Are financial rewards driving an increasing level of activity in the growth and harvesting of babies? Who benefits financially from abortion?

In the first instance, the abortionist will obviously benefit financially. Regardless of his motivation for entering the field, the doctor who performs an abortion will receive significant financial reward. While each routine first-term abortion may not individually have a big return, the sheer number that can be done in one session allows considerable profits. Unlike many other types of operation, abortions (in many countries) are subsidized through government programs, thus increasing payment reliability.

The cost of an abortion depends on the location, the facility used, the stage of pregnancy, and the type of procedure. Costs therefore vary widely, but the following provides a guide to typical costs in a few locations:

• United Kingdom: The National Health Service provides a free abortion service. If you choose to use the private system, medical abortions cost £440-£470 during the first trimester, and up to £1225 at 23 weeks gestation; surgical abortions cost from £350-£550 during the first trimester, and up to £1700 at 23 weeks.
• United States: There are large variations, but medical abortions tend to cost $300-$650 during the first trimester, and as much as $3000 for a later abortion; surgical abortions can cost $200-$1000 during the first trimester, as much as $5000 (but more commonly $700-$2000) during the second trimester, and up to $10,000 for a third-trimester abortion. Reductions may be possible with private insurance or Medicaid.
• Australia: First-trimester abortions cost $300-$800, and second-trimester abortions cost $640-$1800. Reductions may be possible with private insurance or Medicare.

The largest abortion provider in the United States is Planned Parenthood Federation of America, which posted a net profit of $85 million in 2008 on gross revenue of $1.038 billion, some of which was used to fund political strategies to protect the right to abortion.[1]

In May 2011, Planned Parenthood Minnesota, North Dakota and South Dakota sued the state of South Dakota, challenging a new law that required women to undergo counselling before seeking abortion. The law also imposed a 72-hour delay following a woman’s initial consultation with her doctor before the abortion could be performed, and required doctors to obtain proof in writing that the counselling was completed.[2]

The fetal tissue industry

An unintended consequence of the widespread right to abortion has been the creation of a vast and lucrative market in fetal tissue, fetal organs and fetal parts.

The fate of aborted fetuses is not often discussed. If they are disposed of by the clinic, incineration is the usual method. But where it is legal, there are financial incentives to look at alternative means of disposal.

Research

Fetal tissue—that is, any part of the fetus’s body—can be used for research, transplantation and product development in the medical and pharmaceutical industries. Fetal tissue is attractive to researchers because it retains the potential to grow and change into different types of cells, similar to embryonic stem cells. It has been used in research since the 1930s and in transplants since the 1960s. The transplants were initially aimed at curing illnesses like Parkinson’s disease and diabetes. Some jurisdictions have introduced legislation to make sure pressure is not put on women to abort in order for tissue to be obtained (the industry being worth potentially thousands of dollars per month for a clinic).

Fetus farming

Fetus farming is a way of obtaining whole organs that can be used in transplants. Experiments in mice have shown that fetal kidneys grow extremely quickly when transplanted into adult animals. It is easier to take a liver from an 8-month gestation fetus than to grow the liver from embryonic stem cells. While the industry as visualized in movies like The Island (2005) is still in the realm of science fiction, some jurisdictions have been worried enough to introduce legislation to prevent it (United States Congress prohibited it in 2006).[4] In 2009, Oxford University Professor and advisor to Britain’s Human Fertilisation and Embryology Authority Sir Richard Gardner called for studies into the feasibility of transplanting fetal organs. He said he was surprised the possibility had not been considered, and that “It is probably a more realistic technique in dealing with the shortage of kidney donors than others”.[5] Note that to harvest an organ for transplant, one would have to abort the fetus in the second or third trimester with arrangements in place for careful transfer of the tissue to the transplant facility so that it remained fresh. But in a society that allows abortion on demand, why wouldn’t this be attractive to the parents of a dying child who was desperately in need of an organ transplant?

The pharmaceutical industry

The pharmaceutical industry has consistently ranked highly in the Fortune 500 since the 1980s.[6] It has historically manufactured vaccines using cell lines derived from aborted fetuses.[7]

Cell lines (continually renewed cultures of specific cells in a laboratory) are used to grow the viruses used in the production of vaccines. Viruses require the presence of cells in order to replicate, and some human-specific viruses will only grow on cell lines originally derived from a sample of human tissue. They are incubated until enough virus has grown for harvest.

In the 1960s, certain cell lines (WI-38 and MRC-5) were developed from fetal tissue that came from elective abortions indicated for medical reasons. WI-38 came from lung cells of a female fetus of 3 months gestation, and MRC-5 came from lung cells of a male fetus of 14 weeks gestation. (The abortions were not conducted for the purpose of collecting cells for cell lines.) The cells currently in use have been growing independently for more than 40 years, and so were never part of the original aborted fetus’s body.

These cell lines (which are different from embryonic stem cells) have been used to manufacture vaccines for rubella (German measles), MMR (measles, mumps and rubella), hepatitis A and B, varicella (chickenpox and shingles), polio, smallpox and rabies. Further research is ongoing to develop new vaccines. The question is not whether these are useful vaccines—of course they are. The question is: can we make the same vaccines in an ethical manner? Is it necessary to use fetal cells in this process?

Is it necessary?

The PER.C6 technology is based on the PER.C6 fetal cell line, which was developed from embryonic retinal cultures taken from a 1985 elective abortion. This is an example of newer technology, developed to industry standards and marketed by the company Crucell as a “safe and cost-effective manufacturing system for high-yield, large-scale production of vaccines, recombinant proteins including monoclonal antibodies, and gene therapy products”.[8]

It is not necessary to use aborted fetal tissue for these processes. It would be possible to make vaccines and monoclonal therapies with recombinant DNA technology, or using human tissue from another source.

It would be possible to develop future vaccines without culture of human diploid cells for the attenuation of the virus and its growth. Vaccine could be prepared from the genome of the virus and its antigens. This would be a scientifically valid and ethical alternative. However, it will be difficult to change a practice that is already in place and upon which a whole industry is built—not only due to cost but also the challenge of having manufacturers agree that an alternative is necessary.

If alternatives are not available and you are concerned about using vaccines that were developed using tissue from aborted fetuses, what should you do?

The ethics of vaccine use

The ethical concern for Christians is that by using these vaccines we are somehow complicit in the abortions that led to the death of the fetuses used to harvest the original cells for culture. To be complicit means to be a partner in an evil act.

Moral complicity can be judged by asking several questions:

1. Have you had any role in causing the wrong act? Did we intend the original abortion? In this case, obviously not. Whatever the ‘medical indications’ for the abortion were, we were not involved in the original decision.
2. Are you facilitating the wrong act directly? Does our action (using the vaccine) promote the performance of the morally wrong act (the abortion)? Again, the answer is no—the collection of the fetal cells has long since passed.
3. Does your action perpetuate the moral wrong? No. By using the vaccine now, we do not promote further abortions for this particular purpose. However, we still can let manufacturers know we object to the use of fetal cells for ongoing development of vaccines.

In other words, we did not cooperate in the performing of the abortion that led to the death of the fetus whose tissue was used in developing the cell lines used in producing virus vaccines. Therefore, using the vaccines is morally justified, since we are not morally complicit in the original abortions.

Furthermore, we have an important moral reason for using the vaccines: the protection against potentially life-threatening infectious diseases. Not only do we help those we vaccinate directly (for example, children), but we also make these diseases less common, thus benefitting the general community—including pregnant women, whose unborn children could be adversely affected by infections such as rubella. Immunization has been demonstrated to be one of the most effective medical interventions available to prevent disease, estimated to save 3 million lives per year throughout the world.[9] This argument for allowing the use of vaccines produced using fetal cell lines is supported by the Vatican.[10]

Parents with specific concerns regarding immunization should discuss the issue with their local doctor before deciding against such an important medical intervention.[11]

The cosmetics industry

The new technology of stem cells has found its way to the beauty department. Biotechnology companies have started developing anti-ageing cosmetics using fetal stem cells, marketed as ‘cosmeceuticals’—a topical application with active ingredients that apparently have medical-type benefits.

Enormous financial investments have been made in embryonic stem-cell technologies worldwide, with little return so far. At the 2008 World Stem Cell Summit held in Madison, Wisconsin, the mood was pessimistic:

Commercialization is “excruciatingly slow”, said Michael Haider, CEO of BioE Inc., a St Paul company that extracts stem cells from blood in human umbilical cords. “I’m not aware of a successful stem-cell company. If you thought gene therapy was difficult, then [stem cells] are astronomically difficult.”[12]

Some people hope that cosmetic applications will be one way to get some money back. Like all cosmetics these products need to be safe, but unlike pharmaceuticals, they don’t have to prove that they actually do what they say they do (much to the manufacturer’s relief, as this process of documenting efficacy is long and costly—though it would be interesting to see how many face creams passed the test!).

This use of stem cells on skin arose from the successful application of fetal tissue to treat burn victims. Skin cells taken from an aborted male fetus of 14 weeks gestation were used to grow sheets of skin that healed children’s burn wounds without scarring, in research at the University Hospital of Lausanne, Switzerland.[13] The team went on to use the fetal cells to develop a cell bank, to be the ongoing supply for a cream designed to reduce the signs of ageing, improve skin texture and reduce wrinkles. The active ingredient (Processed Skin Cell Proteins, or PSP) has been trademarked by Neocutis, a company founded as a spin-off from the Lausanne University Hospital, with the research team becoming the founding entrepreneurs.

A new market has been created by the arrival of the baby-boomer generation at a stage when work needs to be done if they are to avoid looking their age. This group includes many individuals with the determination and resources to stay ‘young’ at any cost. According to one report, “The global anti-aging market for the boomer generation was worth $162.2 billion in 2008. This should reach $274.5 billion in 2013…”[14]

What cosmetics are available for those with the will and wallet to proceed? At the budget end you can buy ‘miracle’ serums developed from fetal cell technologies (all unproven as to efficacy, remember), such as Voss Laboratories’ Amatokin, 25 ml for $69.99; Neocutis’s Journee Bio-Restorative Day Cream with PSP, 1 oz for $120; or ReVive Skincare’s Peau Magnifique, 4 x 1 ml bottles for $US1,500, £930 or $AU2,500, depending on where you shop. The products are expensive because they have a limited shelf life and are not mass-produced.

At the more exclusive end of the line, you can go to a clinic at an international tourist destination and receive an injection of fetal stem cells for a ‘mere’ $US25,000/£15,000 per session. Cited benefits include improvements in appearance, sleep, libido and general quality of life. The clinics, operating without regulation or external supervision, apparently exist (or have existed) in Barbados, Ecuador, Russia and the Ukraine.[15] These centres do not just give beauty treatments, but also stem-cell remedies for a wide variety of problems.[16] The director of King’s College London stem-cell biology laboratory, Dr Stephen Minger, commented that the therapies were “not based on scientific evidence”.[17]

Alarming though the use of fetal stem cells for this type of unsubstantiated treatment may be, their source is even more disturbing.

Fetal trafficking

The Institute for Regenerative Medicine (IRM) in Barbados was closed down in 2007 after business slowed following a
critical BBC television report. It named the Institute as one of the clinics using stem cells from aborted
fetuses and dismembered babies that were imported from the Ukraine. The Institute’s Scientific Director, Professor Yuliy Baltaytis, had another stem-cell treatment centre closed down in Hungary in July 2009 for illegal practices, which once again cost the equivalent of $US25,000 each. Shipments from the Ukraine were also received at the Budapest clinic.[18]

In 1995, the trafficking of babies from the Ukraine was already well known, with arrests on record for doctors in Lvov who had sold newborn babies to foreigners. Even then it was said it have been going on for a decade.[19]

In 2006, BBC reporter Matthew Hill published an exposé on the possible kidnapping and murder of babies in Ukrainian hospitals to furnish the international stem-cell trade with lucrative biological material.[20] Reporters interviewing many women in the Ukraine at the time found an atmosphere of fear, with many claiming that their babies had been stolen; that they had been told they had died but then were not allowed to see them.

In 2003, the authorities had agreed to exhume around 30 bodies of infants (pre- and full-term) from a cemetery used by maternity hospital number six in the city of Kharkiv. One campaigner was allowed into the autopsy to gather video evidence. She gave that footage to the BBC and the Council of Europe. The pictures apparently show tiny dismembered bodies stripped of organs (which is not standard post-mortem practice). Some injuries could be the result of harvesting stem cells from the bone marrow. Hospital authorities denied the allegations.

In August 2005, Ms Ruth-Gaby Vermot-Mangold was sent by the Council of Europe to investigate the maternity clinic in Kharkiv at the centre of the allegations. She expressed “extreme concern 
about the disappearance of new-born babies in the country and
allegations of trafficking of babies for adoption and of fetuses for scientific purposes”.[21]

In response, the Council of Europe recommended in 2008 that the authorities of the countries concerned reopen investigations into the disappearance of newborn babies.[22]

The Institute of Cryobiology in Kharkiv, which supplied the IRM with
stem cells, refused to be interviewed for the BBC documentary. The scandal affected many clinics around the world that had their use of fetal and umbilical stem cells called into question, and a number of clinics remain tainted by association. Some clinics have subsequently chosen to use only autologous adult stem cells (harvested from the patients themselves) in order to avoid the legal, ethical and political consequences of using either embryonic stem cells or umbilical cord blood from undisclosed sources.

Concerns have also been expressed over the lack of evidence that any of the treatments work, not to mention the direct-selling methods used to entice vulnerable patients into having often exorbitantly priced treatments with no guarantee of success. A 2011 edition of Nature highlighted the problem, and the United States Food and Drug Administration (FDA) is responding by clamping down on the proliferation of unapproved stem-cell treatments being offered to Americans.[23] Currently the FDA is involved in a court case demanding that Regenerative Sciences of Broomfield, Colorado, which has a clinic treating patients with their own adult stem cells for $7000-$9000 per treatment, stop selling its adult stem-cell product Regenexx, on grounds of concerns about safety and efficacy. The International Society for Stem Cell Research (ISSCR) has established a service that, on request, will judge whether a treatment or clinic provides a safe and effective treatment,[24] although practitioners in the field complain that their real intention is to outlaw these centres completely.[25]

As long as there are financial rewards, human fetuses will be viewed through the lens of profit. Enterprises such as these will continue until there is significant public outcry at the harm being caused. Those involved in the business may initially feel repugnance, but we know from experience that they will quickly become desensitized to the horror of their actions.

But this is not just the result of callous entrepreneurs looking at an unused ‘resource’ (the growing number of aborted fetuses as a result of abortion on demand) and trying to make a quick buck. There are other problems here—such as the cultural worship of the young and healthy, and the persistent underlying belief that the unborn are not fully human and not deserving of respect. If the use of fetal tissue continues by mavericks, how long will it be before scientists want to push past the current 14-day limit for experimentation on human embryos?

Legislation can be educative. Just as Roe v. Wade made abortion seem more acceptable, so could prohibition of fetal stem-cell therapy make it less palatable. Insufficient action in the developed world can lead to the development of substantial unethical industries that affect large numbers of people in the developing world.

