New reproductive technologies and Catholic teaching . conference proceedings from congress International Bioethics 1999. Bioethics Material. Unit of Humanities and Medical Ethics

This work examines the "new reproductive technologies", that is, ways of generating human life that do not require a coital union between a man and a woman, whether marital or not. In it I will defend the Church's teaching that God, in his wise and loving plan for human existence, desires that human life be given - "begotten" - only through the marital embrace, that is, through a procreative marital act, and that, consequently, it is always wrong to generate human life through procedures that substitute for the marital act.

First of all, I will describe the new reproductive technologies; secondly, I will summarise the relevant teachings of the Church; thirdly, I will give reasoned arguments in support of the truth of the Church's teaching . As we shall see, the Magisterium of the Church distinguishes between artificial insemination (a technological procedure substitute for the marital act) and assisted insemination (a technological procedure that makes it possible for a marital act to be crowned by the gift of life), declaring the former intrinsically immoral and the latter morally permissible. Therefore, the final part of this work will consider the question of "assisted insemination", and in particular the procedure known as GIFT or gamete transfer into the fallopian tube which, as some Catholic theologians claim, "lends attendance" to the marriage act and hence is morally permissible, while others reject it as a "substitute" for the marriage act.

I.- New reproductive technologies

New reproductive technologies can be divided into two broad categories: (1) artificial fertilisation, which encompasses (a) artificial insemination and (b) in vitro fertilisation and embryo transfer, and (2) agametic reproduction or cloning.

1.- Artificial insemination

Artificial fertilisation occurs when the male sperm unites with the female egg, not through intercourse, but by other means. In artificial insemination, the male sperm is introduced into the female reproductive tract through a cannula or other instruments, and fertilisation occurs when one of the sperm fuses with the woman's egg. Fertilisation occurs inside the woman's body. In in vitro fertilisation, male sperm and female eggs are placed in a Petri dish and the subsequent fusion of the sperm and egg and fertilisation occur outside the woman's body.

Consequently, the embryo at development can be implanted in the womb of a woman, either the woman whose egg has been fertilised or another person.

These two forms of artificial fertilisation - artificial insemination and in vitro fertilisation - can be either homologous, where the gametic cells used are supplied by a married couple, or heterologous, using gametic cells from people who are not married to each other (although both parties whose gametic cells are used may be married to another person)1.

Artificial insemination

i. Homologous Artificial Insemination or HAI

Homologous artificial insemination or artificial insemination by husband (AIH) introduces the husband's semen into the wife's body through the use of a cannula or other instruments. The husband's semen is usually obtained by masturbation, although an alternative is intercourse using a perforated condom, or, in the case of obstruction of the vas deferens, which serves as a conduit for sperm, surgical collection of semen from the epididymis, where the sperm is stored2.

ii. Heterologous Artificial Insemination or AI or DAI

Heterologous artificial insemination is commonly referred to reference letter by the acronym AID, which stands for "artificial insemination by a donor". But, as Walter Wadlington correctly observes, "the term "sperm donor" is a misnomer, because it has been internship customary to compensate persons who provide sperm3. It is more appropriate, therefore, to designate this form as "artificial insemination by a seller".

Traditionally, heterologous artificial insemination has been used by married couples so that the wife could raise a child of her own, when her husband was infertile or in cases of "incompatibility Genetics" between the couple, i.e. when the couple carries a recessive genetic defect and therefore the likelihood that any child they conceive would actually be affected by that genetic defect. Today, however, artificial insemination is also used by single women who want to have a child and who, as Walter Wadlington notes, "do not have a husband or a stable heterosexual partner, or by a woman in a lifelong partnership with another woman".4 It is also used to implement surrogacy arrangements whereby a woman will conceive and carry a child who will be returned to the sperm "seller" or others after birth.

1.2. In vitro fertilisation and embryo transfer

In the late 1970s Robert Steptoe and Paul Edwards achieved the birth of a child conceived in vitro and transferred a few days after conception into the mother's womb. Thus, with the birth of Louise Brown on 25 July 1978, a new mode of human reproduction became a reality, in vitro fertilisation. It is ironic to note that Louise was born on the tenth anniversary of Pope Paul VI's encyclical, Humanae Vitae, in which he affirmed the "inseparable connection, willed by God and which man must not break on his own initiative, between the unitive and procreative meanings of the conjugal act".

In vitro fertilisation makes it possible for human life to be conceived outside the mother's body (Genetics), but it is still a form of generating human life that is gametic, i.e. it is possible only by the fusion of a male gametic cell, the sperm, with a female gametic cell, the egg. The new human life is conceived in a Petri dish using sperm provided by a man and eggs provided by a woman. Approximately two days after the fertilisation process has been completed, the embryo, which by then has developed to the 4-8 cell stage, is ready to be transferred to the uterus, where it can implant and, if implantation is successful, continue the intrauterine development until birth.

Initially IVF-ET was developed by obtaining a single egg from a woman through a laparoscopy, a procedure that requires general anaesthesia. When performing a laparoscopy, the doctor aspirates the woman's egg through a hollow needle placed in the abdomen and guided by a narrow optical instrument called a laparoscope. Today it is standard practice procedure to over-stimulate the ovaries with ovulatory medication so that the woman produces several oocytes for retrieval and subsequent fertilisation. A common internship is to retrieve the oocytes (eggs) that she produces, not by laparoscopy, which requires attendance and general anaesthesia, but by ultrasound-guided transvaginal aspiration, which can be performed without general anaesthesia. This, of course, greatly simplifies procedure. internship Today it is also standard practice to fertilise many eggs by mixing them in a Petri dish with sperm (usually collected by masturbation), which have been "washed" to make them more suitable for a successful fertilisation process. This is done so that several new human zygotes can be generated and allowed to grow to the early embryo stage. Of these premature embryos, it is now customary to transfer two to four to the womb to increase the likelihood of implantation and subsequent gestation and birth, and to freeze and store the others so that they can be used for implantation purposes in the event that the initial attempts at embryo transfer, gestation and birth are unsuccessful. Frozen "spare" embryos can also be "donated" for the purpose of research. Finally, if the persons responsible for their production do not claim them and they are not used for research, the frozen embryos will be destroyed5 .

i. Homologous IVF and embryo transfer

Initially homologous IVF and embryo transfer was used almost exclusively in women with damaged fallopian tubes, to enable them and their husbands to have children of their own. However, the indications for homologous IVF and embryo transfer have now been extended to include male factor infertility (oligospermia, for example), and other cases where no precise cause for the couple's infertility has been determined6. As it is now possible to separate male sperm carrying Y chromosomes (which produce male children) from those carrying X chromosomes (which produce female children), this procedure can be used to avoid generating a child with haemophilia (always in the male sex) by couples at risk of having a haemophiliac child. Undoubtedly, with the advances that make it possible to identify the chromosomal causes of genetically induced pathologies, the use of in vitro fertilisation and embryo transfer to prevent the generation of children affected by such pathologies will increase in the future.

ii. Heterologous IVF and embryo transfer

Obviously IVF and embryo transfer make it possible for gametic cells (eggs and sperm) from individuals who are not married to each other to be used to generate new human life at laboratory. Heterologous in vitro fertilisation is therefore sometimes used instead of artificial insemination by a donor/vendor in cases where there is an incompatibility Genetics between the spouses. It is also used when the wife lacks ovaries and consequently does not produce eggs. The eggs can be donated by another woman, fertilised in vitro with the husband's sperm, and the embryo implanted in his wife's womb. Embryos can also be "donated". In fact, the "donation" of sperm and embryo is easier to handle than the donation of an egg insofar as the latter is complicated by the need to synchronise the menstrual cycles of the donor and the woman in whom the resulting embryo conceived as in vitro will be implanted. Both homologous and heterologous IVF may involve the transfer of the embryo into the womb of a woman other than the one who supplied the egg, so called surrogate mother7.

