated by that light, and that illumination will be stronger and more penetrating as the lamp of the gospel is allowed to shine more brightly and clearly in the church institute.²⁵

Adult stem cells could be harvested from patients like my father. His own stems cells grown in culture would then be transplanted back into his own liver to regenerate diseased tissue. Already several hundred therapeutic successes have been seen in the scientific literature. Stems obtained morally and ethically could then be used in myriads of diseases without violating conscience, humanity or people. Future scientific breakthroughs in nanotechnology with delivery of medications, enzymes, chemotherapy, or even stem cells would be analyzed in the illumination of solid traditional values. Biotechnology in the modern world may then in this sense be engaged fearlessly with a resolute knowledge of the truth. Science may take its rightful place as a subordinate discipline and servant of the family. The licit use of any new technology or medical advance rests on the exploration of its morality in light of the presuppositions of covenant keeping people. From our values we develop moral solutions. Reproductive science would be harnessed by the morality of the traditional family to provide true reproductive services. No longer would the term “reproductive science” be the code word for unbridled fertility treatments or abortion. Instead, naprotechnology to enhance natural reproduction would be used. Naprotechnology uses enhance temperature observation, mucous quality, hormone level tracking, and appropriate timing of intercourse to allow couples to have children. Dubious practices as seen in the United States in California where octuplets came about from reckless use of in vitro fertilization of a single mother on public assistance. Separation of sex from children would be the happy by-product. Children could take their rightful place as blessings in the family. Couples would be able to wisely consider how best to become a family and enjoy their children.

Rather than using prenatal diagnosis with blood tests and ultrasound as “search and destroy missions”, we use them as opportunities to identify babies in need of more advanced medical care, pregnancies at increased risk for still birth, and pregnancies eligible for advanced in utero surgeries. Those patients with fatal fetal anomalies not amenable to therapy today would be offered family centered hospice care in the context of compassionate and multidisciplinary perinatal hospice.

Advanced reproductive techniques could learn to heed ethical guidelines for obtaining embryos, transferring embryos responsibly, and not creating frozen humans or multiples. Embryos would not be created to experiment upon since this provides no moral or useful source of stem cells or clinically useful information. Adult stem cells or cord blood stem cells obtained with informed consent and in an ethical manner could be used for clinical care. No embryos need to die. Parents no longer would need to agonize about how to deal with frozen babies or live with the some 35% loss rates for re-thawing embryos.

The traditional family could be free to morally engage in the use of biotechnology by providing the society how to best perform ethical research, i.e. no experimenting on embryos, prisoners, or the disabled. Research not adhering to the moral illumination of the Church (in its broadest sense) would not be funded, allowed to be published, and/or suspended.

The family may stand with Abraham Kuyper and boldly proclaim, “. . .that

illumination will be stronger and more penetrating as the lamp of the gospel is allowed to shine more brightly and clearly in the church institute”²⁵ and from the church institute throughout our societies to illuminate the world.

References:

1. Abraham Kuyper. Modernism: A Fata Morgana in the Christian Domain. Address 14 April 1871 at Odeon theater in Amsterdam. In The Methodist Review translated by John H. de Vries and appeared 88/1-2 (March and May 1906), pg 185-203, 355-78.

2. Hoffman DI, Zellman GL, Fair CC, Mayer JF, Zeitz JG, Bibbons WE, Turner TG. Fert & Ster 2003;79(5): 1063-1069.

3. Lewis, Clive Staples. The Abolition of Man. Macmillan Publishing Co., Inc. New York, NY. 1947, page 35 (1978 paperback edition).

4. Genesis 3:5. King James Version of the Bible.

5. Ibid. King James Bible. Genesis 3:4b.

6. Gissler, M., et al. (2005). Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. European Journal of Public Health, 15, 459-463.

7. Gissler, M., Berg, C., Bouvier-Colle, M., Buekins, P. (2004). Pregnancy-associated mortality after birth, spontaneous abortion, or induced abortion in Finland, 1987-2000. American Jurnal of Obstetrics and Gynecology, 190, 422-427.

8. Gissler, M., Kauppila, R., Merilainen, J., Toukomaa, H., & Hemminki, E. (1997). Pregnancy associated deaths in Finland 1987-1994: Definition problems and benefits of record linkage. Acta Obstetricia et Gynecologica Scandinavica. 76: 651-657.

9. Gissler, M., Hemminki, E., $ Lonnqvist (1996). Suicides after pregnancy in Finland, 1987-94: Register linkage study. British Medical Journal. 313, 1431-4.

10. Lanska, J. et al., (1983). Mortality from abortion & childbirth. Journal of the American Medical Association, 250:361, Cited in P. Cunningham & C. Forsythe, Is abortion the “First Right” for women?: Some consequences of legal abortion. In Butler, J. & Walbert, D. (1992). Abortion, Medicine & the Law. New York.

11. Reardon, D.C., Strahan, T.W., Thorp, J.M. & Shuping, M.W. (2004). Deaths associated with abortion compared to childbirth: A review of new and old data and the medical and legal implications. The Journal of Contemporary Health Law and Policy, 20, 279-327.

12. World Health Organization. (2004). Maternal Mortality in 2000-Estimates by UNICEF, WHO, & UNFPA. Geneva, Switzerland: Department of Reproductive Health & Research, WHO.

13. Law & Health Research Brief. How Many Frozen Embyros Are Available for Research. Rand-SART. 2003.

14. Rooney B, Calhoun BC. Induced abortion and risk of later premature births. J of Am Physicians and Surgeons; 8(2): 46-49.

15. Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, Boulet P, Fresson J, Arnaud C, Subtil D, Marpeau L, Roze J, Maillard F, Larroque B, EPIPAGE. BJOG 2005;112:430-437.

16. Ancel PV, Lelong N, Papiernik E, Saurel-Cubizolles MJ, Kaminski M. History of induced abortion as a risk factor for preterm birth in European countries: results of EUROPOP survey. Human Repro 2004;19(3):734-740

17. Henriet L, Kaminski M. Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey. Br J Obstet Gynaecol 2001;108: 1036-1042.

18. Zhou W, Sorenson HT, Olsen J. Induced abortion and subsequent pregnancy duration. Obstet Gynecol 1999;94:948-953.

19. Martius JA, Steck T, Oehler MK, Wulf K-H. Risk factors associated with preterm (<37=) weeks) and early preterm (<32+0 weeks): univariate analsysis and multvariate analysis of 106,345 singleton births from 1994 statewide perinatal survey of Bavaria. Eur J Obstet Gynecol Repro Biol 1998;80:183-189.

20. Lumley J. The association between prior spontaneous abortion, prior induced abortion and preterm birth in first singleton births. Prenat Neonat Med 1998;3:21-24.

21. Reime B, Schucking BA, Wenzlaff P. Reproductive Outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents' first pregnancies. BMC Pregnancy and Childbirth 2008;8:4.

22. Freak-Poli R, Chan A, Graeme T, Street J. Previous abortion and risk of pre-term birth: a population study. J Maternal-Fetal Med Jan. 2009; 22(1):1-7.

23. van Oppenraaij RHF, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG, Exalto N. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Human Repro Update 2009;1:1-13.

24. Swingle HM, Colaizy TT, Zimmerman MB, Morriss FH. Abortion and the risk of subsequent preterm birth: A systematic review with meta-analyses. J Rrepro Med 2009;54:95-108.

25. Abraham Kuyper. Common Grace. Published as 3 Volumes 1902, 1903, 1904. Hoveker & Wormser. Amsterdam Holland. Volume II, Chapter 35, “The Church’s Radiancy in the World”. Pp 264-65, 267-68.