The study of human genetics is developing rapidly, bringing with it a paradigm shift in our understanding of the molecular basis of disease. Genetics will have an important role in shaping society in the future because it increases our understanding of how disease occurs and how treatments work differently between individuals. It promises new ways to improve the health of the population. But perhaps even more significantly, genetics will shape society in the future because it is now allowing an insidious form of eugenics to develop within the reproduction industry.

The genetic revolution is mind-blowing in its benefits when we consider that 100 years ago, physicians didn’t even have antibiotics to offer their patients. But once again, we are faced with the double-edged dilemma of technology: it promises great benefits on the one hand, but great dangers on the other. If you have already read earlier chapters in this book, you will realize that widespread genetic screening of the unborn is occurring in our community without an informed public debate about whether it is necessary or acceptable.

This appendix provides a basic introduction to genetics, covering basic terms that have appeared through the book and then conducting a closer examination of the potential benefits and problems of a genetic future. It aims to give you some background regarding the ethical challenges of human genetic technology, rather than dealing with the ethical dimensions of personal decision-making for Christians (this is covered in the relevant chapters of the book). Some of the options that are available to the public and mentioned in this appendix will not be ethical for Christians.

DNA and genes

The chemical nature of inheritance was discovered in 1953 by James Watson and Francis Crick at Cambridge University, when they determined the structure of the DNA (deoxyribonucleic acid) molecule. They discovered that DNA is in the form of a double helix—a twisted ladder—and that its information-carrying capacity is determined by the series of chemical compounds that comprise the rungs of the ladder. There are only 4 different chemical bases in DNA—adenine, thymine, cytosine and guanine—but they can be arranged and rearranged in countless ways.

The order in which the bases occur determines the messages to be sent, much as different letters of the alphabet combine to form words and sentences. In DNA, God has designed an astoundingly elegant and efficient system, and the information it contains is known as our genetic code. There are small differences between every individual’s genetic code. The chance of two unrelated people having identical DNA is at least 1 in 6 million. (But you already knew that from watching CSI, didn’t you?)

The structure of DNA[1]

In the nucleus (‘control centre’) of each of your body cells, there are long strands of DNA that are coiled up into packages called chromosomes. If we untwisted a chromosome it would look like a string of beads, and each of the beads is called a gene. A gene is a particular section of a strand of DNA. Thousands of genes make up each chromosome, and altogether we have around 20,000 genes making up our entire genetic code (or ‘genome’).

Each cell in your body contains 23 pairs of chromosomes, one side of the pair from your mother and the other from your father. (Another way of saying this is that humans have 46 chromosomes: 23 from your mother and 23 from your father.) The 23 pairs are numbered 1-22 (called autosomes), with the final pair being two sex chromosomes (X and Y).

Since the chromosomes come in pairs, the genes also come in pairs. The exceptions to this rule are the genes carried on the sex chromosomes. Since men (XY) have only one copy of the X chromosome, they have only one copy of the all the genes carried on that chromosome, and they have a Y chromosome that women (XX) don’t have, which is responsible mainly for the development of male characteristics.

Just as we read the words on a page to understand what the author is telling us, the body reads the genetic code like a recipe book so that it can make proteins, which are the building blocks for our bodies. The genetic code in the DNA is very similar across all living organisms. The way our bodies metabolize iron, for example, is determined by part of the genetic code that is shared by all humans and by many other living organisms. You have probably heard that you have around 98% of your genes in common with a chimpanzee. Did you realize you also have about 60% in common with a banana?

Although the genetic code is highly similar in different humans, it is not identical. And what makes each of us different or unique is carried within this very small percentage of our genes that varies from one person to the next. This is what accounts for differences in such things as hair colour, facial appearance, height and so on. I have genes inherited from my parents that resulted in my blue eyes and brown hair.

Now all the different types of cells in your body contain the same genetic code, but we have many different types of cells—such as those in skin, muscle, liver and brain. What happens is that different genes are active in different cell types, producing the necessary specific proteins for different tissues and organs to function correctly; some genes are ‘switched off’ and others are ‘switched on’. For example, the genes that are active in a liver cell are different from the genes that are active in a brain cell. That is because these cells have different functions and therefore use different parts of the genetic code.

Just as we may read a book under different circumstances or bring different backgrounds to it, so our genetic code is ‘read’ by our cells on a background of our personal internal and external conditions. Internally this includes our diet, the chemicals we are exposed to, and the other genes in the cells. Externally our environment plays a major role in how we develop and how our bodies work.

It was previously thought that some diseases are caused entirely by the environment and others by our genes, but we now realize our diseases are caused by a combination of the two. Even ‘pure’ genetic diseases (such as problems with metabolism) can be controlled by environmental factors such as diet, and ‘pure’ environmental diseases (such as HIV/AIDS) can be influenced by a protective gene variant (CCR5del132).

Many researchers have made the decision to start studying disease almost entirely from the perspective of genetics instead of environment because it is technically easier.

Faulty genes

We are all born with several faulty genes. Our genetic code may also change during our lifetime for a variety of reasons, including exposure to radiation or certain chemicals. The most common cause of faulty genes is ageing: as our bodies age, our cells need to be continually replaced, and the cells (and their genetic code) are copied over and over again as time goes by. Sometimes mistakes occur in this copying process, and changes in the genetic code build up in our cells. This explains why the egg and sperm of older parents are more likely to have chromosomal abnormalities.

The types of changes that occur can include:

• a variation in the sequence of ‘letters’ in the message
• a deletion or insertion of either individual ‘letters’ or whole ‘words’
• the deletion of a whole ‘sentence’.

A permanent change in the genetic code that may make it faulty is called a mutation. Some mutations may not cause any problems. As genes occur in pairs there will be a ‘back-up’ copy of the gene that can keep working, and this usually protects us from any problems.

But sometimes when the genetic code is changed, a different message is given to the cells of the body. Sometimes this might mean we have an increased susceptibility to disease. But if the gene becomes so faulty that the message is not read correctly, it can interfere with our development and functioning.

When cells have the wrong number of chromosomes, this is called aneuploidy. A well-known example is Down syndrome (where there are 3 copies of chromosome 21). Chromosomal abnormalities lead to miscarriage 70% of the time, and stillbirth 3% of the time, and they will usually be due to aneuploidy. Aneuploidy occurs either as a mutation during replication in the developing baby, or it is passed on from one (or both) of the parents. The risk of miscarriage depends on which chromosomes are altered.

The Human Genome Project

The most significant event leading to rapid changes in genetics in recent years was the mapping of the human genome.

The Human Genome Project was an international collaboration established in 1990 with the goal of producing biological maps of human chromosomes and determining the complete chemical sequence of human DNA. The announcement that the human genome had been mapped came (two years early and under budget!) in April 2003. This achievement generated an enormous amount of genetic information, but the discovery of the structure of the human genome didn’t give scientists as much information about its function as they had hoped. Determining the function of the 20,000 or so genes is a task that continues today.

As we understand more about human genetics, we will gain a greater understanding of the extent to which our individual genetic codes matter in determining particular traits and behavior. It will also help us better understand and modify human disease. We have always known the value of genetic history in medicine (that’s why doctors ask you about the diseases affecting people in your family). But instead of thinking of genetics as the study of relatively rare genetic conditions (as was the case not very long ago), we now realize it will need to be incorporated into our understanding of possibly all diseases in some way. It is therefore of increasing importance in the delivery of healthcare.

As Christians, we will not underestimate man’s tendency to sin (Rom 3:23). As in any new industry, the problem of commercial and utilitarian values driving developments will always need to be watched. But the beneficial potential is enormous.

Current issues in genetics

Direct gene testing

Direct gene testing is an examination of human tissue to look at the sequence of letters in the gene to determine whether a known gene mutation is present. You might have seen it on television, when someone collects a sample of blood, saliva or hair from a child or adult. As mentioned in previous chapters, in unborn babies cells are taken from the placenta, the fluid around the baby (amniotic fluid), or from the developing embryo to examine the genes. Newer tests use the mother’s blood.

The tissue DNA is examined under the microscope and the genetic sequence is read. This can give us information about the health of the baby now, as well as an indication of illnesses it may develop in the future. (This is slightly different from the tests done in forensic laboratories that aim to match tissue samples and establish identity.) The number changes often, but at the time of writing there are more than 1200 genetic tests available to physicians to aid in the diagnosis and therapy for more than 1000 different diseases.[2]

While in some cases genetic tests provide reliable and accurate information, in other cases it is not possible to obtain a definitive result. Our genetic understanding is not yet complete. We are not always sure when the body will be able to cope with a mutation or when it will be expressed as an abnormality. Some genes only indicate that you have an increased risk for a particular problem, with no guarantee that it will ever develop (think weather forecast). This may be because more than one gene is involved with the disease, and we don’t yet know which one/s. Many results are therefore expressed as probabilities. A friend of mine has an 80% chance of developing breast cancer. That statistic is based on populations, not individuals. What does that mean for her personally? Either she’ll get it or she won’t, and she doesn’t know which, because she doesn’t know if she’s in the 20% group or the 80% group. So these probabilities are not as useful as you might think. Most people, including doctors, find probabilities difficult to understand, and need help to work through what the statistics mean for a particular person.

The degree of complexity involved in genetics is such that it is recommended genetic testing (and in fact all areas of genetic treatment) be done in the context of genetic counselling so that the advantages and disadvantages of testing are considered before the test is done. Some possible implications are mentioned below. Remember, once you know, you can never go back.

Genetic testing on the internet

The many genetic tests available on the internet represent a real problem, since counselling is not available and participants may not be aware of the implications of the information they receive. They may also find it difficult to interpret the results if it is a probability score. Reliability of testing can also be questionable. Some tests have not been properly validated before being sold (if companies are in a rush to get a return on their investment), and not all internet companies are screened for standards. A United States government undercover investigation found that 4 genetic testing companies delivered contradictory predictions based on the same person’s DNA, and that test results often contradicted patients’ actual medical histories. This has led to consideration of regulations by the United States Food and Drug Administration.[3]

Online paternity testing is of particular concern. Testing can be done by examining the DNA of hairs pulled out by the roots, or from a swab taken from the mouth (or a child’s dummy/pacifier). It is therefore possible to test without the mother, the child or even the father knowing. Who should have to consent before the test is done? If we say that the parents should give consent, what happens if one parent wants it and the other doesn’t? Considering the implications for custody of the child, financial support and family bonding, should the rules be tightened to include consent and counselling?

Who owns genetic information?

Because genetic information is inherited, genetic disorders are family health problems, not just an issue for an individual. A diagnosis in one member has implications for other family members. For example, consider Huntington Disease (HD).

We know that HD is inherited from one’s parent, so if the child has the faulty copy of the HD gene (located on chromosome 4), we know the parent must have it. If you have the HD gene you are almost 100% sure to get this terrible disease.[4]

But who has the right to own or share this information? Say, for example, that a mother (let’s call her Rita) wants to test for the HD gene because of her husband’s family history, and the father (let’s call him Joe) doesn’t want to know if the baby has the HD gene because he doesn’t want to know if he has the HD gene himself (because it would make him anxious). Here we have a conflict between the right of the mother to know if her child is at risk, and the right of the father not to know his own genetic status. (Of course, if the baby doesn’t have the gene, Joe still doesn’t know if he has the HD gene, but at least there is still a chance he doesn’t.)

Now, HD is a disease with no preventative measures available. But for diseases where there is preventative treatment available, it is good to know if you have a risk of developing a disease so you can take measures to stop it from appearing[5]—hence the recommendation for counselling.

Genetic discrimination-2

Do employers have the right to demand genetic history information from an employee?

The risk of discrimination against those at risk for diseases that may either affect their work performance or cost the employer money in sick benefits has led to the passing of legislation in some countries to outlaw discrimination in the workplace on the basis of genetic makeup. Once again there is a tension: the rights of the individual to privacy versus the rights of the employer, and at times the public, if their safety is threatened. For example, using the analogy above, if Joe’s daughter was found to have the HD gene, meaning that he also has it, is he obliged to tell his employer? What if he is an air traffic controller? The early symptoms of HD can be impairment of reasoning and judgement, of which the sufferer may be unaware.[6]

Insurance

In many countries the current policy is that the insurer and applicant should have equal access to known information, but that no-one can be forced to have genetic testing. However, could the testing of one family member have an impact on the insurance application of another? In the example above, if Joe knows the result of his child’s HD test was positive, does he have a responsibility to tell his insurer? There is concern that some people may avoid genetic testing for this reason and miss out on the opportunity to take preventative measures.

With regard to prenatal testing, you are testing another individual (that is, the fetus) without his or her knowledge or consent. The results will be known before the child is born. Should there be a restriction on genetic testing for adult-onset disease until a child is 18 years old so they can decide for themselves whether they want to know their genetic destiny?

Prenatal genetic screening

There are several standard methods used to check the genome of an unborn child,[7] although there is no test that gives a 100% guarantee of a healthy baby. The tests give some information about the baby’s health, but they do not find all potential health problems. We do not yet know which genes are involved in some illnesses, and so we can’t check for all of them.

The number of conditions we can test for is increasing all the time, and we already have far fewer treatments than tests. The expectation behind prenatal screening is that if your embryo or fetus is found to be abnormal it will be discarded. Either the embryos without the preferred characteristics will not be transferred to the womb (in assisted reproduction) or the fetus will be aborted (in pregnancy). The unspoken inference is that only normal babies should be born—or at least only babies where prenatal screening has not thrown up any red flags.

What kind of diseases should be screened for?

We can describe the different genes being tested with regard to the type of disease they indicate, and how strong the link is between having the gene and having the disease. When genetic testing was first introduced, it was only used for very serious conditions that were very likely to cause illness or death early in life. In their 2005 review, the Human Fertilisation and Embryology Authority (HFEA) in the United Kingdom reviewed which conditions could be screened for in preimplantation genetic diagnosis (PGD), focusing on some types of cancer.[8] These are the qualities they considered:

1. Penetrance: This is the probability that the presence of a gene will lead to disease. For example, some cancer genes can be present in an individual who never gets cancer. Perhaps more than one gene is required for cancer to be expressed. Perhaps it depends on an environmental trigger to be expressed. The HFEA report suggested that a 30%-80% risk of developing a condition is significant enough to justify PGD. Some people would go even lower.
2. Treatability: Originally only untreatable illness was screened for. Now it seems that you can screen for treatable diseases if the treatments are unpleasant or unreliable (like chemotherapy). The HFEA report suggested that a disease requiring “regular invasive treatment” (such as the regular blood transfusions required by some diseases) would be serious enough to warrant PGD.[9]
3. Age of onset: In the past, screening was done for diseases that would be present when the child was born. Now it seems you can screen for diseases that do not affect an individual until adulthood—like some cancers.