As can be seen from the above, many changes and combinations of generating human life are now technically feasible as result of in vitro fertilisation, including procedures such as TCTF (zygote to fallopian tube transfer), which occurs when the zygote resulting from IVF is inserted into the fallopian tube instead of transferring the embryo to the uterus; TTEP (pronuclear tubal transfer), which transfers the embryo very early into the fallopian tube by laparoscopy. Other combinations are possible and will undoubtedly be developed further in the future.

1.3. Alternative technologies making use of male and female gametic cells

Certain contemporary techniques are not, strictly speaking, variants of in vitro fertilisation, insofar as fertilisation takes place inside the mother's body and not outside it in a Petri dish. They are therefore technically more closely related to artificial insemination than to in vitro fertilisation as methods of artificial fertilisation, but their development was stimulated by the research of in vitro fertilisation and embryo transfer. Nor in these procedures is sexual union necessary to unite male and female gametic cells.

A similar technique is TETF or sperm transfer to the fallopian tube. It is sometimes used as an option for infertile couples who have not conceived with HAI. In this procedure the woman's ovaries are hyperstimulated; the hyperstimulation is accompanied by laparoscopy under general anaesthesia to inject a prepared concentrate or "wash" of the husband's (or "donor" if necessary) sperm into the fallopian tubes so that conception can occur there8.

Another procedure of special interest is GIFT or gamete transfer to the fallopian tube. This is similar to IVF, in that the woman's ovaries are hyperstimulated to produce multiple eggs. The eggs are obtained either laparoscopically or by transvaginal ultrasound-guided procedures. An egg is placed in a catheter with semen (provided either by masturbation or by the use of a condom punctured during intercourse), which has been treated and "capacitated", with an air bubble separating the eggs from the semen, so that fertilisation cannot occur outside the woman's body. The catheter is then inserted into the woman's womb, the egg (or eggs) is removed from the catheter and fertilisation/conception can then occur inside the woman's body (who may, of course, be the wife of the man whose sperm has been employee)9.

2.- Cloning or agametic reproduction

The 27 February 1997 issue of Nature magazine issue carried the news of the birth of Dolly the sheep thanks to work by Scottish researchers Jan Vilmut and K. H. S. Campbell and their associates at Roslin in Edinburgh. H. S. Campbell and their associates at high school Roslin in Edinburgh. They succeeded in generating a new sheep by a process called "cloning" or, more technically, "somatic cell nuclear transfer"10. What they did was to produce "Dolly" by fusing the nucleus of a somatic (body) cell from an adult sheep with an oocyte whose nucleus had been removed, i.e. an oocyte deprived of its maternal genome. The identity Genetics of the new sheep, Dolly, was derived from a single source, namely the adult sheep whose somatic cell nucleus was transferred to an oocyte without nucleus to "cause" the development of a new individual of the species. This procedure can be employee, in principle, to generate new human beings, and towards the end of 1998 a team of scientists in Korea claimed to have succeeded in generating a new human life through cloning. Cloning is a way of generating life through a procedure that is asexual or agametic in nature. Therefore, even from a biological perspective, cloning is a rather more radical mode of reproduction than artificial insemination or in vitro fertilisation and embryo transfer. It represents, as the Pontifical Academy for Life has observed, "a radical manipulation of the constitutive relationality and complementarity that are at the origin of human procreation.... tends to turn bisexuality into a purely functional surplus, since the ovum must be employee without its nucleus to make way for the cloned embryo"11.

II.- teaching of the Church on reproductive technologies

The main sources for the teaching of the Magisterium of the Church on these new reproductive technologies are to be found in four speeches of Pope Pius XII and in the Instruction on Respect for Human Life at its Source and on the Dignity of Procreation, published by the Congregation for the Doctrine of Faith in February 1987. The Catechism of the Catholic Church summarises, in essence, the teaching of the Instruction (cf. Catechism ..., nos. 2375-2378). Another magisterial document, important because it deals with the question of cloning, not considered by Pius XII and only briefly observed (and rejected) by Donum Vitae, is Reflections on Cloning of the Pontifical Academy for Life, published at the end of June 1997.

Here I will give a broader view of Pope Pius XII's teaching , a more detailed explanation of the Instruction on Respect for Nascent Human Life and on the Dignity of Procreation (hereafter referred to by its Latin degree scroll Donum Vitae), and conclude by considering the document of the Pontifical Academy for Life.

1.- The teaching of Pope Pius XII (+1958)

In four of his speeches, Pius XII considered the morality of artificial insemination, although this was not the central topic he was dealing with, and, in one of these four, he also addressed the morality of in vitro fertilisation, which, at the time of his speech, was proposal as a mode of human reproduction, even if it was not then actually possible12.

The teaching of Pius XII is very clear. Artificial insemination, either by a third person or by the husband, is intrinsically immoral. Pius XII summed up the issues in the following passage. "The Church," he wrote:

"has ... rejected the ... attitude which sought to separate biological activity from the personal relations between husband and wife in procreation. The child is the fruit of the marital union, which acquires full expression when the functional organs, the sensitive emotions attached to it and the spiritual and disinterested love which animates such a union converge in action; it is in the unity of this human act that the biological condition of procreation must be considered. In no case is it permissible to separate these different aspects to the point of positively excluding both the intention of procreation and the conjugal relationship"13.

Here Pius XII articulates the principle of inseparability, desired by God and which man is not authorised to break on his own initiative, between the unitive and procreative meanings of the marriage act.

Specifically referring to artificial insemination by the husband, the following comments from his 1951 speech to Italian midwives are very pertinent:

"To reduce the common life of husband and wife and the conjugal act to a mere organic function of sperm transmission would be nothing but to turn the domestic sphere, the family sanctuary, into a biological laboratory . Therefore, in our address of 29 September 1949 to the International congress of Catholic Physicians, we expressly excluded artificial insemination in marriage. The conjugal act is in its natural structure an action staff, a simultaneous and immediate co-operation of husband and wife, which by the nature of the agents and of the property of the act, is an expression of the reciprocal gift which, from agreement with Sacred Scripture makes the union "in one (only) flesh" effective. This is much more than the union of two genes, which can be effected by artificial means, i.e. without the natural action of husband and wife. The conjugal act, ordained and designed by nature, is a co-operation staff, of which husband and wife, by contracting marriage, exchange the right"14.