Screening characteristics in

It is also possible to check embryos and fetuses for a genetic feature you do want. Once again, you simply allow only the preferred embryos to develop. There is much debate about which conditions should be screened for. While we have all heard about genes for serious diseases like cancer being checked so that the baby will be born without a risk of contracting those diseases, few are aware of the parental requests to identify genes carrying a disorder so that it can be screened in. PGD has now been used in several countries by deaf parents who want to screen their embryos for genetic evidence of the ‘deafness’ gene—that is, to make sure that their child is deaf. According to one British news report:

[One] couple have become icons in a deaf movement which sees this impairment not as a disability but as the key to a rich culture which has its own language, history and traditions: a world deaf parents would naturally want to share with any offspring. Moreover, they argue that to prefer a hearing embryo over a deaf one is tantamount to discrimination.[10]

A 2006 survey by the Genetics and Public Policy Center in Washington DC on how PGD is being used in the United States found that 3% of fertility clinics had used the technology this way.[11] I think one of the worrying things about these technologies is that there has been so little public discussion about whether the community supports these trends. If society identifies deafness as a disability, are we happy for parents to choose this for their child? Is this a form of child abuse? How will the child feel once he knows that he was denied a chance of being able to hear? Or is it simply a case of ‘parents know best’? The parents quoted did think what they were doing was in the child’s best interests.

Saviour siblings

Since 2008, the HFEA has allowed preimplantation tissue typing (PTT) on a case-by-case basis and as a ‘treatment of last resort’.[12] If you have a child with a life-threatening blood disease (such as Fanconi’s Anaemia), one of the best treatments available is a transfusion of stem cells from cord blood provided by a related donor who has the same tissue type. By using PTT, parents have a chance of conceiving a child who is a tissue match for the older sibling. The child born through this process—the ‘saviour sibling’—may be expected to donate further tissue after birth to support the sick child.[13] It may take several cycles of IVF and the discarding of many embryos before the saviour embryo is identified, and sometimes even then none is found.

In the United Kingdom, the Hashmi family, who applied to the law courts to be allowed to have a tissue-matched IVF child to save their son Zain (suffering from Beta Thalassaemia), had 6 IVF cycles and discarded numerous embryos and still found no match. In the United States, the Nash family was successful in the birth of Adam, a tissue match for his sister Molly, who had Fanconi’s Anaemia. It took the creation of 30 embryos and 4 pregnancies to achieve this. In this process each discarded embryo may have appeared normal, but it was still discarded if it was not a tissue match for the sick child.

When the suffering of these families is plainly in the public eye, and the embryos remain unseen, it is difficult to deny hope to the sufferers. But if the solution to disease remains the pursuit of the ‘perfect’ embryo, it allows parents to engage in a kind of “embryonic creation and destruction relentlessness” with no foreseeable end.[14] However, this is not a strong argument for those who do not value embryonic life. “Parents have the right to choose technology to help them overcome their extraordinarily painful circumstances”, said ART doctor Simon Fishel when this practice was allowed in the United Kingdom. “I have no doubt that this is the right decision [i.e. to allow PTT]. In the real world these families are often faced with trying to conceive a tissue-matched child through natural conception and this can result in numerous heart breaking terminations of pregnancy, the birth of children not tissue matched or further children with a life threatening disease.” A spokeswoman for the British Medical Association agreed: “If the technology to help a dying or seriously ill child exists, without involving major risks for others, then it can only be right that it is used for this purpose.”[15]

Ethical arguments against the use of PTT include the concern that the donor child is treated as a commodity and that his or her welfare may be subjugated to that of the sick child. Exploitation of the child could lead to potentially damaging psychological effects on children born not for themselves but to save another. And what happens if the sick child is not saved? Those in favour of the practice describe it as ethical and humane, and argue that many of these problems could be avoided with careful counselling. They argue that a child may in fact feel proud to have contributed to the wellbeing of a sibling. It is the kind of thing family members do for each other, they say.[16] John Harris, professor of bioethics at the University of Manchester commented, “There could be no better reason for having a child than to save the life of another child… so this is genuinely a ‘pro-life’ decision by the parents and the HFEA and they are to be congratulated”.[17] Besides, as one little girl said of her soon-to-be-born saviour sibling, We’re going to love our new baby. And who can argue with that? It seems that the discarded embryos have faded into insignificance even before the saviour sibling arrives.

Sex selection

The HFEA has been criticized for their “conservative approach” in not allowing PGD for sex-selection purposes.[18] The main argument for sex selection is respect for procreative autonomy—that is, the right for couples to decide for themselves how to procreate and what children to have. The main reason given for requesting sex selection in developed countries is ‘family balancing’ (so you can have pink and blue towels in the bathroom).

However, the United Nations opposes sex selection for non-medical reasons. (Some places allow it when a particular serious disease is linked to one of the sex chromosomes.) This is because the preference for boys in China, India and other Asian countries has led to widespread aborting of female fetuses. China’s one-child policy is thought to have made matters worse. Across human populations, the normal sex ratio at birth—the number of boys born to every 100 girls—is about 105. However, with the advent of ultrasounds that enable sex selection, the sex ratio at birth in some cities in South Korea climbed to 125 (males to 100 females) by 1992, and it is over 130 in several Chinese provinces from Henan in the north to Hainan in the south. The problem in India is thought to be related to the cultural requirement for a dowry to be given by the bride’s family to the groom’s family at the time of a daughter’s marriage. This can be financially ruinous for a family. In agricultural areas, boys are preferred as they inherit the land. In India, the 2011 census revealed 7.1 million fewer girls than boys aged under 7 years—up from 6 million in 2001 and 4.2 million in 1991. The sex ratio in this age group is now 915 girls to 1,000 boys, the lowest since record-keeping began in 1961.[19] The societal implications mean that a significant percentage of the male population will not be able to marry or have children because of a scarcity of women. In China, 94% of unmarried people aged 28 to 49 are male, 97% of whom have not completed high school.[20] There are fears that the inability to marry will result in psychological issues and possibly increased violence and crime.[21] Supporters of sex selection have suggested that these arguments do not apply in non-Asian contexts. Sex selection is not allowed in Australia at the time of writing, but fertility clinics are lobbying hard to change the ruling.

~

Prenatal genetic testing raises a minefield of difficult ethical issues. Who should decide which conditions may be tested for before birth? Which conditions make the life of the embryo not worth salvaging? What about conditions where there is a risk of disease, but not a guarantee of it? What about diseases that are not fatal? Should parents be allowed to screen unborn children for a condition that may not develop until adulthood? Is it fair to abort a child who may have 50 healthy years before getting sick (by which time a cure may have been found)?

What of saviour siblings? Are they disadvantaged by being created to save another? They may never have been born otherwise. Would your attitude to saviour siblings change if a doctor told you that this was the only way to save your own sick child?

What about sex selection for the purpose of family balancing? Are we just accommodating the selfish desires of the parents rather than aiming at the best interests of the child? Does the whole idea of genetic screening for the unborn make it harder for parents to unconditionally love their children?

Sandra Dill, executive director of IVF support organization ACCESS, has agreed that discarding human embryos raises ethical questions, but she says “it’s an ethical question for the couple involved. We argue that the people who create the embryos are the ones who value life and value children. Regardless of whether they are infertile or not, their wishes should be respected, because they are the ones who value the embryos the most.”[22] I have discussed with Ms Dill my difficulty in reconciling ‘valuing the embryos the most’ with deciding to destroy them, but she remains firm.

Genetic screening before birth and the subsequent discarding of embryos and fetuses that do not have the preferred characteristics, whatever they are, is not consistent with the Bible’s teaching that all human beings are made in the image of God and deserve to be treated with respect.

Genetic engineering

Genetic engineering is the general term for manipulation of the genetic code. It includes gene therapy, where the human genetic code is altered as a form of medical treatment to correct a mutation—for example, inserting a working copy of a gene to repair a faulty copy. Progress has been slow in this complex area of research. In theory, it would also include manipulation of the human genetic code to enhance physical or mental characteristics, making them ‘better’ than normal. This would be a form of ‘selecting in’ preferred characteristics, but instead of eliminating disease the goal would be improving the appearance and capabilities of the child. Now we are in the science-fiction territory of the ‘designer baby’.

Genetic engineering could potentially be used to select genetic advantages for one’s offspring, such as increased height, intelligence, beauty, athletic ability or similar. In a way, we already do this when we choose our spouse. Creation of designer children may never eventuate—it could be that the genetics are so complex that it will never be possible. But lots of people are interested in trying. One fictional portrayal of the consequences can be seen in the movie Gattaca (1997).

Enhancement

But really, what is science fiction? When Aldous Huxley wrote Brave New World, IVF was science fiction. Now much of it is routine practice in fertility clinics. I saw a movie set in the 1960s where they got excited because a computer could fit into a single room! But whether or not something is possible does not determine its morality.

Where is the line between healing and enhancing? On the 50^th anniversary of his discovery of DNA, Nobel prize winner James Watson proposed that low intelligence is an inherited disorder and that molecular biologists have a duty to devise gene therapies or screening tests to tackle stupidity:

If you really are stupid, I would call that a disease. The lower 10% who really have difficulty, even in elementary school, what’s the cause of it? A lot of people would like to say, “Well, poverty, things like that”. It probably isn’t. So I’d like to get rid of that, to help the lower 10%…

It seems unfair that some people don’t get the same opportunity. Once you have a way in which you can improve our children, no-one can stop it. It would be stupid not to use it because someone else will. Those parents who enhance their children, then their children are going to be the ones who dominate the world.[23]

Genes that influence beauty could also be engineered, Watson suggested. While Watson is known for his provocative remarks, he is not alone in his views. I have asked many parents what they think about creating designer children. Generally it seems to be seen as a benevolent extension of the nurturing process. “Of course, I would want to give my child every advantage”, responded Daniel enthusiastically as we waited in line at a school function. He was convinced it would be widely accepted: “It’s perfectly natural to always want the best for our children”. But will it be rewarding to win a race when your advantage is due not to your own talent and hard work, so much as the skill of a technician? Don’t we normally call this cheating?[24] And if some children in the class were enhanced, wouldn’t that put pressure on the other parents to enhance their children too?

Author Kenan Malik, has commented:

Medicine, and hence biotechnology, is only necessary because evolution has left us with shoddily built bodies that constantly break down, leaving us with headaches and backaches, cancers and coronaries, schizophrenia and depression. So why shouldn’t we try to improve our genome?[25]

He doesn’t see why there is so much fuss over technology that is so unlikely to be possible in the foreseeable future, and suggests we focus instead on what can be done now with current technology. He has a point. We don’t want to discourage the good outcomes from the study of genetics, and if we already use reading glasses and hearing aids, aren’t we already ‘enhancing’ those people who have the money and the opportunity? Why stop there?

One difference between inserting a pacemaker and genetically enhancing a child is that the pacemaker dies with the patient (in a manner of speaking), whereas the genetic manipulation may be passed on to the patient’s offspring. The cells from the parents that pass to the child are the egg and sperm—these are called germ cells. The rest of the cells in the body are classed as somatic cells. If you change a germ cell, the changes are passed on. If you change a somatic cell, they probably aren’t. There is a strong consensus view among scientists at present that the risks of manipulating the germ cells far outweigh the benefits. This is partly due to inadequate knowledge of the intricacy of human genetics and the technical challenges of gene therapy itself. This will change with time.

Addressing the needs of future generations is complex, even apart from the consent issues. As the world changes, how can we be sure which genetic characteristics are going to be an advantage in the future? Who, for example, would have predicted a generation or two ago how important typing skills would become?

The late Marc Lappé was in touch with the politics of expediency when he wrote:

Were the technique of somatic cell therapy plus indirect germ line alteration to prove successful to both the parent and his offspring, it would provide appreciable impetus to do more such experimental manipulations irrespective of the ethical nuances raised by non-consenting experimentation and embryo research. (This is exactly what happened with in vitro experimentation.)[26]

In other words, if ever it is found to be beneficial to alter the germ line, the ethics will be thrown out as fast as you can say ‘genetic improvement’. Anyway, as Lappe goes on to say, there’s no need to make a big deal out of it, because it’s easier just to abort any affected individuals and get rid of so-called ‘deleterious’ genes that way.

Will a ‘deleterious’ gene of today still be considered a ‘deleterious’ gene tomorrow? Ethical concerns around gene therapy include the need to protect human genetic diversity. We know that the gene for sickle cell anaemia is protective against malaria. Removing some so-called ‘faulty’ genes from the human gene pool may make us more susceptible to other conditions. Bill McKibben, a scholar who warns against genetic engineering on these grounds, says that as a species we are good enough, and not in need of a drastic redesign: “A species smart enough to discover the double helix should be wise enough to leave it more or less alone”.[27] Who will be the lifesaver in the gene pool?

I may have asked more questions in this chapter than I have answered. In many ways, this reflects the number of problems concerning genetic technology that have not been adequately debated in the public forum. If this is the public consensus in a democratic society, so be it. But I don’t think we know at the moment what the consensus is. There is confusion rather than clarity. Scarce funds for medical research are being spent on developing therapies to repair faulty genes, and at the same time on developing tests that allow us to abort the children who would have been able to use the gene therapies had they lived.

Materialism and genetic determinism

A final point for Christians to remember is that scientific research is often conducted within a materialist framework—that is, the idea that what you see is what you get; that physical matter is the only thing that exists. Following on from this thinking, there is an implication in much of the genetic revolution that our genes determine who and what we are. When the Human Genome Project was completed, there were headlines around the world proclaiming that we now had ‘the book of life’ in our hands. Have we?

We have already discussed the legitimate genetic basis for disease, but the media has promoted the idea that we simply have ‘a gene for this and a gene for that’—as if to deny the existence of environmental factors and human agency. We now have a book about a ‘God’ gene—the absence of which, it is suggested, may explain why some people don’t go to church.[28] There has also been research suggesting the possibility of an ‘infidelity’ gene.[29]

On the basis of this line of thinking, it would be easy to draw the conclusion that anything bad you do is the result of your genes. You’re just a victim of your DNA. It’s not your fault. But this is not a biblical view. From the Bible we know that we are not just physical but also spiritual beings. Human beings are responsible for our choices and we are warned: “Do not be deceived: God is not mocked, for whatever one sows, that will he also reap” (Gal 6:7). Genetic determinism is not consistent with scientific observation either—identical twins are genetically similar and yet individual. This attitude assumes a view of the human person that is too superficial. The author of Hebrews reminds us:

“What is man, that you are mindful of him,

or the son of man, that you care for him?

You made him for a little while lower than the angels;

you have crowned him with glory and honour,

putting everything in subjection under his feet.” (Heb 2:6-8)

We are so much more than our DNA.

Public accountability

It is encouraging to see that governments have responded to concerns about genetic discrimination in the workforce and in the insurance industry, at least for now. It shows what can be achieved when people speak up and the political will exists.

What can be done about the steady march towards eugenics for the unborn? Certainly more transparency is needed so that the public knows exactly what is being done, especially with regard to genetic screening of the unborn. For example, we need centralized records of exactly which conditions are being screened out, and how many embryos and fetuses are discarded for each disorder. The general public may be consulted the next time government institutions want to relax the guidelines—but how can we sensibly respond to discussions about where we want to head with these procedures when we don’t know what is happening now?