In one of his speeches, Pius XII explicitly condemned in vitro fertilisation, which at that time was only a possibility and not a reality. Addressing this problem, he stated in very precise terms: "As far as the experiments of artificial human fertilisation 'in vitro' are concerned, it is sufficient to observe that they must be rejected as immoral and absolutely illicit"15. 15 Furthermore, Pius XII attempted to provide arguments to demonstrate why in vitro fertilisation is absolutely immoral.

While condemning artificial insemination by the husband as intrinsically immoral, Pius XII declared that "this does not necessarily proscribe the employment of certain artificial means intended solely to facilitate the marriage act, or to ensure the fulfilment of the purpose of the natural act normally carried out"16. He distinguished, in other words, between technological procedures which replace the marriage act (artificial insemination, whether homologous or heterologous), and procedures which assist the marriage act to be crowned by the gift of human life.

This distinction, as we shall now see, is central to the teaching of Donum Vitae.

2.- The teaching of the Donum Vitae

This lengthy document contains an introduction, three major sections and a conclusion. The first major section deals with the respect due to human embryos; the second deals explicitly with new reproductive technologies; and the third deals with the values and moral obligations that must be respected by civil law.

The basic rule provided by Donum Vitae for the moral evaluation of reproductive technologies is as follows:

"Fertilisation is licitly sought when it is the result of a "conjugal act which is per se appropriate to the generation of children to which marriage is ordered by its nature and by which the spouses become one flesh". However, from the moral point of view, procreation is deprived of its true perfection when it is not desired as the fruit of the conjugal act, that is to say, of the specific act of the union of the spouses"17.

By conjugal act "per se suitable for the generation of children", the document means the subject or class act through which new human life can be given if the persons engaged in it are fertile and the conditions for conception are favourable.

Donum Vitae draws a conclusion from this premise rules and regulations, namely that a reproductive technology to make fertilisation effective "cannot be admitted except in those cases where the technical means are not a substitute for the conjugal act, but serve to facilitate and assist, so that the act reaches its natural purpose "18.

The Instruction incorporates here the teaching of Pope Pius XII: the basic principle for morally evaluating a reproductive technology is whether it assists or replaces the conjugal act. If it replaces the marital act, it is absolutely immoral; if it assists the act, that is, if financial aid it helps the marital act itself to reach its natural end and is crowned with the gift of life, then it may be morally permissible.

The distinction made by Pius XII and Donum Vitae between technological procedures which replace the marriage act and those which "assist" it in procreating human life was later reaffirmed by Pope John Paul II in a message to his fellow bishops, who were meeting to study the issues related to new technologies in the light of Donum Vitae. goal In his message, the Holy Father said, after quoting a relevant passage from the Instruction, that "it is important to distinguish artificial insemination from therapeutic techniques whose purpose is to remedy the deficiencies of nature"19.

Donum Vitae then addresses in some detail first heterologous artificial fertilisation and then homologous fertilisation. It rejects heterologous fertilisation as immoral because it violates the unity of marriage, the dignity of the spouses, and the right of the child to be conceived and brought into the world within marriage and from marriage. Moreover, the fertilisation of a woman who is unmarried or widowed can never be justified, regardless of who the donor was20.

It then deals with the issue of homologous artificial insemination, i.e. the insemination of the wife21 , either by artificially inseminating her with her husband's own sperm or by extracting eggs from her body and fertilising them in vitro with her husband's sperm. The moral principle core topic invoked to demonstrate why homologous artificial insemination is immoral is the one mentioned above, which lies in the intimate alliance between procreation and the marital act: the procreation of a new human person must be "the fruit and the sign of the mutual submission of the spouses".

The document then develops three lines of argumentation to support its teaching on the grave immorality of homologous fertilisation. The first (1) is based on the inseparable connection, desired by God and which man is not authorised to break on his own initiative, between the unitive and procreative meanings of the conjugal act; the second (2), on the dignity of the conceived child, who should not be treated as if he were a product; the third (3), on the "language of the body"22.

The first line of argument based on the inseparable link between the unitive and procreative meanings of the conjugal act was, as Donum Vitae observes, the reason given by Pius XII for rejecting artificial insemination by the husband. Reaffirming this inseparable connection, Donum Vitae then states: "homologous artificial insemination, in pursuit of a procreation which is not the fruit of a specific act of conjugal union, objectively effects ... a separation between the goods and meanings of marriage"23.

The second line of argument maintains that the dignity of the child as a person is violated by artificial insemination, even if it is homologous and not heterologous. The dignity of the child is violated because the child is treated as if it were a product and not as a person equal in dignity to its parents. As Donum Vitae points out, "the person conceived must be the fruit of the love of his parents. He cannot be desired or conceived as the product of an intervention of biological or medical techniques; that would be tantamount to reducing him to an object of scientific technology. No one can subject the coming into the world of a child to conditions of technical efficiency, which must be evaluated from agreement with standards of control and domination"24.

In introducing this third line of argumentation the Vatican Instruction refers to the teaching of Pope John Paul II25, who has written and spoken at length about the truth that spouses through their one love express themselves to each other with the "language of the body". Summarising his thought, Donum Vitae presents the question as follows:

"The conjugal act by which the couple express their mutual self-giving to each other, at the same time expresses their openness to the gift of life. It is an inseparably bodily and spiritual act. It is in their bodies and through their bodies that the spouses consummate their marriage and are able to become father and mother. To respect the language of their bodies and their natural generosity, the conjugal union must take place with respect for their openness to procreation; and the procreation of the person must be the fruit and the result of married love. The origin of the human being, therefore, follows a procreation which is "linked to the union, not only biological but also spiritual, of the parents, made one by the covenant of marriage"26.

3.- Reflections on Cloning

This document of the Pontifical Academy for Life was published at the end of June 1997, following the success of the Wilmut team in cloning "Dolly". It is the only magisterial document that deals at length with cloning as a reproductive technology. After observing that cloning "represents a radical manipulation of the constitutive relationality and complementarity that are at the origin of human procreation in both biological and strictly personal aspects", it states: "all the moral reasons that lead to the condemnation of in vitro fertilisation as such and to the radical censure of in vitro fertilisation for purely experimental purposes must also apply to human cloning"27.

III.- An ethical and theological assessment of the new reproductive technologies

I will offer here first reasons of a philosophical ethical nature to show the truth of the Church's teaching that it is morally permissible to generate human life only in and through the marital act and that, consequently, new reproductive technologies that substitute for the marital act, whether heterologous or homologous, are intrinsically immoral. I will then give a consideration, based on a theological understanding of human existence, to support this teaching.

In my presentation, I will focus my attention on homologous insemination and in vitro fertilisation, i.e. on procedures in which the gametic cells used to achieve fertilisation come from the husband and the wife. I do so because if it can be shown that homologous insemination/fertilisation is always immoral, then it follows a fortiori that heterologous insemination/fertilisation will always be wrong.

Ethical/philosophical reasons why non-marital ways of generating human life are immoral.