You may be thinking that all this is very complex and that you need not be concerned with such issues. But apart from the need for Christians to be more involved with public debate about the future of technology,[30] genomics is growing in importance by the week. It may be a friend having to decide whether to have a genetic test to see if she is at risk of cancer. It may be a suggestion that you genetically screen your pregnancy. It may be your own physician wanting to check your genetic profile to let you know what interventions could improve your health over the next 20 years. Full of promise, full of challenges—we will all be involved in the genetic revolution before we know it.

Pregnant couples are often the target of advertisements recommending umbilical cord blood (UCB) collection at the time of their child’s birth: Support your child’s future—the best decision you’ll ever make.

What does UCB involve, and is it ethical for Christians?

Umbilical cord blood

During pregnancy, the umbilical cord connects the baby to the mother’s placenta in the uterus. It contains blood vessels. UCB refers to the human blood that remains in the placenta and the umbilical cord following the birth. Umbilical cords have traditionally been discarded following the birth. However, they have been found to be a rich source of multipotent hematopoietic stem cells (HSCs), which can be used in transplants to treat more than 70 different diseases, including diseases of the blood, the heart and the immune system. This branch of therapy is called regenerative medicine.

Stem cells are special cells that are capable of developing into many of the different types of tissue in the human body (so blood stem cells can be turned into nerve cells, for instance). The stem cells in UCB are classified as adult stem cells, even though they come from a baby. These are different from embryonic stem cells (which are taken from a 5-day-old embryo), and their use is ethically acceptable for those who wish to respect embryonic human life.[1]

How is UCB collected?

After the delivery (vaginal or caesarean), the cord is clamped and cut in the normal manner (often by the proud father). This separates the baby from the mother and the placenta, and it doesn’t hurt because there are no nerves in the cord. The part of the cord still attached to the placenta is cleaned, and a needle is used to drain the blood into a storage bag. This can be done before or after the placenta is delivered. The blood is then taken away for processing, which includes screening for infectious and genetic diseases. After processing it is placed in (frozen) storage in a blood bank, where it will stay until its possible future use as a source of stem cells for transplants or other therapies (current evidence suggests that freezing does not damage UCB).[2] The whole process is safe and painless, and takes just a couple of minutes.

Collection can only take place at the time of the delivery, so you need to decide beforehand if you want it done and let your doctor or midwife know.

UCB treatments

When the stored UCB is needed, it is thawed and delivered to the patient for treatment. When the stem cells are collected from a donor other than the patient, it is called an allogeneic treatment. When the cells are collected from the same patient for whom they will be used, it is called an autologous treatment. At the moment, UCB is being investigated for transplantation, gene therapy and stem-cell therapy. It is possible that more uses for UCB will be found in the future.

UCB transplants

There are several benefits in using UCB rather than the usual bone marrow for transplants. The cells proliferate more rapidly than bone marrow cells. UCB cells are immunologically immature compared to cells from adult bone marrow or peripheral blood stem cells, so they can tolerate an element of mismatch. As a result, there is less graft-versus-host disease (GVHD) following allogeneic transplantation. For patients with uncommon tissue types, UCB may be an option if an adult donor cannot be found. It is already in storage, so there is no delay in collecting it from a donor. It can usually be ready to give within two weeks, whereas finding a bone marrow donor can take much longer. Disadvantages in using UCB include the fact that there is a small risk (1:10,000) that a genetic disease may be transmitted to the patient.

UCB has been used successfully in transplants for people related to the donor for both malignant and non-malignant diseases.[3]

UCB stem-cell therapy

UCB is also being investigated for use in stem-cell therapy. HSCs are being trialled to modify the body’s immune system in diseases such as diabetes and arthritis. Researchers are currently using HSCs in gene therapy, as a way to deliver new genes to repair damaged cells. The benefits of using HSCs include the ease with which they are collected compared to all other stem cells. They are also believed to be more flexible, or plastic (able to turn into a larger number of different tissue types), than adult bone marrow stem cells.[4]

HSCs are being investigated for use in a wide variety of diseases, including heart, liver, eye, bone, nerve and hormonal diseases.[5]

UCB banks

UCB is stored by both public and private cord blood banks. Public cord blood banks store UCB for the benefit of the wider population. They are strongly supported by the medical community. Computerized registries allow the matching of patients needing a transplant to UCB supplies. Private cord blood banks are commercial organizations that store UCB for the exclusive use of the donor or the donor’s relatives. Fathers and siblings have a 25% chance of matching their child’s UCB stem cells. Of course, the match is perfect for the baby from whom the blood was collected. There is usually a collection fee, and then an ongoing storage fee. Private UCB banking is illegal in some parts of Europe.

There are arguments for both public and private banking. It should be remembered that if the blood is stored in the public domain, the individual is still eligible to access it (before it is used by someone else). The probability of actually utilizing one’s own UCB is very small. Estimates are difficult, but some put it as low as 0.0005% (1:200,000) within the first 20 years of life. This is partly because it is sometimes better to use stem cells from another donor. Your own UCB may contain the very same defect that means you need treatment. This is an argument for storing UCB in a public facility where more people will benefit from your donation.

However, private banking (where you are basically collecting and storing UCB for a family member) is recommended when there is a sibling with a disease that may be treated successfully with an allogeneic transplant.[6] In the end there is no absolutely wrong choice in ethical terms. You should discuss your own situation with your doctor. Several authorities warn parents to beware of misleading marketing by some private UCB banks.[7]

Ethics

It is ethical for Christians to use medical therapies to bring the body back to normal health so long as no other biblical principles are violated.[8] With UCB therapies in particular, as mentioned above, there are no ethical problems with the stem-cell treatments due to the ethical source of the stem cells. Regenerative therapy is a field of great promise to which no sensible person objects.

What about the ethics of collecting UCB? There are concerns that the rise of private UCB banks undermines the traditional idea that the donation of blood is a ‘gift’ to unknown others. Will private UCB banking allow those with sufficient money to keep blood for themselves, even though the chances of using your own blood may be very small? Some have also questioned whether it is right to take UCB without informed consent—since parents are often inadequately educated, and the child has no autonomy in giving permission for UCB to be taken.[9]

It is true that a market system discourages a sense of social solidarity, and undermines the altruism that is required for a society to exist successfully.[10] (This is why there have always been concerns about such practices as the selling of human organs for transplant.) Where private blood banking has been allowed, it has often led to unevenness in the quality of the product. This has prompted some to argue for a public system where all deliveries have cord blood collected, and where the government then regulates standards of quality.[11]

These discussions should not deter those who do have a high chance of using the UCB from taking advantage of the private system while it continues to exist, especially since there is a limit to how many cords public banks can store, and some are getting close to the limit.[12]

What of the infant autonomy argument? This seems disingenuous to me, given how quickly we have abandoned any autonomy for the fetus up to the moment of its birth. Besides, we allow parents to consent to treatment for minors, including the donation of renewable tissue (tissue that can replace itself). There is further ethical justification in collecting UCB in that it is beneficent (it does good) by making potential medical cures available for more people.

The issue, then, is making sure that parents are fully informed of what is involved. To achieve informed consent, we need agreement from mentally competent people who have not been pressured in any way, and who are aware of all the benefits, risks and burdens of the procedure. I would suggest this could be achieved by following these guidelines:

1. Doctors should be honest about their financial or other interests in private banks, and not accept rewards for providing private banks with UCB samples.
2. Collectors should be aware that both parents have the right to participate in the decision, and therefore both need to be informed. To avoid pressure to make a decision quickly, this should happen well before the birth, with written as well as verbal explanations in language the parents can understand.
3. Any explanation should cover both public and private banking and the benefits and burdens of each, in particular making sure private banks don’t offer more than they can deliver. There are detailed documents available which outline the information that should be covered.[13]

Theologian Andrew Cameron notes that this subject may bring an ancient biblical theme to mind: that the life of the creature is in the blood (Lev 17:11; cf. Gen 9:4; Lev 17:10-14; Deut 12:23). It is well known that some religions still regard this teaching as prohibiting treatment with blood products. But evangelical Christians will resist this interpretation, since we know that the laws of ancient Israel have been fulfilled in Jesus Christ. They are no longing binding on us (Gal 5:18).[14]

Sometimes it is easier to understand the issues when we think about them in the context of a personal story. Below are some recommended books and movies that explore in a helpful and/or interesting way the topics covered in this book. It is not an exhaustive list—just some good examples I have come across during my research.

Books

• Josh McDowell and Ed Stewart, My Friend is Struggling with Unplanned Pregnancy, Christian Focus Publications, 2009: a part of the Project 17:17 collection of stories, this book is an easy-to-follow ‘crisis resource’ for young Christians.
• Bernadette Black, Brave Little Bear, Inspire Publishing, 2006: a real-life story of an Australian teenage mother.
• Heather Gemmen, Startling Beauty, Life Journey, 2004: the author tells her story of the healing and forgiveness that is possible after rape. She decided to keep her ‘rape’ baby, and describes the joy a child can bring out of a place of darkness.
• Melinda Tankard Reist, Giving Sorrow Words, Duffy and Snellgrove, 2000: the author tells the stories of women grieving after abortion, and examines their experiences.
• Abby Johnson with Cindy Lambert, Unplanned, Tyndale, 2010: the personal story of a Planned Parenthood clinic director’s change of heart in the abortion debate.
• Sarah Williams, The Shaming of the Strong, Kingsway, 2005: the personal story of a mother and her family learning to love and care for her disabled child, who was expected to die at birth.
• Madeleine Witham, Ella, Ark House, 2009: a mother’s honest account of life with her daughter, who suffers from Cornelia de Lange Syndrome (CDLS).
• Kate Hurley, Take Heart, Blue Bottle, 2008: combines stories from families of children with disability with an honest look at the theological questions they raise.
• Melinda Tankard Reist, Defiant Birth, Spinifex Press, 2006: tells the stories of women who were told to abort because of disability, but decided to continue their pregnancies despite opposition.
• Kazuo Ishiguro, Never Let Me Go, Faber and Faber, 2005: a novel that tells the story of three friends growing up inside an English school that has been established for the raising of cloned children destined to become vital organ donors. Also a movie (2010).

Movies

Movies can be an easy way to start a group discussion about bioethics. Please check film ratings before viewing.

• Juno, 2007: a teenager becomes pregnant and has to decide what to do.
• Vera Drake, 2004: a working-class family woman in 1950s England secretly helps woman end their unwanted pregnancies.
• The Elephant Man, 1980: the story of John Merrick, the hideously deformed 19^th-century Londoner known as ‘The Elephant Man’, who was treated as a sideshow freak.
• Anonymous Father’s Day, 2011: a documentary exploring anonymous sperm donation from the perspective of the now adult offspring.
• Eggsploitation, 2010: a documentary exploring the human egg donation business in the USA.
• My Sister’s Keeper, 2009: a family struggles as a saviour sibling seeks to stop donating tissue.
• Lines that Divide, 2009: a documentary that tells the story of stem-cell research.
• The Island, 2005: set in a future where cloning humans is an industry that provides tissue-matched transplant organs.
• Gattaca, 1997: set in a future where one’s life is determined by genetic engineering.
• Moon, 2010: set in a future where cloning humans provides a reliable source of labour.

Page numbers followed by n indicate footnotes. Page numbers have been retained for parity between the electronic and print editions.

A-E
F-J
K-O
P-T
U-Z

A

• abandonment, of children 148-9, 192-3
• abortion, induced 141-98
  • arguments for 81, 158-62
  • as commercial business 162, 469-78
  • complications of 170-6, 306
  • counselling 470
  • definition of 142
  • ethics of 158-62
  • history of 142-57
  • illegal 151, 154, 159, 161-2
  • legislation 150-7, 163, 177, 189
  • maternal mortality 159-62, 170
  • methods of 163-70
    • medical 163-6
    • surgical 166-70
  • reasons for choosing 181-7
  • statistics on 126-7, 141, 152, 155-7, 161, 182, 194n
  • theology of 145-50
• abortion, spontaneous. See miscarriage
• Abortion Act 1967 (UK) 151
• abstinence, from sexual intercourse 98, 122, 125-6
• access to assisted reproductive technologies 381-4
• acquired immune deficiency syndrome (AIDS) 208-9, 482
• Adjudin 124
• adoption 192, 274
  • disabled children 260
  • embryo 51, 342, 375-6, 407-13, 438
• adult stem cells 424-6, 437
• Advanced Embryo Selection 378
• age factors
  • congenital abnormalities 305
  • infertility 269-71, 277-8
  • miscarriage/stillbirth 305-6
  • older parents 382-4
• AIDS (acquired immune deficiency syndrome) 208-9, 482
• Alcorn, Randy 465
• alternative therapies for infertility 288
• altruistic surrogacy 366, 372-3
• amniocentesis 223-6, 228, 234, 309
• analgesia, fetal 177-80
• anembryonic pregnancy 01
• anencephaly 218, 221, 255-6
• aneuploidy 277, 287, 482-3
• antenatal screening
  • fetal (See prenatal testing)
  • maternal 202-13
• antibody screen 206-7
• anti-Müllerian hormone (AMH) 390
• Antinori, Severino 382, 430
• Aquinas, Thomas 32, 47n, 50, 61, 88-9
• Aristotle 46, 47n, 50, 83, 143, 150n, 238
• ART. See assisted reproductive technologies
• assisted hatching 356-7
• assisted reproductive technologies (ART) 325-90. See also specific technology
  • access issues 381-4
  • as business 368-70, 382, 389, 449-50
  • children of
    • rights of 361-4, 371-5, 382
    • safety issues 385-7, 396
  • ethics of 326-7, 419, 449-50
  • indications for 285-8
  • leftover embryos (See leftover embryos)
  • reasons not to use 391-400
  • regulation of 328-9, 350, 385-6, 403-4
  • stopping 296-8, 389-90
  • theological objections to 393
• atonement (replacement) child 177
• Augustine 47, 86-9, 91
• Australia
  • abortion laws in 156-7, 163, 174, 189
  • abortion statistics in 127, 157, 182
  • ART regulation in 296, 328, 335, 350, 358, 403-4
  • congenital abnormalities in 201
  • embryo research in 31, 36, 38, 413, 440
  • gamete donation in 336, 357-61, 359-61, 433
  • infertility statistics in 269
  • leftover embryos in 403
  • stillbirth statistics in 303
  • surrogacy in 366, 369
• Austria 192, 359, 410
• autonomy 78-9, 101, 153
  • reproductive (See reproductive rights)
• autopsy, after miscarriage/stillbirth 316

B

• barrier contraceptives 118-19
• Barth, Karl 57n, 61, 64n, 92-3, 95, 265
• basal body temperature (BBT) 122, 282
• beginning of life, theories
  • at birth 35, 43
  • embryologists’ view of 29-30
  • at fertilization 19-28, 34, 50, 105
  • at implantation 25-6, 34
  • personhood theories 32-40, 49-51, 236
  • at quickening 34-5
  • at self-consciousness 35
  • at sentience 34
  • theology of 43-50
  • at viability 34-5
• Belgium 404
• beneficence 78-9
• Billings method 122
• Biotechnology 444-59
  • birth. See also childbirth
• life as beginning at 35, 43
• birth control. See contraception
• birth defects. See congenital abnormalities
• bladder infection 207-8
• blastocyst
  • transfer 331, 346-51
  • development 16-17, 335
  • in stem-cell research 424, 427-9
• blastocyst (extended) culture 347-51
• bleeding, vaginal
  • menstrual (See menstruation)
  • during pregnancy 301-2
• blessing, children as 61-3, 89, 93-4, 102-3, 265-8, 394
• blighted ovum 301
• blood, umbilical cord 226, 501-6
• Blood, Dianne 384
• blood testing
  • anti-Müllerian hormone 390
  • fetal 226
  • infertility 283
  • pre-pregnancy 202-4
  • routine antenatal 205-12
• body mass index (BMI) 279, 306
• breast cancer 172, 196-7
• breastfeeding
  • as contraceptive method 114, 123-4
  • contraception use during 112, 114
• Brown, Louise Joy 347, 419
• BufferGel 119
• business, commercial
  • abortion as 162, 469-78
  • ART as 368-70, 382, 389, 449-50
  • embryo research as 450

C

• Calvin, John 47n, 89
• Canada
  • cloning ban in 430, 437
  • gamete donation in 360
• cancer
  • abortion and 172, 186, 196
  • egg donation and 433-4
  • fertility issues 353-4, 374
• Care 118
• Casti Connubii (‘On Christian Marriage’) 91
• castration 97, 131
• Catholic doctrine
  • ART 393
  • contraception 82-93, 96, 459
  • natural family planning 122-3
  • sexual intercourse 56-7, 85
• cell lines, for vaccine production 472-4
• centchroman 127
• Centron 127
• Cerazette 115
• cervical caps 118-19
• cervical mucus
  • contraceptives affecting 109, 112, 114-15, 134, 465-8
  • infertility and 280
  • natural family planning based on 122, 282
• chicken pox (varicella) 204, 472
• childbirth. See alsolabour
  • life as beginning at 35, 43
  • pain during 62, 180
• child destruction 157n
• childlessness. See also infertility
  • social attitudes towards 394-5
  • chosen 100-2
• children
  • ART
    • rights of 361-4, 371-5, 382
    • safety issues 385-7, 396
  • as blessing 61-3, 102-3, 265-8, 394
  • cloned 432
  • disciplining of 64, 64n
  • within marriage 60-2
  • parents’ responsibility to care for 63-5, 99, 129
  • reasons for having 62-3, 265
  • response to sibling death 312-13
  • rights of 232-4
• Chile 159, 162
• China 492, 493n
• Chinese medicine 124, 288
• chlamydia 212, 308-9
• chocolate 311
• chorionic villus sampling (CVS) 224-6, 228, 234, 309
• Christian participation, in public discourse 51, 453, 462-3, 499
• chromosomal abnormalities 244. See also congenital abnormalities; preimplantation genetic diagnosis; prenatal testing; specific anomaly
  • abortion for 198
  • infertility and 287
  • pregnancy loss and 311
  • theology of 245-9
• chromosomes, general 15, 27, 480-3
• Ciclofem 113
• Ciclofemina 113
• Clomid 286, 333
• clomiphene citrate 286, 333
• cloning 28, 426-37
  • egg donation for 433-4
  • regulation of 428-30, 437
  • reproductive 428-30
  • safety issues 434-5
  • therapeutic 427-9, 433-4, 437
• coils (intrauterine devices) 119-21, 133-4
• coitus. See sexual intercourse
• coitus interruptus (withdrawal method) 125
• combined hormone contraceptives 107, 113
  • alternative use for 459
  • emergency 135
  • injectable 113
  • IUD 121
  • mechanism of 107-10
  • oral 109-12
  • patch 116-17
  • vaginal ring 117
• commercial enterprise
  • abortion as 162, 469-78
  • ART as 373, 389, 449-50
  • embryo research as 450
• commercial surrogacy 366, 368-75
• comparative genomic hybridization (CGH) 378
• compassionate transfer 408
• computerized fertility monitors 122
• Comstock Act (USA) 89-90
• conception 15-16, 19, 25, 103. See alsofertilization
  • definition of 104
• condoms 118, 133, 331
• congenital abnormalities 201-2 See also disabled persons; specific defect
  • abortion for 151-2, 182, 186-7, 198, 214, 222, 227, 244, 253-5
  • in ART children 386, 396
  • counselling for 214, 223-4, 227, 249, 252, 257
  • eugenics and 232-8, 253
  • parental age factors 277-8, 287, 305-6
  • risk factors 213, 305
  • screening for (See prenatal testing; specific test)
  • statistics 245
  • surrogacy and 373
  • theology of 238, 243-9
• congenital rubella syndrome (CRS) 203
• conscience, rights of 189-91
• continuous use contraceptive pills 110-11
• contraception 81-139
  • history of 82-93, 143
  • theology of 93-103, 125-6, 128
• contraceptive methods 103-39. See also specific products
  • choosing 106-7
  • marketing strategies 104-5
  • mechanisms of action 103
  • types of 105-6, 139
    • abstinence 125-6
    • barrier 118-19
    • emergency 133-8
    • fertility awareness 121-4
    • hormone (See hormone contraceptives)
    • intrauterine devices 119-21, 133-4
    • lactation amenorrhoea 123-4
    • male 124-5, 130
    • permanent 127-33
    • withdrawal (See coitus interruptus)
• copper-bearing intrauterine devices 120-1, 133-4
• cordocentesis 226
• cosmetics industry 474-6
• Council of Europe 38, 477
• counselling
  • abortion 470
  • Christian values in 457-8
  • congenital abnormalities 214, 223-4, 227, 249, 252, 257
  • gamete donation 360, 365-6
  • infertility 288-9, 392
  • pregnancy 194
• creation, biblical 41-3, 72, 98-9, 247-8
• cryopreservation
  • egg (oocyte) 351-3, 382
  • embryo (See embryo cryopreservation)
  • ovarian tissue 353-4
  • sperm 351, 354-5
• culture media 331, 347, 418
• curettage 167-8
• CycleBeads 122
• Cyclofem 113
• Cyclo-Provera 113
• cystic fibrosis (CF) 230-2
• cystitis 207-8
• cytomegalovirus (CMV) 212, 308
• cytoplasmic transfer 376-7

D

• death
  • gamete collection after 384-5
  • infant 299-324 (See also infanticide)
    • congenital abnormalities 244
  • intrauterine 302
  • maternal (See maternal mortality)
• decision-making. See ethical decision-making
• delayed miscarriage 302
• Depo 112
• Depo-Provera 112-13, 133
• depo-subQ provera 104 (DMPA-SC) 112
• desogestrel 115
• detection of pregnancy 25-6
• diabetes, gestational 211
• diaphragm 118-19
• Dignitas Personae 92n, 393
• dilation and curettage (D&C) 167, 301
• dilation and evacuation (D&E) 167-8
• direct gene testing 483-4
• Disability Discrimination Act (UK) 488
• disabled persons. See also congenital abnormalities; eugenics
  • attitudes toward 236-42, 250, 258-60
  • preterm infants 197
  • statistics 241
  • sterilization of 131-2, 153
  • support 249-53, 260-2
  • theology of 241-2, 246-9
• divorce 458
  • leftover embryos and 343, 402, 406
  • theology of 54, 54n, 59, 76, 415n
• DNA (deoxyribonucleic acid) 15, 22-4, 27
  • genome sequencing 481-3
  • mitochondrial 377
  • structure of 480-2
• Does the Birth Control Pill Cause Abortions? (Alcorn) 465
• Doe v. Bolton (US) 154
• Dolly (cloned sheep) 428, 434-5, 437
• donor embryos 51, 342, 375-6, 407-13, 438
• donor gametes 357-66
  • for cloning 433-4
  • counselling about 360, 365-6
  • eggs 286, 336-9, 357-8, 433-4
  • sperm 286, 337, 358-9, 433
  • theology of 364-5
• donor insemination (DI) 358-9
• Donum Vitae 393
• double effect, principle of 459
• Down syndrome 201, 225-6, 228-9, 232-3, 256-8
  • parenting of child with 250
  • screening for 215-21
  • statistics 201, 228, 258
• drug industry. See pharmaceutical industry

E

• early fetal demise 301
• Early Pregnancy Factor (EPF) 25
• ectopic pregnancy 302
  • after abortion 171
  • with GIFT 355
  • IUDs causing 120
  • tubal abnormalities causing 281
• Edwards, Robert 277, 397, 418-19, 421
• egg (oocyte) 15
  • age factors 277, 286
  • collection of 339, 421
  • cryopreservation of 351-3, 382
  • development of 107
  • donor 286, 336-9, 357-8, 433-4 (See also donor gametes)
  • fertilization of 15-16, 103, 275-6 (See also fertilization)
  • release of (See ovulation)
• ejaculatory disorders 281, 285
• ella 134
• ellaOne 134
• El Salvador 161
• embryo(s)
  • adoption of 51, 342, 375-6, 407-13, 438
  • destruction of 396-8 (See also embryo research)
  • failure to implant 21
  • leftover (See leftover embryos)
  • moral status of 19-30, 31-52
  • morphology (appearance) 340, 346-50
  • viability of 340, 346-9
• embryo cryopreservation 339-51
• embryo donation 51, 342, 375-6, 407-13, 438
• Embryo Protection Act 1990 (Germany) 342
• embryo research 12, 417-42
  • arguments for and against 35-7, 418-42
  • cloning (See cloning)
  • commercial interests in 450
  • creation of embryos for 38, 438
  • public debate 437-41
  • ethical alternatives to 435-7
  • ethics of 38, 420
  • 14-day-rule for 35-6, 422-3
  • history of 418-23
  • leftover embryos donated for 413-14
• embryo transfer
  • blastocysts 347-51
  • regulation of 335-6, 339-40, 342, 350, 385-6
• embryonic development 15-18, 275, 418
• embryonic stem (ES) cells 28, 406, 413, 417, 423-7, 501
• emergency contraception (EC) 133-8
• emerging personhood 36
• empty sac 301
• endometrial biopsy 283
• endometriosis 281, 287
• endometrium 108
  • contraceptives affecting 109, 112, 114-15, 127, 465-8
  • medical abortion affecting 164-5
• enhancement, genetic engineering for 494-7
• ensoulment, delayed 47n
• Equality Act 2010 (UK) 488
• ERPC (evacuation of retained products of conception) 302
• estradiol 108
• estradiol cypionate 113
• estradiol valerate 113
• ethical decision-making 69-80
  • about embryo research 438
  • in healthcare 456-9
• ethinyl estradiol 110, 116, 117
• etonogestrel 115-16, 117
• eugenics
  • prenatal screening 232-8, 253
  • sterilization 130-1, 153
  • surrogacy and 369
• Evangelium Vitae 198
• Evra 116-17
• excess embryos. See leftover embryos
• extended (blastocyst) culture 347-51
• extended cycle contraceptive pills 110-11

F

• fall, biblical 72
• fallopian tube
  • fertilization in (See fertilization)
  • occlusion 130, 281, 287
  • pregnancy in (See ectopic pregnancy)
• family, definitions of 65-6, 458
• fasting glucose tolerance test 211
• fathers
  • abortion desired by 183-4
  • grief after miscarriage/stillbirth 317-18
  • psychological effects of abortion on 176-7
  • rights in abortion 152, 155, 157, 184
  • role of 194 (See also parenthood)
• female condom 118
• female factor infertility 277-8, 280-1. See also infertility
  • assessment of 282-4
  • treatment of 286-7
• female reproductive cycle 103, 107-8, 275
• Femidom 118
• Feminena 113
• Femplant 115-16
• Femulen 114
• fertility awareness 86, 121-4
• fertilization 15-16, 103, 275-6
  • contraceptives acting after 105, 120-1, 127, 133-8, 465-8
  • contraceptives acting before 109, 112-17, 134, 465-8
  • life as beginning at 19-28, 34, 50, 105
  • syngamy 22-4, 344
  • in vitro (See in vitro fertilization)
• fetal abnormalities. See congenital abnormalities
• fetal blood sampling 226
• fetal cell lines, vaccine production from 472-4
• fetal development 18-19
• fetal growth restriction 310
• fetal movement
  • monitoring of 310
  • quickening 34-5, 150n, 150-1
• fetal pain relief 177-80
• fetal reduction 186-7, 309
• fetal tissue industry 470-1
• fetal trafficking 476-8
• first-trimester screening 210, 215-23
• FISH 226
• folic acid 201, 278, 310
• follicle stimulating hormone (FSH) 107, 109, 112, 115, 276, 332
• 14-day-rule for embryo research 34-6, 422-3
• France
  • eugenics case in 232-3
  • genetic discrimination in 488
  • surrogacy in 369
• freezing embryos. See embryo cryopreservation
• funerals, for miscarriage/stillbirth 315-16
• future consummation, biblical 72

G

• gamete intra-fallopian tube transfer (GIFT) 355
• gametes. See alsoegg; sperm
  • donation of (See donor gametes)
  • post-mortem collection of 384-5
• gemeprost 166
• gender-linked genetic disorders 214
• gender selection 193, 236, 379, 381, 492-3
• gene(s), general 480-3
• gene therapy 494-7
• genetic determinism 497-8
• genetic discrimination 486-8, 498
• genetic engineering 494-7
• genetic information, ownership of 485-6
• Genetic Information Nondiscrimination Act 2008 (USA) 487
• genetic testing. See prenatal testing; preimplantation genetic diagnosis
• German measles (rubella) 202-3, 232, 308
• Germany
  • ART regulation in 342, 344, 378, 404
  • cloning ban in 437
  • surrogacy in 369
• germ cells 496
• germinal vesicle transfer 376-7
• gestational age 17n
• gestational diabetes (GDM) 211
• gestational surrogacy. See surrogacy
• gift, children as 61-3, 102-3, 265-8, 394
• GIFT (gamete intra-fallopian tube transfer) 355
• glucose challenge test (GCT) 211
• gonadotropin-releasing hormone (GnRH) 276, 333
• gonadotropins 333-4
• Gonzalez v. Carhart (US) 155
• grief
  • infertility 290-1, 297-8
  • miscarriage/stillbirth 313-19
• Groningen protocol 238
• group B streptococcal disease (GBS) 212, 308
• growth restriction, fetal 310
• Gynol II 119