As we have seen above, Donum Vitae provides three lines of reasoning to support the conclusion that it is always immoral to generate human life outside the marriage act. Here I will develop the second line of reasoning outlined in Donum Vitae, namely, that generating human life by procedures that substitute for the marriage act violates the dignity of the child, insofar as the child is treated as if he or she were a product, thus exchanging an act of procreation for one of reproduction. I do so because I believe that this line of reasoning provides the most direct and cogent argument in support of the claim that generating human life outside of the marriage act is always wrong. But before doing so, I will provide some brief reflections by considering the first and third lines of reasoning. These two lines of reasoning illuminate broader issues related to human existence raised by new reproductive technologies. To appreciate them, however, it is necessary to check the meaning of marriage and the ties that bind it, the marriage act and the relationship between marriage and the marriage act, and the generation of human life.

1.1. Marriage rights and capacities, the marriage act and the generation of human life

The central truth underlying the first line of reasoning based on the inseparability of the procreative and unitive meanings of the marriage act is that husbands and wives, precisely because they have given themselves irrevocably to each other in marriage, have enabled themselves, have prepared themselves to do what married couples are supposed to do, namely, to give each other a special subject love, a spousal or conjugal love, to express that love in the marriage act, and to welcome the gift of new human life, and to give it the home where it can take root and grow. In marked contrast to the union of fornicators and adulterers, which in no way unites two irreplaceable and irreplaceable spouses, but merely board two individuals who are, in principle, replaceable, substitutable, disposable, the marriage act of husbands and wives unites two persons who, by their own freedom and irrevocable choice, have made each other absolutely irreplaceable and irreplaceable. Precisely because they have done this, husbands and wives have made themselves capable of committing themselves in the marriage act, in and through it, to receive the gift of human life lovingly, to nourish it humanly, and to educate it in the love and service of God and neighbour.28 In other words, they have made themselves capable of committing themselves in the marriage act, in and through it, to receive the gift of human life lovingly, to nourish it humanly, and to educate it in the love and service of God and neighbour28. In other words, they have given themselves the capacity to be fathers, mothers and fathers, of new human persons. Of course, as Pope Paul VI said, the marriage act "makes them capable (the Latin text says eos idoneos [literally "fit"] facit) of bringing forth a new life from agreement with the laws written into their very being as husband and wife"29. The marriage act, in other words, is not merely a sexual act between people who are simply married. It is, moreover, by its very intimate nature and its very dynamism, a submission of love (unitive) and a gift of life (procreative); at final, it is an act which partakes of the "goods" or "blessings" of marriage. The bond, therefore, which unites the two meanings of the marriage act is marriage itself. But "what God has joined together, let no man put asunder". It is for this reason, I believe, that there is an inseparable connection, willed by God and not to be broken by man on his own initiative, between the unitive and procreative meanings of the conjugal act.

Moreover, the marriage act, as the third line of reasoning maintains, is an act that speaks the "language of the body", that beautifully embodies the integrity staff and bodily integrity and unity of the spouses. This is so because in the marital act, husband and wife are freely choosing and realising real goods in the world - their own marital union and the gift of life to which their union is open - and their own bodily activity, "the language of their body", is the constitutive subject of what they do: the bodily gift they give to each other makes them "one flesh", the common subject of the same act, and their cooperation is not only appropriate but absolutely essential and necessary. To see what this means it is valid to reflect on the following observations of John Finnis concerning integrity staff and bodily:

"Integrity staff implies ... that one achieves by one's own will, that is, by freely choosing, real goods, and that one's efforts to realise these goods involve, where appropriate, one's own bodily activity, so that the activity is both the constitutive subject of what one does and the very act of choosing it. That one is actually realising real goods in the world; that one does so out of one's own freedom and conscious choice; that that choice is carried into effect by one's own bodily action, including, where appropriate, the bodily acts of speech and cooperation with another real person, these are the fundamental aspects of integrity staff"30.

In the marriage act, husband and wife are, of course, freely choosing and realising real goods in the world: their own marital union and new human life; their bodily activity: the "language of the body" is the constitutive subject of what they do; and co-operation with each other is not only appropriate but absolutely essential. This is the truth behind the third line of reasoning employed by Donum Vitae.

1.2. Procreation versus reproduction

I believe that the second argument proposed in Donum Vitae to support its teaching that it is always immoral to generate human life outside the marriage act requires that we first consider the central distinction between two forms of human action, "doing" and "making". The act of marriage is not an act of "making", neither children nor love. Love is not a product one makes, it is a gift one gives: the gift of oneself. Similarly, a child is not a product inferior to its producers. It is, instead, a person equal in dignity to its parents. The act of marriage is certainly something that husbands and wives "make": it is not something they "manufacture". But what is the difference between "making" and "doing" and what does this have to do with artificial insemination and homologous in vitro fertilisation?

In manufacturing, action proceeds from an agent or agents towards something, a product, in the external world. Car manufacturers, for example, produce cars, cooks make meals, bakers bake cakes, and so on. Such action is transitive in nature because it passes from the agent subject(s) to the object formed by him (or them) and external to them. In manufacturing that is governed by the rules of art, the focus is on the manufactured product and, ordinarily, products that do not fit the standards are rejected, they are considered in any case as "defective". Those who produce the product in question may be morally good or morally bad, but our interest in the manufacture is in the product, and most of us would rather have delicious pasties made by a morally bad cook than indigestible ones made by a saint.

In "doing" the action resides in the agent subjects. Action is immanent and is governed by the requirements of a moral virtue, prudence. If the act done is good, it perfects the agent; if it is bad, it degrades and dehumanises him. It should be noted, moreover, that every act of making is also a doing insofar as it is freely chosen, for the choice to make something is something that we "make", and this choice, as self-determination, resides in us. There are, moreover, some things that we should not choose to do, such as, for example, pornographic films31.

When human life comes in and through the marriage act, it comes, even more ardently desired, as a "gift" that crowns the act itself. When husband and wife perform the marriage act they are "doing" something, that is, engaging in an act open to speech and furthering their unique conjugal love (its "unitive" meaning) and open also to receiving the gift of new human life that comes from God if the conditions for receiving this gift are present. When they commit themselves, in the act of marriage, husbands and wives are not "manufacturing" anything; they are not "manufacturing" love because love is not a product but much more, the sincere gift of oneself. Nor, even if it comes as a gift that crowns their union staff, do they "manufacture" the child. The new human life that crowns the marriage act of husband and wife is not safely treated as if it were a product. The life they engender is not a product of their art, but, as the Catholic Bishops of England accurately observed, as a "gift that supervenes and permanently embodies" the marriage act itself32 . When human life comes into being through the marriage act, we can truly say that the spouses are "creating" or "begetting" new human life. They are not "manufacturing" anything. The life they receive is "begotten, not manufactured".

But when the new human life comes into being as result from homologous insemination or homologous in vitro fertilisation, it is the end product of a series of actions, transitive in nature, carried out by different people in order to make a particular product, a human baby. The spouses "produce" the gametic materials that others will then use to make the final product, the child. In such a procedure, the child "comes into existence, not as a gift following an expressive act of union ... but as the product of a fabrication (and, usually, as the end product of a process managed and carried out by persons other than its parents)"33. The new human life is "manufactured", not "begotten".

procedure Precisely because homologous artificial fertilisation/insemination - like heterologous artificial fertilisation/insemination - is an act of "fabrication", it is standard practice, as we have seen in our review of the literature related to topic, to overstimulate the woman's ovaries so that several eggs can be retrieved and then fertilised with semen (usually obtained by masturbation), with the result result that several new human beings (zygotes at this stage of development) are brought into existence. Some of these new human beings are usually frozen and stored as reservation in case initial efforts to achieve implantation and gestation until birth fail. Moreover, it is not uncommon for several embryos to be implanted in the womb to increase the likelihood of successful implantation and, in the event that a large issue number of embryos are successfully implanted, to rule out the issue "excessive" taking of human life through a procedure that some euphemistically call "pregnancy reduction". Moreover, it is common, when performing in vitro fertilisation, to monitor the development of the new human life while it is still outside the womb and to determine, after all, whether or not it suffers from any "defects". If serious defects are discovered, abortion is not infrequently recommended. As a form of "manufacturing" or "production", artificial fertilisation/insemination, whether homologous or heterologous, leads to the use of these methods, because they simply carry out the logic of manufacturing conveniences: one should employ more efficient, time-saving, and suitable methods for submit the desired product, and put in place quality controls to ensure that the resulting "product" is not, in any case, "defective".

One can easily see how dehumanising such "production" of human babies is. Human babies are not to be treated as products inferior to their producers and subject to quality controls; they are persons equal to their parents in dignity.

However, some people, including some Catholic theologians, observe, correctly, that homologous fertilisation/insemination does not require hyperovulation of the woman, creating a issue of new human beings in the Petri dish, freezing some, implanting others, monitoring the development without ruling out abortion in the event that defects are discovered, etc... ... From agreement with them, if these characteristics commonly associated with homologous fertilisation/insemination are rejected, then a limited resource by married couples to artificial fertilisation/insemination does not transform the generation of human life from an act of procreation into an act of reproduction necessarily.

A leading representative of this school of thought, Richard A. McCormick, S.J., states that spouses who resort to homologous in vitro fertilisation do not perceive this as the "manufacture" of a "product". Fertilisation occurs when the sperm and egg come together in a Petri dish, but "the intervention of the 'technicians' is a condition for this to occur; it is not a cause"34. Moreover, he continues, "the attitudes of parents and technicians can be reverential and respectful as they face the naturally conceived new life"35. 35 Indeed, in McCormick's view, and in that of other writers as well, Thomas A. Shannon, Lisa Sowle Cahill and Jean Porter,36 for example, homologous in vitro fertilisation can be considered as an "extension" of the marital union, so that the child generated can still be considered as the "fruit of the spouses' love". While it is preferable, if possible, to generate the child through the marital act, in the cases at hand, it is impossible to do this, and hence their marital act - so these writers claim - can be "extended" to encompass in vitro fertilisation.

Given the concrete status , some disadvantages inherent in the generation of human life outside the marriage act, as these authors reason, are clearly outweighed by the great good of new human life and the fulfilment of the desire of couples to have children, who could not otherwise have them. Under such conditions, the argument goes, it would not be far from the truth to say that in vitro fertilisation and embryo transfer is simply a way of extending the marriage act.

It is, I think, evident that this justification of homologous fertilisation is based on the proportionalist method of making moral judgements. This asserts that one may rightly procure so-called "premoral", "immoral" or "ontic" evils (the "disadvantages" I referred to above) in order to achieve a proportionally greater good, in this case, by helping the couple to have a child of their own. However, this method of making moral judgements is very flawed and has been explicitly repudiated by Pope John Paul II in Veritatis Splendor. He goes on to state that one can never judge a human action as morally evil because of its freely chosen object, but can judge an act as morally good or morally evil only by taking into account its "object", the circumstances in which it was done and, above all, the "end" for which it was done. If the end for which it has been done is "a proportionately better good", then the evil one does in choosing this object (e.g., manufacturing a child in a Petri dish, killing an innocent person intentionally) may be morally justifiable37.

In sum, it seems to me that the reasoning proposed by McCormick et al. is based on rhetoric rather than on a realistic understanding of what is involved. Obviously, those who choose to produce a child make that choice for an ulterior purpose. They may seek - in the sense of their ulterior intention - that the child be received into an authentic parent-child relationship, in which he or she lives in a community of persons in which those who share a common dignity have a place staff. If so, this intended purpose for which the choice to produce the child is made will be good for both the child and the parents. But even so, and despite McCormick's assertion to the contrary, their "effective intention", that is, the choice they are freely making here, is precisely to "make a child", the initial state of the child is the state of a product. In in vitro fertilisation the technician does not simply assist the marriage act (which would be licit), but, as Benedict Ashley, O.P., rightly observes, "substitutes for that act of personal relationship and speech , which is like a chemist making a mixture or a gardener planting a seed. The technician has thus become the primary cause of generation, acting through instrumental forms of sperm and egg"38.

Moreover, the assertion that in vitro fertilisation is an "extension" of the marriage act and not a substitution for it is simply contrary to the facts. "What is extended", as Ashley also observes, "is not the act of union, but the intention: from an intention to beget a child naturally to achieving it by IVF, by artificial insemination, or by the financial aid of a surrogate mother"39. Since the initial state of the child is therefore, in these procedures, that of a product, it is a subpersonal state. Therefore, the choice to produce a child is, inevitably, the choice to establish a relationship with the child, not as an equal, but as a product inferior to its producers. However, this initial relationship of those who choose to produce children to the children they produce is inconsistent and thus prevents the communion of persons endowed with equal dignity that is appropriate to any interpersonal relationship. It is the choice of an evil means to a good end. Moreover, in producing children, if the product is defective, the new person becomes unwanted. Those who choose to produce children, therefore, not only choose life for some, but - and can this really be doubted - sometimes quietly discard some of those who are not developing normally40.

In my opinion, the reasons proposed here to show that it is not morally right to generate new human life outside the marriage act can be summarised in the form of a syllogism, which I offer for consideration. It is as follows:

Any act of generating human life that is non-marital is irresponsible and violates the respect due to human life in its generation.

But artificial insemination, in vitro fertilisation and other forms of generating human life on a laboratory, including cloning, are not marital.

Therefore, these ways of generating human life are irresponsible and violate the respect due to human life in its generation.

I believe that the minor premise of this syllogism does not require extensive discussion. However, McCormick, commenting on an earlier essay of mine in which I proposed this syllogism, claims that my employment of the term "non-matrimonial" in the minor premise is "impenetrable", because the meaning of a "non-matrimonial" action is not entirely clear41. This objection, however, fails to take into account all that I had said in that essay considering the marriage act, which is not simply a genital act between persons who happen to be married, but is "one flesh", corporeally, the sexual union of husband and wife (an act of intercourse) who participate in or are open to the goods of marriage42.