H

• Hashmi family 490
• hatching, assisted 356-7
• hCG. See human chorionic gonadotropin
• healing 443, 454-6
• healthcare
  • decision-making in 76, 78-9
  • ethics of 443-59
• healthcare professionals
  • involvement in abortion 146, 180-1
    • rights of conscience 189-91
  • assessment of preterm infants 197
  • choosing 457-8
  • contraception provided by 137-8
  • counselling by 194, 252
  • miscarriage/stillbirth support 313-15
  • pregnancy complications treated by 185-6
• hematopoietic stem cells (HSCs) 501-6
• hepatitis B virus (HBV) 209
• hepatitis C virus (HCV) 209-10
• herpes zoster (shingles) 204
• Hill, Michael 41, 72-3, 75-6
• Hippocratic Oath 39, 80, 144
• HIV (human immunodeficiency virus) 208-9, 482
• homocysteine 278
• hormone contraceptives 107-17
  • brand names for 107n
  • ectopic pregnancy and 467-8
  • implants 115-16, 133
  • injectable 112-13
  • intrauterine devices 120-1
  • male 124
  • oral (See oral contraceptive pill)
  • patches 116-17
  • vaginal ring 117
• human chorionic gonadotropin (hCG) 25, 166, 217n, 331, 333
• human cloning. See cloning
• human development 15-19
• human embryos. See embryo(s)
• Human Fertilisation and Embryology Authority (HFEA) (UK) 328, 328n, 337, 358, 358n, 406, 433, 471, 488-92
• Human Fertilisation and Embryology Act (UK) 36, 152
• Human Genome Project 483, 497-8
• human immunodeficiency virus (HIV) 208-9, 482
• human life, beginning of. See beginning of life
• human personhood 32-40, 49-51, 236
• human relationships. See marriage; relationships
• human rights 38, 69, 77, 161, 420
  • of child 232-4, 361-4, 371-5, 382
  • reproductive (See reproductive rights)
  • rights of conscience 189-91
• Humanae Vitae (‘Of Human Life’) 56, 56n, 91-2, 92n, 393
• Hungary 476
• hyperemesis gravidarum 184
• hypertonic saline, intra-amniotic injection of 168-9
• hysterectomy 129-30, 170
• hysterosalpingo-contrast-sonography (HyCoSy) 283
• hysterosalpingogram (HSG) 283
• hysterotomy 170

I

• ICSI (intracytoplasmic sperm injection) 285, 352, 356, 376-7, 386, 396
• illegal abortions 151, 154, 159
• image of God 41-3, 247-8, 441, 458
• immunological problems, infertility caused by 281
• Implanon 115-16, 129, 133
• implantation 275
  • contraceptives affecting 109, 112, 114-15, 127, 133-7
  • failure of 21
  • life as beginning at 25-6, 34
  • medical abortion affecting 166
  • pregnancy as defined by 104
• implants, contraceptive 115-16, 129, 133
• India
  • commercial surrogacy in 368-9, 372
  • infant abandonment in 193
  • sex selection in 492
• induced abortion. See abortion, induced
• induced pluripotent stem cells (iPS) 435-7
• infanticide
  • for congenital abnormalities 238
  • historical perspective 33, 142-5, 148-9
  • theology of 145-8
• infection, antenatal 202-23, 308-9. See also specific infection
• infertility 263-98
  • acceptance of 296-8
  • causes of 277-82
  • counselling for 288-9, 392
  • definition of 264-5
  • emotional response to 263-4, 289-98
  • medical assessment of 282-4
  • reproductive rights and 271-2
  • statistics on 265, 269-71
  • supporting couples with 292-5
  • theology of 265-9
  • treatment of 284-8 (See also assisted reproductive technologies)
    • alternative therapies 288
    • stopping treatment 296-8, 389-90
• injectable contraceptives 112-13
• instillation abortion 169-70
• insurance, genetic testing and 487-8
• intact dilation and extraction (IDX) 170
• internet, genetic testing on 485
• intracytoplasmic sperm injection (ICSI) 285, 352, 356, 376-7, 386, 396
• intrauterine cranial decompression 170
• intrauterine death 302
• intrauterine devices (IUDs) 119-21, 133-4
• intrauterine insemination (IUI) 285, 329-30
  • donor 358-9
• intrauterine surgery 218-19, 222, 257
  • fetal anaesthesia during 179-80
• intrauterine systems (IUS) 121
• in vitrofertilization (IVF)
  • abortion following 186
  • embryo donation after 51, 342, 375-6, 407-13, 438
  • history of 325-6, 347, 397, 418-20
  • indications for 285-8
  • technique of 331-2
• iodine 279, 310
• iron deficiency anaemia 206, 310
• Israel, ancient
  • abortion in 145, 147-8
  • contraception in 83-4, 97-8
  • infanticide in 145-8
  • marriage in 55n
• Italy 342, 344, 404
• IUDs (intrauterine devices) 119-21, 133-4
• IUI (intrauterine insemination) 285, 329-30
  • donor 358-9
• IVF. See in vitro fertilization

J

• Jadelle 115-16

K

• karyotype 226
• kidney infection 207-8

L

• labour 163-4
  • inducing 168, 171
  • pain during 62, 180
• lactation amenorrhoea method (LAM) 114, 123-4
• Lady-Comp 122
• laminaria 166
• language, problems with 19, 53-4, 104-5, 251-2, 402
• laparoscopy 283, 418
• late-term (partial-birth) abortions
  • legislation on 154-5, 157
  • methods of 168-70
  • reasons for 184-5
• leftover embryos 401-15
  • alternatives for 405-15 (See also embryo research)
  • cost of storage 404, 406
  • statistics 403
  • stem cells created from 406, 413
  • time limit for storage 403
• legislation
  • abortion 150-7, 163, 177, 189
  • contraception 138
  • embryo donation 410
  • fetal tissue industry 471
  • gamete donation 359-60
  • infanticide 192
  • post-mortem gamete collection 385
  • safe haven laws 192
  • surrogacy 366-70
• Levonelle 134
• levonorgestrel 110, 114, 116, 121, 134
• lifestyle factors, infertility 278-80
• listeria 308-9
• Lord Ellenborough’s Act 1803 (UK) 150-1
• LoSeasonique 110-11
• Lunella 113
• Lunelle 113
• luteinizing hormone (LH)
  • detection of 122, 332
  • in males 276
  • during menstrual cycle 107, 282
  • suppression of 109, 112, 115
• Luther, Martin 47n, 81, 89
• Lybrel 110-11

M

• male condom 118
• male contraceptives 124-5
• male factor infertility 277-8, 281
  • assessment of 282-3 (See also infertility)
  • treatment of 285-6
• manual vacuum aspiration 167
• marriage
  • abstinence within 98, 122, 125-6
  • childlessness within 61-2, 67, 100-2
  • contraception within 99 (See also contraception)
  • gamete donation and 364-6
  • stress from infertility 289-91
  • theology of 54-61
• materialism 497-8
• maternal mortality 159-62, 171, 185-7, 200-1
• McCorvey, Norma 154
• medical abortion 163-6. See alsoabortion; RU-486
  • complications of 171, 176
• Medically Assisted Reproduction Law 2004 (Italy) 342
• medroxyprogesterone acetate 112-13
• Megestron 112
• memorial services, for miscarriage/stillbirth 315-16
• menopause 96, 129, 275, 286, 382-4
• menstrual aspiration 167
• menstrual cycle 107-8, 275, 282
• menstruation 108, 275
  • abstinence during 125
  • during breastfeeding 123-4
  • cessation of
    • menopause 96, 129, 275, 286, 382-4
    • pregnancy 17
  • during oral contraceptive use 111, 117
• mental health
  • abortions for 182
  • after abortion 172-6
• mentally disabled, sterilization of 131-2, 153
• Mesigyna 113
• methotrexate 166
• Mexico 161
• Micronor 114
• microsurgical epididymal sperm aspiration (MESA) 285, 356
• Microval 114
• midstream urine (MSU) 207-8
• mifepristone. See RU-486
• Milophene 286, 333
• mini-pill 114-15
• Mirena 121
• miscarriage 17, 299-324
  • after abortion 171, 177, 306
  • after diagnostic tests 223, 225-6, 228, 234, 309
  • after selective reduction 187, 309
  • causes of 303-4
  • with congenital abnormalities 228, 245, 304
  • definition of 142
  • emotional response to 311-20
  • investigation of 311
  • missed/delayed 302
  • pregnancy after 319-20
  • recurrent 287, 302-3, 311
  • risk factors 305-11
  • statistics 21, 245, 275, 299, 302-3
  • as taboo subject 319
  • theology of 320-4
  • threatened 301-2
  • treatment following 166
  • types of 300-2
• misoprostol 164, 166
• missed miscarriage 302
• mitochondrial DNA 377
• monogamy 55-6, 59
• monophasic pills 110
• moral relativism 70, 77
• moral status of embryo 19-52
  • embryologists view of 29-30
  • common arguments regarding 20-9
  • personhood and 32-40
  • theology of 40-52
• morning-after pill (MAP) 133-8
• multiple gestation. See also twinning
  • blastocyst transfer 348-9
  • ethical issues 334-6
  • with GIFT 355
  • safety issues 385-6, 396
  • selective reduction 186-7, 309
• multiple index method 122

N

• natural cycle IVF 331
• natural family planning (NFP) 86, 90, 121-3, 282
• Neogest 114
• Netherlands, the 238, 359
• neural tube defects 201, 218, 221, 226, 228
• New Zealand 174, 359, 434
• Next Choice 134
• nonoxynol-9 119
• norelgestromin 116
• norethisterone 114
• norethisterone enanthate (NET-EN) 112, 113
• Norgeston 114
• Noriday 114
• Norigynon 113
• Noristerat 112
• NorLevo 134
• Norplant II 116
• Novafem 113
• Novex-DS 127
• nuchal translucency (NT) screening test 215-16
• nuclear family 65
• NuvaRing 117

O

• obesity 279, 306
• OCP. See oral contraceptive pill
• oestrogen 107-17, 113-14, 116-17, 122, 127, 135-6, 220n, 275, 282, 332, 334
• Offences Against the Person Act 1861 (UK) 156
• older parents 382-4
• oocyte. See egg
• oral contraceptive pill (OCP) 109-12
  • as abortifacient 465-8
  • marketing strategies 104
  • therapeutic use of 459
• ormeloxifene 127
• Ortho Evra 116
• osmotic dilators 166
• ovarian hyperstimulation syndrome (OHSS) 334, 433
• ovarian stimulation 286, 332-6, 339, 396
• ovarian tissue cryopreservation 353-4
• ovulation 103, 107-8, 275
  • during breastfeeding 123-4
  • contraceptives preventing 109, 112-17, 465-8
    • in emergency situation 134-6
  • determining timing of 136, 282
  • escape 466
• ovulation age 17n
• ovulatory dysfunction 280, 286
• oxytocin 168

P

• pain. See also suffering
  • during childbirth 62, 180
• Pain-Capable Unborn Child Protection Act (Nebraska) 177
• pain relief, fetal 177-80
• palliative care 228, 241, 255
• Pap (cervical) smear 204
• parenthood
  • congenital abnormalities 243-62
  • historical perspective 143, 143n
  • responsibilities 63-5, 67, 160
  • older parents 382-4
  • theology of 61-7, 99, 129
• Partial-Birth Abortion Ban Act 2003 (USA) 155
• partial-birth (late-term) abortions
  • legislation on 154-5, 157
  • methods of 168-70
  • reasons for 184-5
• parvovirus 308
• patch, contraceptive 116-17
• patents 450
• paternity testing 485
• payment
  • for egg donation 336-8, 357, 433
  • for sperm donation 337, 359
  • for surrogacy 366-70
• pelvic factors, infertility caused by 280
• permanent contraception 127-33
• Persona 122
• personhood 32-40, 49-51, 236
• Petogen 112
• pharmaceutical industry -4
• the Pill. See oral contraceptive pill
• placental development 20-1
• Plan B 134
• Plan B One-Step 134
• Planned Parenthood 155, 181, 198, 470
• polygamy 55n, 55-6, 59, 364
• population growth
  • abortion limiting 143-5, 153
  • ART and 393-4
  • birth control limiting 90, 90n
• pornography 330-1
• post-abortion syndrome 172-6
• postconceptional age 17n
• Postinor-2 134
• post-mortem examination, after miscarriage/stillbirth 316
• post-mortem gamete collection 384-5
• post-partum haemorrhage 165
• post-term gestation 309
• pre-conception health 278-80
  • assessment of 202-4
• preeclampsia 186
• pregnancy
  • anembryonic 301
  • biology of 275-6
  • clinical assessment before 202-4
  • complications of 185-6
  • death caused by (See maternal mortality)
  • duration of 17n
  • early signs of 17, 25
  • ectopic (See ectopic pregnancy)
  • fetal testing during (See prenatal testing)
  • infection during 202-23, 308-9 (See also specific infection)
  • loss (See miscarriage; stillbirth)
  • maternal mortality 185-6, 200
  • maternal screening during 202-13
  • medicalization of 238
  • multiple fetuses (See multiple gestation; twinning)
  • post-term 309
  • support counselling during 194, 214
  • surgery during 179-80, 218-19, 222, 257
  • termination of (See abortion)
  • unwanted, alternatives for 192-4
  • vaginal bleeding during 301-2
• pregnancy associated placental protein-A (PAPP-A) 217n
• preimplantation genetic diagnosis (PGD) 287, 311, 378-81, 488-9
  • ethics of 379-81
• preimplantation tissue typing (PTT) 490
• prenatal testing 201-2, 210, 213-26. See also chromosomal abnormalities; specific test
  • decision-making about 199-232
  • decision-making after 249-60
  • diagnostic 223-6
  • direct gene testing 483-4
  • eugenics 232-8, 253
  • evaluation of 221-3
  • first-trimester 215-18
  • second-trimester 218-21
• preterm infants 171, 197, 385-6
• primary infertility 264, 271, 274. See also infertility
• primitive streak 36
• procreative purpose of intercourse 56, 60-1, 86-7, 89, 96, 393
• PRO2000 gel 119
• progesterone 107-8, 117, 134-6, 164, 166, 332
• progestin 107, 109-10, 112-16, 121, 468
• progestin-only injections 112-13
• progestin-only pill (POP) 114-15, 468
• progestogen 107, 109, 120
• pronuclei 16, 22, 331, 344
• prostaglandins 165-6, 168-9
• psychological response
  • abortion 172-6
  • gamete donation 360-3
  • miscarriage/stillbirth 316-19
• punitive sterilization 131
• pyelonephritis 207-8

Q

• quadruple (quad) test 220-1
• quickening, life as beginning at 34-5, 150n, 150-1

R

• rape
  • abortion after 161, 182, 186, 195-6
  • emergency contraception after 136-7
  • of mentally disabled persons 132
• Reality 118
• recurrent miscarriage 287, 302-3, 311
• refusal of treatment 186
• regenerative medicine 424
• relationships 53-67. See also marriage
• replacement (atonement) child 177
• reproduction, sex without 11, 81, 99, 141. See also contraception
  • for unitive purpose 56-60, 92-3, 96, 129, 393
• reproductive cloning 428-30
  • ethical issues 431-3
• reproductive cycle, female 107-8, 275, 282
• reproductive rights 66-7, 158-9
  • ART and 394
  • as burden 102
  • cloning and 433
  • as human right 69, 77, 154, 161
  • infertility and 271-2
  • prenatal testing and 232-6
  • theology of 66-7
• research
  • embryo (See embryo research)
  • fetal tissue 470-1
  • materialism and 497-8
• research subjects, rights of 38, 420
• retrieval ethic 75-6
• retrograde ejaculation 285
• Rhesus (Rh) negative women 206-7
• rhythm method 86, 90, 121-3
• risk factors
  • congenital abnormalities 213, 305
  • miscarriage/stillbirth 305-11
• RNA-induced pluripotent stem cells (RiPSCs) 436
• Roe v. Wade (US) 154-5, 478
• Roman Catholic Church. See Catholic doctrine
• RU-486 (mifepristone)
  • abortion induced by 164-5
  • complications of 171, 176
  • contraceptive use of 126-7
  • emergency use of 135-6
• rubella (German measles) 202-3, 232, 308
• R v. Bourne (UK) 156