It is obvious, I think, that insemination, heterologous fertilisation and cloning are "non-marital". But "non-marital" is also homologous artificial insemination/fertilisation. Even if married people have collaborated in these procedures, they are still non-marital because the marital status of the man and woman involved is accidental and not essential. They are not only procedures which can, in principle, be carried out by unmarried individuals, they are also procedures in which the matrimonial character of those who participate in them is, as such, completely irrelevant. What makes husband and wife capable of participating in homologous insemination/fecundation is definitely not their marital union nor the act (the marital act) that participates in their marital union and is made possible by virtue of it. On the contrary, they are able to take part in these procedures simply because, like unmarried men and women, they are producers of gametic cells which other individuals can then use to manufacture new human life. Just as spouses do not generate human life in marriage when this life (which is always good and precious, no matter how it is engendered) is initiated through an act of spousal abuse, neither do they generate new human life in marriage when they simply provide other people with gametic cells that can be joined by those people's transitive acts.

The above reflections should be sufficient to clarify the meaning of the minor premise of the syllogism and establish its truth.

The truth of the major premise is supported by all that I have said about the intimate bonds that unite marriage, the marriage act and the generation of human life. These bonds are the indispensable and necessary means of properly respecting human life. They safeguard respect for the irreplaceable good of the marital union and for the new human life which needs a home in which to take root and grow, a "home" prepared for it by the unique love of the spouses.

The basic theological reason why human life must be given only in the act of marriage.

There is, in my opinion, a very profound theological reason that offers primary support for the truth, established in the Church's teaching , that new human life is to be given only in and through the marriage act - the proper and only act of the spouses - and not generated by acts of fornication, adultery, spousal abuse, or new "reproductive" technologies.

The reason is this: human life is to be "begotten, not made". Human life is the life of a person, a being, undoubtedly male or female, made in the image and likeness of the all-holy God. The human person, which comes into being when the new human life comes into existence, is, so to speak, an icon or "word" of God. Human beings are, so to speak, the "created words" that the uncreated Word of the Father came to be and is, precisely to show us how deeply God loves us and to make us capable of being, like Him, children of the Father and members of the divine family.

However, the uncreated Word, whose brothers and sisters have been called to be human persons, was "begotten, not made". These words were chosen by the Fathers of the Council of Nicaea in 325, to express unequivocally their belief that the eternal, uncreated Word of God the Father is indeed, like the Father, true God. This Word, personally become true man, in Jesus Christ while remaining true God, was not inferior to His Father; He was not a product of the Father's desire, a being made by the Father and subordinate to Him in dignity. Rather, the Word was one with the Father and therefore, like the Father, true God. The Word, the Son of the Father, was begotten by an immanent act of love staff.

Likewise, human persons, the "created words" of God, should, like the uncreated Word, be "begotten, not made". Like the uncreated Word, they are of one nature with their parents, and not inferior products to their producers. This dignity staff is equal to that of their parents, just as the dignity staff of the uncreated Word is equal to the dignity staff of their Father. That dignity is respected when his life is "begotten" in an act of love between husband and wife. It is not respected when that life is "made", that is, when it is the end product of a series of transitive actions on the part of different persons43.

IV.- "Assisted" insemination/fertilisation

The Magisterium of the Church, as we have seen, distinguishes between technological procedures, such as artificial insemination and in vitro fertilisation, whether homologous or heterologous, which replace the marriage act, and those procedures which assist the act to be crowned with the gift of human life. While married couples should never employ techniques that replace the marriage act, they can, rightly, employ those that assist it to generate new human life. As Pope John Paul II has said, "Infertile couples ... have the right to any legitimate therapy. have the right to any legitimate therapy available to remedy their infertility"44.

However, there is serious controversy, even among Catholics who uphold the truth of the Church's teaching on the generation of life, in considering the kinds of procedures that assist rather than replace the marital act. After presenting some criteria that are helpful, in my opinion, in determining whether a procedure financial aid or replaces the conjugal act, I will examine some specific techniques proposed by Catholic theologians as morally legitimate methods of financial aid to the marital act, and offer a judgment considering them, focusing attention on the TTIG.

Some basic criteria

The basic principle concerning the generation of human life is exactly stated in the following text of Donum Vitae:

"The human person must be accepted in the act of union and love of his or her parents; the generation of a child must therefore be the fruit of that mutual submission which is realised in the conjugal act, in which the spouses cooperate as servants and not as masters of the Creator's work , which is love"45.

In other words, the child must be the "fruit" of the marriage act. This means that the marriage act must be directly related (= have a direct causal relationship) to the origin of the new human life and not merely accidental. Technological procedures can be the means of removing obstacles to the fruition of the marriage act. If the procedures do, indeed, remove such obstacles, then they "assist" the marriage act to be fruitful, and do not substitute or replace it.

It also follows, I believe, that a procedure "financial aid" to the marital act if, and only if, the marital act takes place and the procedure in question avoids the obstacles that prevent that specific marital act from being unfruitful. This would be the case, for example, if the technique allowed the entrance of semen given by the husband during the marital act into his wife's body, entrance perhaps prevented by some physiological condition, or if the technique facilitated the union of semen introduced into the woman's body by the marital act with her ovum, a union sometimes prevented because of some illness or injury.

2. Some specific procedures

2.1. Tubal transfer leave of the ovum (TTBO)

This procedure, originally designed for women whose infertility was caused by blocked, damaged or diseased, or absent fallopian tubes, repositions her egg or ovum, bypassing and going around the area of the tubal pathology to place it in the fallopian tube, below the point of damage, disease or blockage, where fertilisation by the woman's husband's own sperm, introduced into her body through a specific marital act, can take place. This is called "tubal transfer leave of the egg" because the egg is usually placed in the most leave part of the fallopian tube (or sometimes in the uterus itself).

This procedure also "financial aid" and does not replace the marriage act. It financial aid removes the obstacles that prevent the marriage act from being unfruitful, in this case, because of damage or illness in the wife's fallopian tubes. Fertilisation occurs as result of a true marriage act and not directly as result of a technical activity. All the technician does is relocate the woman's egg from one part of her body to another. The sperm that fertilises the egg is introduced into the wife's body directly as result of a marital act in which her husband gives himself to her and she receives it by giving herself to him.

Again, all the Catholic moralists I know who have dealt with this issue agree with agreement that TTBO is a morally legitimate means of assisting the marriage act46. Unfortunately, it does not seem to have a very high success rate.

Gamete to Fallopian Tube Transfer (GIFT) and Tubal Egg to Sperm Transfer (TTOE)

TIFT has been described previously: the woman's eggs are retrieved by laparoscopic or ultrasound-guided transvaginal procedures. An egg (or eggs) is placed in a catheter with semen (provided by masturbation or by a condom punctured during intercourse) that has been treated and "capacitated", with an air bubble separating the eggs from the semen. Thus, fertilisation does not take place outside the woman's (wife's) body. The catheter is then inserted into the womb of the wife (and this can be done either before or immediately after the marriage act). The egg and sperm are removed from the catheter and fertilisation and conception occur inside the woman's (wife's) body.