S

• safe haven laws 192
• Saheli 127
• San Jose Articles 161
• saviour siblings 430-1, 490-2
• Seasonique 110-11
• secondary infertility 264, 271, 274, 288-9. See also infertility
• second-trimester screening 218-21
• selective oestrogen receptor modulator (SERM) 127
• selective reduction 186-7, 309
• semen 276
  • analysis of 283
  • poor quality 281, 285
• sequential media 347
• Serophe 286
• Serophene 333
• Sevista 127
• sex chromosomes 481
• sex selection 193, 236, 379, 381, 492-3
• sexual assault. See rape
• sexual intercourse (coitus) 56-61
  • procreative purpose of 56, 60-1, 86-7, 89, 96, 393
  • theology of 56-7, 59-60, 84-9, 92-9, 129
  • without reproduction 11, 81, 99, 141 (See also contraception)
    • unitive purpose of 56-60, 92-3, 96, 129, 393
• sexually transmitted infections 119
• shingles (herpes zoster) 204
• siblings
  • parents’ responsibility for 63-5, 99, 129
  • saviour 430-1, 490-2
• sin
  • congenital abnormalities and 247
  • contraceptive use as 87-8
  • suffering as consequence of 451
• Sino-implant II 116
• skincare products derived from embryo/fetus 474-6
• snap freezing (vitrification) 352
• Snowflakes Frozen Embryo Adoption Program 51, 411-13
• social infertility 326
• social prejudice, against childlessness 394-5
• somatic cell nuclear transfer (SCNT) 427-31
• somatic cells, reprogramming of 436-7
• South Korea 492
• sperm 27
  • abnormalities of 281
  • collection of 330-1, 356, 359
    • post-mortem 384-5
  • cryopreservation of 351, 354-5
  • development of 276
  • donor 286, 337, 357-9, 433 (See also donor gametes)
  • fertilization of egg by 15-16, 103, 275-6 (See also fertilization)
• spermatogenesis, contraceptives affecting 124-5
• spermicides 118-19, 125
• sperm sorting 381
• spina bifida 201, 218, 221-2, 258
• sponge, contraceptive 118-19
• spontaneous abortion. See miscarriage
• stem cells 423-6
  • adult 424-6, 437
  • cloning (See cloning)
  • in cosmetics industry 474-5
  • embryonic 28, 406, 413, 417, 423-6, 501
  • hematopoietic 501-6
  • induced pluripotent 435-7
  • international trade in 476-8
• sterility 264, 271. See also infertility
• sterilization 127-33
• stillbirth 299-324
  • causes of 303-4
  • definition of 301
  • risk factors 305-11
  • statistics 303
  • theology of 320-4
• Stopes, Marie 90, 153
• streptococcal disease, group B 212, 308
• stress, infertility and 280, 289-91, 308, 388
• suction curettage 167
• suffering
  • congenital abnormalities and 244, 248, 258-9
  • infertility 263-4, 289-98
  • theology of 450-3
• support groups
  • infertility 295-6
  • miscarriage/stillbirth 318
  • parents of disabled children 250
• surgical abortion 163, 166-8. See also abortion
• surrogacy 366-75
  • altruistic 366, 372-3
  • attitudes toward 367-8
  • commercial 366, 368-70
  • ethical issues 370-75
  • indications for 286, 367, 409
  • legal issues 370
  • motivation for 367, 372-4
• Sweden 91
• Switzerland 344, 437, 475
• sympto-thermal method 122
• syngamy 22-4, 344
• Syngestal 112
• syphilis 207

T

• technology
  • ethical issues 444-50
  • reproductive (See assisted reproductive technologies)
  • research (See embryo research)
• testes 276, 278, 281
• testicular sperm aspiration (TESA) 285, 356
• testosterone 276, 278, 281
• Thailand 368-9
• thalidomide 151n
• therapeutic abortion 143, 154, 157, 182-5, 196
• therapeutic cloning 427-9, 433-4, 437
• threatened miscarriage 301-2
• thyroid function tests 212
• tissue transplantation 430-1, 470-1
• toxic shock syndrome 119
• toxoplasmosis 212, 308-9
• traditional Chinese medicine 124, 288
• transplantation
  • tissue 430-1, 470-1
  • umbilical cord blood 502-3
• triple test 220-1
• Tripterygium wilfordii 124
• trisomy 13 215
• trisomy 18 215
• trisomy 21. See Down syndrome
• tubal abnormalities 130, 281, 287
• tubal pregnancy. See ectopic pregnancy
• 24sure methodology 378

U

• Ukraine 476
• ulipristal acetate 134-5
• ultrasound
  • first-trimester 215-18
  • routine antenatal 210-11, 215
  • second-trimester 218-20
  • sex selection using 492
• umbilical cord
  • blood collection from 226, 501-6
  • stem cells collected from 424n, 503
• unexplained infertility 281-2, 287
• United Kingdom
  • abortion laws in 36, 150-2, 163, 174
  • abortion statistics in 152
  • antenatal screening in 222, 234-5, 488
  • ART regulation in 328, 404
  • Down syndrome statistics in 258
  • egg donation in 337
  • embryo research in 49-50, 422, 425-7
  • gamete donation in 359, 363, 433
  • infertility statistics in 269
  • leftover embryos in 401, 403-4, 406
  • saviour siblings in 490-1
  • stillbirth statistics in 303
  • surrogacy in 366
  • Warnock committee 35-6, 38, 51, 423
• United Nations
  • abortion as human right 161
  • cloning ban 432, 434
  • Convention on the Rights of a Child 361
  • disability statistics 241
  • Millennium Development Goals 200
  • sex selection ban 492
  • The Universal Declaration of Human Rights 69, 272
• United States
  • abortion laws in 150, 152-6, 163, 177
  • abortion statistics in 155-6, 194n
  • antenatal screening in 211, 219, 235, 490
  • ART regulation in 328-9, 342, 358, 397-8, 404
  • embryo research in 36, 423, 425-7, 430, 478
  • eugenics in 130-1, 153
  • fetal tissue industry in 471
  • gamete donation in 337, 359, 433
  • IVF approval in 35-6
  • leftover embryos in 403-4, 411
  • post-mortem gamete collection in 385
  • pregnancy support counselling in 194
  • safe haven laws in 192
  • saviour siblings in 490
  • stillbirth statistics in 303
  • surrogacy in 368
• unitive purpose of intercourse 56-60, 92-3, 96, 129, 393
• unwanted pregnancy 81
  • alternatives for 192-4
• urinalysis 207-8
• uterine abnormalities 280, 286
• uterine lining. See endometrium

V

• vaccines, fetal cell lines for 472-4
• vacuum aspiration 167
• vacuum curettage 167
• vaginal bleeding
  • menstrual (See menstruation)
  • during pregnancy 301-2
• vaginal ring, contraceptive 117
• varicella (chicken pox) 204, 472
• varicocele 286
• vasectomy 129-30
• viability
  • embryos 340, 346-9
  • life as beginning at 34, 35
  • preterm infants 197
• vitamin D deficiency 212, 278-9
• vitrification 352

W

• Warnock committee (UK) 35-6, 38, 51, 423
• wastage, embryos 21, 347-8
• Watson, James 233, 480, 495
• weight, maternal 279, 306
• WinBOM Charting System 122
• withdrawal bleeds 111, 117
• withdrawal method 125
  • history of 82-3, 87, 89
  • theology of 97
• World Health Organization (WHO)
  • abortion method guidelines 167
  • abortion statistics 141, 161
  • antenatal screening guidelines 205, 221-3
  • disability classification 241-2
  • disease classification 160, 175-6
  • health definition 271
  • RU-486 approval 165
  • stillbirth definition 301

X

• X chromosome 481

Y

• Y chromosome 481
• Yuzpe method 135

Z

• Zarin 115-16
• zona pellucida 277, 352, 356
• zygote 15, 418
• zygote intra-fallopian tube transfer (ZIFT) 355

PAGE NUMBER GOES HERE

Genesis

• 1…………………………………….. 62
• 1:21………………………………… 42
• 1:24-25……………………………. 42
• 1:26-27……………………………. 41
• 1:27………………………………… 89, 247, 409, 414, 458
• 1:28………………………………… 56, 61, 83, 88, 89, 93, 95, 98, 129, 145, 444
• 2…………………………………….. 58
• 2:7………………………………….. 44
• 2:16-17……………………………. 99, 321
• 2:18………………………………… 42, 57, 58, 89
• 2:18-22……………………………. 61
• 2:18-25……………………………. 56
• 2:21-22……………………………. 89
• 2:23-24……………………………. 58
• 2:24………………………………… 15, 55, 56, 57, 59, 86
• 2:25………………………………… 59
• 3…………………………………….. 43
• 3:7………………………………….. 60
• 3:15………………………………… 62, 93
• 3:16………………………………… 59, 62
• 3:19………………………………… 62, 321
• 3:20………………………………… 58, 62
• 3:22-24……………………………. 62, 321
• 4:1………………………………….. 47, 56, 99, 268
• 4:17………………………………… 56, 445
• 4:19………………………………… 56
• 4:21-24……………………………. 445
• 4:25………………………………… 56
• 5:1………………………………….. 43, 61
• 5:3………………………………….. 43
• 6:13-22……………………………. 445
• 9:1………………………………….. 61, 83, 93
• 9:4………………………………….. 506
• 9:6………………………………….. 42, 43, 74, 147, 409, 414, 458
• 9:7………………………………….. 61
• 10…………………………………… 95
• 11…………………………………… 445
• 12:3………………………………… 145
• 15…………………………………… 93, 323
• 15-21………………………………. 267
• 15:5………………………………… 145
• 16…………………………………… 55
• 16:1-3……………………………… 364
• 16:2………………………………… 268
• 18:19………………………………. 64
• 18:23-25………………………….. 324
• 22…………………………………… 146
• 22:1-3……………………………… 324
• 22:18………………………………. 324
• 25:21………………………………. 267
• 25:24-26………………………….. 47
• 29:14………………………………. 59
• 29:31………………………………. 267
• 29:31-30:24……………………… 55, 364
• 30:1………………………………… 326
• 30:22-24………………………….. 267
• 32:24-31………………………….. 247
• 36…………………………………… 95
• 37:27………………………………. 59
• 38…………………………………… 84, 89
• 38:6-10……………………………. 97
• 38:8-10……………………………. 83
• 38:28-30………………………….. 47
• 48:10………………………………. 241

Exodus

• 1:16………………………………… 145
• 1:22………………………………… 145
• 3:6………………………………….. 323
• 4:6-7……………………………….. 454
• 4:11………………………………… 245
• 11:6………………………………… 299
• 13:2………………………………… 147
• 15:26………………………………. 454
• 19:15………………………………. 125
• 20:13………………………………. 43, 74, 195, 228, 414
• 20:14………………………………. 59
• 21:10………………………………. 94
• 21:10-11………………………….. 55
• 21:22-23………………………….. 50
• 21:22-25………………………….. 45, 46, 47
• 21:24………………………………. 43
• 23:26………………………………. 47
• 31:3-5……………………………… 445
• 34:6-7……………………………… 72

Leviticus

• 12:1-8……………………………… 125
• 15:24………………………………. 125
• 17:10-14………………………….. 506
• 18:19………………………………. 125
• 18:21………………………………. 146
• 20:2-5……………………………… 146
• 20:10………………………………. 59
• 20:10-21………………………….. 97
• 20:18………………………………. 125
• 20:20-21………………………….. 266
• 21:17-23………………………….. 238, 247
• 22:18-25………………………….. 247
• 24:20………………………………. 43
• 26:29………………………………. 146

Numbers

• 5:11-28……………………………. 266
• 35:10-28………………………….. 43
• 35:33………………………………. 43

Deuteronomy

• 1:10………………………………… 145
• 6:7………………………………….. 64
• 7:13-14……………………………. 83
• 10:12………………………………. 400
• 10:17-18………………………….. 50
• 12:23………………………………. 506
• 12:29-31………………………….. 146n
• 18:10………………………………. 146
• 23:1………………………………… 97, 128
• 24:1-4……………………………… 54
• 24:14………………………………. 50
• 24:16………………………………. 195
• 25:5………………………………… 97
• 25:5-6……………………………… 364
• 25:5-10……………………………. 55n
• 28…………………………………… 146, 266
• 28:4-11……………………………. 265
• 28:18………………………………. 266
• 28:32………………………………. 266
• 28:41………………………………. 266
• 28:53-57………………………….. 146, 266
• 28:62-63………………………….. 266

Joshua

• 4:4-7……………………………….. 65
• 4:20-24……………………………. 65

Judges

• 11…………………………………… 147
• 13:2-24……………………………. 267

Ruth

• 3-4………………………………….. 364

1 Samuel

• 1:1-14……………………………… 291
• 1:1-20……………………………… 55
• 1:8………………………………….. 289
• 1:11-20……………………………. 267
• 1:19………………………………… 291
• 21:4-5……………………………… 125

2 Samuel

• 5:6-8……………………………….. 238
• 9…………………………………….. 238
• 12:15-23………………………….. 299
• 12:22-23………………………….. 323

1 Kings

• 1:1………………………………….. 241
• 7:13-51……………………………. 445

2 Kings

• 4:32-35……………………………. 454
• 5:1-14……………………………… 454
• 5:20-27……………………………. 451
• 6:24-29……………………………. 146
• 8:12………………………………… 145
• 17:31………………………………. 145
• 20:4-7……………………………… 454
• 23:10………………………………. 145

2 Chronicles

• 28:3………………………………… 145n
• 30:18-22………………………….. 454
• 33:6………………………………… 145n

Job

• 1:13-20……………………………. 299
• 1:21………………………………… 92, 322
• 2:12-13……………………………. 293
• 3:3-16……………………………… 321-2
• 3:16………………………………… 47n
• 10:8-12……………………………. 44-5
• 33:29-30………………………….. 322
• 39:14-18………………………….. 246
• 42:10-17………………………….. 454

Psalms

• 8:4-8……………………………….. 444
• 16:10-11………………………….. 323
• 17:15………………………………. 323
• 23…………………………………… 320
• 32…………………………………… 451
• 51:5………………………………… 87
• 58:8………………………………… 47n
• 63:7-8……………………………… 322
• 65:2………………………………… 268
• 66:10………………………………. 451
• 90…………………………………… 320
• 127:3………………………………. 63
• 127:3-5……………………………. 61, 94, 265
• 128:3………………………………. 145
• 128:3-4……………………………. 94
• 128:6………………………………. 145
• 139…………………………………. 49, 245
• 139:1-10………………………….. 44
• 139:13-14………………………… 3
• 139:13-16………………………… 44
• 139:14…………………………….. 50
• 139:16…………………………….. 47n, 322