Some Catholic authors, including Donald McCarthy, Orville, Griese, Peter Cataldo and John W. Carlson, strongly defend TGTF as a procedure that financial aid does not replace the marriage act. They therefore assert that this procedure can be lawfully employee as long as the husband's semen is not obtained by masturbation. According to agreement with them, fertilisation occurs as result of actual conjugal acts, aided by various acts carried out by technicians with the semen and eggs before their fertilisation in the wife's body47.

Like many others, I strongly disagree with the approval of the TGTF. Note, first of all, that originally the procedure developed with the requirement of masturbation to obtain the husband's semen. Informed that the Catholic Church condemns masturbation even as a means of obtaining semen, the doctors practising procedure suggested that semen be obtained by using a condom pierced during the conjugal act. This sample definitely shows, in my view, that in TGTF the marital act is used merely to obtain semen without masturbation and is not essential for the achievement of pregnancy. Moreover, and this is critically significant, the semen thus procured and subsequently employee to fertilise the woman's egg has been intentionally separated from the marital act and deposited not in the wife's body, but in a condom. Therefore, these spermatozoa can in no way be considered as "part" of the marriage act. Thus, in this procedure, the marriage act is not essentially but accidentally related, and there is a complete dissociation between the marriage act and the generation of new human life. Therefore, with other authors, including Grisez, DeMarco, Tonti-Filippini and Ashley/O'Rourke, I conclude that this method of generating human life does not financial aid replace the marriage act, but replaces it and is therefore not morally acceptable48.

TTOE is a procedure similar to TGTF. In it, the sperm is procured by the husband through the use of a punctured condom during the marital act; the sperm is then placed in a catheter together with the wife's egg (eggs) and separated by an air bubble and the catheter is then inserted into the fallopian tube (hence the name tubal transfer of egg with sperm), where the egg (eggs) and sperm are placed and fertilisation can occur. As can be seen, TTOE is quite similar to TFRT. Theologians who claim that TFRT is a way of assisting the marriage act say the same about TTOE49 , while those who, like me, hold that TFRT replaces and does not assist the marriage act similarly judge that TTOE does the same.

Someone might say that with regard to the procedures taken here Catholics are free to employ them since there is no magisterial teaching with regard to them, and some theologians' views can be followed as a "probable opinion". This way of looking at the matter, however, is rather legalistic. In making moral choices, one must first try to discover the truth and then choose from agreement with it. So the proper way to proceed here is to examine the reasons given by theologians to support their claims, to see which reasons are reasonably good and which are not.

V. Conclusion

Someone may think that the position taken here in support of the Church's teaching is cruel and heartless, that it does not care about the anguish experienced by married couples who legitimately and ardently wish to have a child of their own and who must suffer the disappointment of a pathological disease.

I do not believe that this position is cruel and heartless, nor that it is unconcerned about the suffering of many married couples. Here, two truths are of critical importance. The first is that husbands and wives do not have a "right to have a child". They do not have the right to have a child because a child is not a thing, not a pet, not a toy, but a person of inviolable dignity. Husbands and wives have the right to perform the class action that is in itself fit to receive a new human life: the act of marriage. But they do not have the right to have a child. Their desire to raise and support a child is noble and legitimate, but this desire does not justify some or all of the means to achieve its fulfilment.

The second point to bear in mind is that we must be realistic and recognise that for some reason it will not be possible for some married couples to beget a child in and through their marriage act. If this is the case, then it is necessary to recognise that all of us must carry our own cross. But we must remember that Jesus is our Simon of Cyrene, and that He will help us to bear whatever cross He may give us.

Notes

(1) It is instructive to note here that in his article on artificial insemination in the prestigious Encyclopedia of Bioethics, Luigi Mastroianni includes in "homologous" fertilisation procedures "that use the sperm of the husband or of a designated partner " (emphasis added) ("Reproductive Technologies, Introduction", in Encyclopedia of Bioethics, ed. Reich (2nd rev. ed.: New York: McGraw Hill, 1995, 2207). Since this edition of the Encyclopedia of Bioethics now includes a essay graduate "Marriage and other domestics partnerships" (emphasis added) by Barbara Hilkert Anderson (pp. 1397-1402) the apparent equating of spouses with "designated partners" is not too surprising. It is sadly an indication of contemporary Western attitudes.

(2) On this, see the text cited: L. Mastroianni, Reproductive Technologies, Introduction, 2207.

(3) Wadlington, Reproductive Technologies, Artificial Insemination, cit., 2220.

(4) Wadlington, Reproductive Technologies, Artificial Insemination, 2217.

(5) On all this, see Mastroianni, Reproductive Technologies, Introduction, 2209-2210; Andrea L. Bonnicksen, Reproductive Technologies, In vitro Fertilization and Embryo Transfer, in Encyclopedia of Bioethics, 2221-2224; and McLaughlin, A Scientific Introduction to Reproductive Technologies, 58-59.

(6) L. Mastroianni, Reproductive Technologies, Introduction, 2211.

(7) See Bonnicksen, Reproductive Technologies, In vitro Fertilization and Embryo Transfer, 2222.

(8) For these and other procedures see McLaughlin, A Scientific Introduction to Reproductive Technologies, 60-62.

(9) Ibid. See also L. Mastroianni, Reproductive Technologies, Introduction, 2211-2212.

(10) "Somatic cell nuclear transfer" is the expression used to describe mammalian cloning by the National Bioethics Advisory Commission in its document, published in June 1997: Cloning Human Beings: The Report and Recommendations of the National Bioethics Advisory Commission. A summary of this report is printed in "Hastings Center Report", 1997, September-October, 7-9.

(11) Pontifical Academy for Life, Reflections on Human Cloning, Libreria Editrice Vaticana, Vatican City, 10-11.

(12) The four speeches are as follows: (1) Allocution to the Fourth International Conference of Catholic Doctors, September 29, 1949; text in Papal Teachings on Matrimony, ed. The Benedictine Monks of Solesmes, trans. Michael J. Byrnes, St. Paul Editions, Boston, 1963, 381-385; (2) Allocution to Italian Catholic Midwives, October 29, 1951; Papal Teachings ..., 405-434; (3) Allocution to the Second World Congress on Fertility and Human Sterility, May 19, 1956 Papal Teachings ..., 482-492; and (4) Allocution to the Seventh Hematological Congress, September 12, 1958; Papal Teachings ..., 513-525. He picked up artificial insemination, either by a "donor" or by a husband, in these four discourses, and in issue 3 he explicitly considered the topic of in vitro fertilisation.

(13) Pius XII, Allocution to the Second World Congress on Fertility and Human Sterility, May 19, 1956; in Papal Teachings ..., 485. Emphasis added.

(14) Pius XII, Allocution to Italian Catholic Midwives, October 29, 1951, in Papal Teachings ..., 427-428.

(15) Pius XII, Allocution to the Second World Congress on Fertility and Human Sterility, May 19, 1956; in Papal Teachings ..., 470.

(16) Pius XII, Allocution to the Second World Congress of Catholic Doctors; in Papal Teachings ..., 559.

(17) Congregation for the Doctrine of the Faith, Donum Vitae, II, B, no. 4. The internal quotation is from the Code of Canon Law, c. 1061.