Proverbs

• 1:8………………………………….. 64
• 3:11-12……………………………. 64n
• 5:18-19……………………………. 60, 96
• 13:12………………………………. 63
• 13:24………………………………. 64n
• 19:18………………………………. 64n
• 22:15………………………………. 64n
• 23:13-14………………………….. 64n
• 29:15………………………………. 64n
• 30:15-16………………………….. 263
• 31:8-9……………………………… 415

Ecclesiastes

• 1:14………………………………… 321
• 6:3………………………………….. 47n
• 6:3-6……………………………….. 321
• 11:5………………………………… 47

Song of Solomon

• Song of Solomon………………. 60, 96

Isaiah

• 1:17………………………………… 50
• 35:5-6……………………………… 455
• 42:18-20………………………….. 247
• 43:8………………………………… 247
• 45:7………………………………… 245
• 53:2-5……………………………… 247

Jeremiah

• 1:5………………………………….. 41n
• 16:1-4……………………………… 101
• 19:4-5……………………………… 145
• 19:9………………………………… 146n
• 29:6………………………………… 96, 101
• 29:10-14………………………….. 101
• 31:15………………………………. 299
• 32:35………………………………. 145, 146

Lamentations

• 2:20………………………………… 146n

Ezekiel

• 5:10………………………………… 146n
• 23:36-39………………………….. 146

Daniel

• 2:22………………………………… 324

Hosea

• 13:16………………………………. 145

Micah

• 6:8………………………………….. 75

Malachi

• 2:13-16……………………………. 59
• 2:14………………………………… 54
• 2:15………………………………… 63, 93
• 2:16………………………………… 415n

Matthew

• 1:1-16……………………………… 62
• 1:20-21……………………………. 48
• 2:16-18……………………………. 299
• 4:23………………………………… 455
• 5-7………………………………….. 72
• 5:11-12……………………………. 146
• 5:21-22……………………………. 73, 74
• 5:27-28……………………………. 73, 74
• 5:27-32……………………………. 55
• 5:45………………………………… 64
• 7:9-11……………………………… 64
• 8:3………………………………….. 247
• 9:25………………………………… 247
• 9:32-33……………………………. 455
• 10:5-8……………………………… 455
• 10:34-38………………………….. 66
• 12:46-50………………………….. 66
• 13:55………………………………. 445
• 18:5………………………………… 148
• 18:21-22………………………….. 295
• 19:3-9……………………………… 55
• 19:5………………………………… 86
• 19:8………………………………… 76
• 19:8-9……………………………… 54
• 19:10-12………………………….. 94, 128
• 19:13-15………………………….. 148
• 22:23-32………………………….. 323
• 22:37-39………………………….. 341
• 22:37-40………………………….. 73
• 25:34-40………………………….. 260

Mark

• 1:23-26……………………………. 455
• 1:34………………………………… 455
• 2:3-12……………………………… 455
• 3:31-35……………………………. 66
• 5:2-13……………………………… 455
• 7:21-23……………………………. 73
• 7:32-37……………………………. 455
• 8:22-25……………………………. 455
• 9:17-27……………………………. 455
• 9:24………………………………… 247
• 9:36-37……………………………. 148
• 10:2-12……………………………. 55
• 10:5………………………………… 415n
• 10:13-16………………………….. 148
• 10:28-31………………………….. 66
• 10:29-30………………………….. 451
• 10:46-52………………………….. 455

Luke

• 1:5-25……………………………… 290
• 1:6-7……………………………….. 267
• 1:39………………………………… 48
• 1:41………………………………… 48, 148
• 1:43………………………………… 49
• 1:44………………………………… 148
• 2:12………………………………… 48
• 4:40-41……………………………. 455
• 7:11-15……………………………. 455
• 7:18-23……………………………. 455
• 8:19-21……………………………. 66
• 8:41-42……………………………. 455
• 8:49-55……………………………. 455
• 10:9………………………………… 455
• 12:49-53………………………….. 66
• 14:21………………………………. 247
• 14:26………………………………. 66
• 18:15………………………………. 48
• 18:15-17………………………….. 148

John

• 3:6………………………………….. 95
• 5:14………………………………… 451
• 8:1-11……………………………… 155
• 9…………………………………….. 451
• 9:1-7……………………………….. 247
• 9:1-11……………………………… 455
• 9:2-3……………………………….. 267
• 9:3………………………………….. 451
• 11:1-44……………………………. 455
• 14:15………………………………. 72
• 16:8-11……………………………. 191
• 16:33………………………………. 75

Acts

• 3:2………………………………….. 145
• 5:1-10……………………………… 451
• 12:19-23………………………….. 451
• 18:3………………………………… 445

Romans

• 2:15………………………………… 85
• 2:16………………………………… 189
• 3:7-8……………………………….. 74
• 3:8………………………………….. 73, 441
• 3:19………………………………… 74
• 3:23………………………………… 452, 483
• 5:3-5……………………………….. 451
• 5:8………………………………….. 322
• 5:12………………………………… 322
• 5:21………………………………… 322
• 6:14………………………………… 72
• 6:23………………………………… 322
• 7:6………………………………….. 72
• 8:18………………………………… 324
• 8:18-19……………………………. 248
• 8:18-25……………………………. 455
• 8:22-23……………………………. 245
• 8:23………………………………… 322
• 8:26………………………………… 322
• 8:28………………………………… 75, 293, 451
• 8:29………………………………… 43
• 12:2………………………………… 271, 448
• 12:15………………………………. 294, 319
• 13…………………………………… 71
• 14:23………………………………. 112, 190, 468

1 Corinthians

• 6:19-20……………………………. 128
• 7…………………………………….. 84
• 7:2-5……………………………….. 95
• 7:3-5……………………………….. 126
• 7:5………………………………….. 60, 98, 122
• 7:10-16……………………………. 76
• 7:14………………………………… 63
• 7:15-16……………………………. 54n
• 7:32-35……………………………. 94, 101
• 10:13………………………………. 75
• 10:14………………………………. 297
• 10:24………………………………. 77
• 11:8-9……………………………… 58
• 11:27-30………………………….. 451
• 12…………………………………… 261
• 15:20-26………………………….. 324
• 15:26………………………………. 321
• 15:42-44………………………….. 241
• 15:54………………………………. 324
• 15:57………………………………. 324

2 Corinthians

• 4:16-18……………………………. 451
• 5:10………………………………… 457
• 5:21………………………………… 451
• 11:2………………………………… 95
• 12:7-10……………………………. 456
• 12:8-9……………………………… 268
• 12:9………………………………… 247
• 12:10………………………………. 451

Galatians

• 4:4………………………………….. 62
• 4:5-6……………………………….. 62
• 4:28………………………………… 62
• 5:18………………………………… 506
• 5:19-21……………………………. 148
• 5:22-23……………………………. 72
• 6:7………………………………….. 498
• 6:7-8……………………………….. 99

Ephesians

• 3:14-15……………………………. 64
• 3:16-21……………………………. 269
• 4:1-3……………………………….. 72
• 4:32………………………………… 72
• 5…………………………………….. 58
• 5:2………………………………….. 462
• 5:22-33……………………………. 58, 59, 95
• 5:25………………………………… 59, 59n
• 5:30………………………………… 59
• 5:31………………………………… 86
• 5:33………………………………… 59n
• 6:4………………………………….. 64, 407

Philippians

• 1:6………………………………….. 24
• 3:12-14……………………………. 43
• 4:8………………………………….. 72

Colossians

• 3:10………………………………… 43
• 3:12-13……………………………. 72
• 3:21………………………………… 64

1 Thessalonians

• 4:3-4……………………………….. 60n
• 4:3-6……………………………….. 55
• 4:3-7……………………………….. 330

2 Thessalonians

• 1:4-5……………………………….. 451

1 Timothy

• 2:13………………………………… 58
• 3:2………………………………….. 56
• 3:12………………………………… 56
• 4:12………………………………… 72
• 5:4………………………………….. 64
• 5:8………………………………….. 65, 99, 129, 407
• 5:14………………………………… 96, 128
• 6:11………………………………… 72

2 Timothy

• 2:22………………………………… 72
• 3:10-11……………………………. 72

Titus

• 3:1-2……………………………….. 72

Hebrews

• 2:5-8……………………………….. 444
• 2:6-8……………………………….. 498
• 2:17………………………………… 269
• 4:13………………………………… 44
• 4:15………………………………… 44
• 11…………………………………… 147
• 12…………………………………… 64n
• 12:5-11……………………………. 451
• 12:7-11……………………………. 64
• 13:4………………………………… 55
• 13:5………………………………… 269, 298

James

• 1:2-4……………………………….. 247
• 1:3………………………………….. 451
• 1:27………………………………… 462
• 2:14-17……………………………. 453
• 2:16………………………………… 73
• 3:9………………………………….. 43
• 5:13-15……………………………. 443

1 Peter

• 1:7………………………………….. 451
• 2:22………………………………… 451
• 3:8………………………………….. 72

2 Peter

• 1:5-7……………………………….. 72

1 John

• 1:5-9……………………………….. 149
• 1:9………………………………….. 10
• 3:5………………………………….. 451
• 3:11-16……………………………. 65

Revelation

• 7:9………………………………….. 62
• 7:17………………………………… 299
• 13:13………………………………. 288
• 14:1-5……………………………… 94
• 21:4………………………………… 248, 266, 299, 455
• 21:8………………………………… 148
• 22:15………………………………. 148

Megan Best is a medical doctor and a bioethicist. She is passionate about the value of human life and has been involved at both state and federal government levels in the development of Australian legislation regulating the treatment of unborn humans. Megan is married to John and they have two wonderful daughters.

At last—a single volume examining beginning-of-life issues that is equally competent in biology, theology, philosophy and pastoral care. Scarcely less important, Dr Best’s book is admirably clear, simple without being simplistic, comprehensive without being overly complicated. This is now the ‘must read’ book in the field, a necessary resource not only for pastors, ethicists, and laypersons who share her Christian convictions, but also for anyone who wants to participate knowledgeably in current bioethical debates.

DA Carson
Trinity Evangelical Divinity School, Chicago

This is an outstanding resource for concerned Christian laypeople, health professionals, church leaders and students. It is authoritative, up to date, meticulously researched and pastorally sensitive. I strongly recommend this remarkable book.  Megan writes honestly and compassionately from her personal experience as an ethicist, palliative-care doctor, Christian speaker and parent.

John Wyatt
Emeritus Professor of Ethics and Perinatology, University College London

Dr Megan Best’s ambitious work covers every aspect of the science and ethics of the beginning of human life. She has made accessible the best research and much helpful theology to offer a robust Christian account. The book is a welcome reply to much of what passes as ‘bioethics’, and will become a point of first reference for anyone seriously wrestling with this bewildering area.

Andrew Cameron
Lecturer in Ethics, Social Ethics and Philosophy, Moore College, Sydney

Dr Megan Best makes a significant contribution to substantive ethical reflection on some of the most delicate moral issues of our time. Fearfully and Wonderfully Made meets a pressing need, as there are few books that offer guidance to Christians in thinking about how we regard very early human life, whether for research purposes or in the unrestrained possibilities for human reproduction. Dr Best takes things that are often medically and scientifically confusing, and puts them in everyday language. Combining medical expertise, theological insights and practical advice, this volume is a welcome addition.

Paige Comstock Cunningham JD
Executive Director, The Center for Bioethics and Human Dignity, Trinity International University, Chicago

This is a remarkable book written by a remarkable person. Megan Best has committed a large part of her life to understanding the medical and ethical issues that we face in relation to conception, birth, abortion, miscarriage, pregnancy, and reproductive technologies of all kinds. She weaves together the best secular knowledge, ethical, moral and historical writings, medical research, public policy, law, personal experience and biblical wisdom. This incredible synthesis is done with humility and grace, with a great sense of compassion and without judgement.

This timely book will inform, challenge, and offer hope and answers to many.

Trevor Cairney OAM
Master of New College, UNSW, Sydney

In clear and theologically informed language, Dr Best discusses a wide range of issues and problems in contemporary bioethics. Her training in medicine and bioethics is evident on every page. Of particular interest to Christian health professionals and clergy will be her discussion of the basis for ethical decision making, and the way she continually draws readers back to the biblical teaching in seeking to explain and critique various arguments. Her final chapter, exploring whether we are playing God when we try to control when and how we have children, confronts head-on several of the instrumental and utilitarian temptations many of us face today. This will be a valuable resource for anyone engaged in teaching, pastoral care or clinical practice.

Rev Rod Benson
Ethicist and public theologian, Tinsley Institute (Morling College), Sydney

In Fearfully and Wonderfully Made Dr Megan Best offers an intelligent and deeply felt defence of the Christian vision of the beauty and goodness of the human person, sexuality and marriage.  Although we clearly part company on certain fundamental issues such as contraception and IVF, I commend Dr Best’s much-needed work in bringing the tradition of Anglican Reformed theology and her love of Scripture to the crucial field of contemporary bioethics in an engaging and practical way.

Cardinal George Pell
Catholic Archbishop of Sydney

Finally, a bioethics book written by someone who is both a specialist doctor and an ethicist. Dr Megan Best helps us to navigate through the medicine and theology that we need to know for complex issues such as contraception, reproductive technology and antenatal screening. I especially like how Dr Best covers everything so thoroughly, yet also explains it clearly and sensitively.

Fearfully and Wonderfully Made is for everyone who wants to know what a biblically informed viewpoint should be on these current issues. I will be using Dr Best’s book as a reference in the preparation of my own lectures on ethics, and as the basis for any bioethical advice I give as a Christian doctor.

Dr Sam Chan MB BS BTh ThM PhD
Theology, Ethics, Preaching and Evangelism Lecturer, Sydney Missionary and Bible College, Sydney

Fearfully and Wonderfully Made addresses the crucial matters pertaining to the beginning of life. In our world in which technology and choice are often promoted over truth and compassion, Megan Best has applied a biblical framework to reproductive and early-life issues. The book is informative and instructive for both those who seek guidance about early-life questions and those health professionals who are consulted to provide answers.

The book is also more. It represents a journey of exploration by Megan Best through the prevailing attitudes to human life over the centuries. Her conclusion as to the point that modern medicine and society have reached challenges readers to question how they are advocates for some of life’s most vulnerable.

Professor Jonathan Morris
Associate Dean and Head, Sydney Medical School—Northern Director, Kolling Institute of Medical Research, University of Sydney

Dr Megan Best has provided a comprehensive view of the wide range of controversial and complicated issues related to early human life. This is an ever-increasingly demanding area. Dr Best has thoughtfully provided a framework for engagement from the viewpoint of a modern Christian evangelical. This is a helpful book for those concerned with these areas.

Dr Michael Burke MBBS PhD
Former Executive Officer, Christian Medical and Dental Fellowship of Australia