(18) Ibid, no.6; emphasis added.

(19) John Paul II, "To my brother bishops from North and Central America and the Caribbean assembled in Dallas, Texas", in Reproductive Technologies, Marriage and the Church (Braintree, MA: The Pope John Center, 1988), p. xv.

(20) Ibid., II, A, no. 2.

(21) Ibid., II, A, no. 1.

(22) Ibid., B, no. 4.

(23) Ibid.

(24) Ibid. no.4.

(25) At grade footnote 43, Donum Vitae refers to John Paul II's General Audience of 16 January 1980. This audience was but one of the Wednesday audiences on "the theology of the body" over a period of several years, from 5 September 1979 to 28 November 1984. These hearings are collected in a single volume edition, John Paul II, The Theology of The Body: Human Love in the Divine Plan, Pauline Books and average, Boston, 1997.

(26) Donum Vitae, II, B, no. 4. The internal quotation is from John Paul II, Discourse to those taking part in the 35th General Assembly of the World Medical Association, October 29, 1983.

(27) Pontifical Academy for Life, Reflections on Cloning, LEV, Vatican City, 1997, 10, 14.

(28) St. Augustine expressed this truth beautifully centuries ago in his De genesi ad literam, 9, 7 (PL 34, 397).

(29) Paul VI, Humanae Vitae, n. 12.

(30) John Finnis, staff Integrity, Sexual Morality, and Responsible Parenthood, "Anthropos" (now Anthropotes), 1981, 11, 46.

(31) Classical sources on the distinction between "making" and "doing" are: Aristotle, Metaphysics, Bk.9, c. 8, 1050a23-1050b1; St. Thomas Aquinas, In IX Metaphysicorum, lect.8, no. 1865; Summa theologiae, 1, 4, 2, ad 2; 1, 14, 5, ad 1; 1, 181, 1.

(32) Catholic Bishops of England Committee on Bioethical Issues, In vitro Fertilization: Morality and Public Policy, Catholic Information Services, London, 1983, no. 23.

(33) Ibid, no. 24.

(34) Richard McCormick, S.J., The Critical Calling: Reflections on Moral Dilemmas Since Vatican II, Georgetown University Press, Washington, D.C., 1989, 337. The internal quotation is from William Daniel, S.J., In vitro Fertilization: Two Problem Areas, Australasian Catholic Report, 1986, 63, 27.

(35) Ibid., p. 337.

(36) See Thomas A. Shannon and Lisa Sowle Cahill, Religion and Artificial Reproduction: An Inquiry Into the Vatican "Instruction on Respect for Human Life", Crossroads, New York, 1988, 138; Jean Porter, Human Need and Natural Law, in Infertility: A Crossroad of Faith, Medicine, and Technology, ed. Kevin Wm. Wildes, S.J., Kluwer Academic Publisher, Dordrecht/Boston/London, 1997, 103-105. It should be noted that Shannon and Cahill, employing an argument of a proportionalist nature, i.e., that it may be morally permissible to pursue a so-called non-moral evil (e.g., the heterologous generation of a human life) provided that a sufficiently greater non-moral good (e.g., the provision of a child of one's own to a couple who cannot otherwise have children) is possible, imply that, if the spouses consent, recourse to third parties for gametes or even to surrogate mothers would not truly violate spousal dignity or unity. See Artificial Reproduction ..., 115.

(37) As noted in the text Pope John Paul II repudiates (and rightly so) this proportionalist method of making moral judgments in his Veritatis Splendor. For a critique of proportionalism see my An Introduction to Moral Theology, ed. Huntington, IN: Our Sunday Visitor, 1994, ch. 3.

(38) Benedict Ashley, O.P., The Chill Factor in Moral Theology, "Linacre Quarterly", 1990, 57, 71.

(39) Ibid., 72.

(40) The argument proposed in the previous paragraphs was originally taken up in an early essay that I wrote on the generation of human life in a laboratory, Donum Vitae: Catholic Teaching on Homologous In vitro Fertilization, in Infertility: A Crossroad of Faith, Medicine, and Technology, 73-92, esp. 81-87, drawing also on material developed by Germain Grisez, John Finnis, Joseph Boyle, and William E. May in 'Every Marital Act Ought to Be Open to New Life': Toward a Clearer Understanding, "The Thomist", 1988, 52, 365-426.

(41) Richard A. McCormick, Notes on Moral Theology, in Theological Studies, 1984, 45, 102.

(42) In her essay, Human Needs and Natural Law (cf. n. 37), Jean Porter claims that my argument in support of the teaching of Donum Vitae is based on a "Kantian" sexual ethics, one that "gives autonomy pride of place" (pp. 100-101). She even claims that I "dissent" from the Catholic teaching in my analysis of the marriage act because of my emphasis on the role of intention in determining the moral meaning of human action. Porter fails to recognise that my analysis, far from being Kantian, is based on the Catholic tradition that gives importance to the self-determining character of human actions. My analysis, I believe, is also based on John Paul II's understanding of human sexuality and human action.

(43) What is most important here is to emphasise that the Christian faith proclaims that the Incarnate Word is still a human being. The Christian faith rejects docetism, the doctrine that the Uncreated Word only appeared to become human and ceased to appear human after the resurrection.

(44) John Paul II, "To my brother bishops from North and Central America ...", p. xv.

(45) Donum Vitae, II, B, 4, 7.

(46) See, for example, the following: Donald T. DeMarco, Catholic Moral Teaching and TOT/GIFT, in Reproductive Technologies, Marriage and the Church, Braintree, MA, The Pope John XXIII Medical Moral Center, 1988, 122-139; Nicholas Tonti-Filippini, Donum Vitae and Gamete Intra-Fallopian Tube Transfer, in "Linacre Quarterly", 1989, 52, 68-79; Benedict Ashley, O.P.., and Kevin O'Rourke, O.P., Health Care Ethics: A Theological Analysis, 4th ed., Georgetown University Press, Washington, 1997, 242-247; Germain Grisez, Difficult Moral Questions, Vol. 3 of his The Way of the Lord Jesus, Franciscan Press, Quincy, , 1997, 244-249.

(47) See the following: Donald McCarthy, Infertility Bypass, in "Ethics & Medics", 1983, october, 1-2; McCarthy, Catholic Moral Teaching and TOT/GIFT: A Response to Donald T. DeMarco, in Reproductive Technologies, Marriage and the Church, pp. 140-145; Peter Cataldo, Reproductive Technologies, "Ethics & Medics", 1996, 1, 1-3; Griese, Catholic Identity in Health Care, 47-49.

(48) See Grisez, Difficult Moral Questions, 246-248; Tonti-Filippini, Donum Vitae' and Gamete Intrafallopian Tube Transfer, 68-69; DeMarco, Catholic Moral Teaching and TOT/GIFT, in Reproductive Technologies, Marriage, and the Church, 122-140; Ashley/O'Rourke, Health Care Ethics, 246-247.

(49) On TOTS see also McCarthy, TOTS Is For Kids, "Ethics & Medics", December 1988, 1-3.

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