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The Morality of “GIFT” and “IUI”

gift.jpegBackground and Introduction
In September 2010 Culture-of-Life.org posted on this website my article, “Clarification of GIFT and IUI: Assisting or Substituting the Conjugal Act?” Dr. José Florez had kindly corrected me for an article in Zenit in which I confused GIFT or Gamete Intrafallopian Tube Transfer with IUI or Homologous Intrauterine Insemination. He informed me that GIFT is seldom used today in the U.S. because IUI is simpler and apparently more effective.

Procedure
I will first describe GIFT/IUI, identify the moral issue, summarize arguments given until 2011 pro and con the moral rightness of these procedures, summarize a somewhat new argument in opposition to them advanced in 2011 by Helen Watt, briefly reflect on the way “the language of the body” relates to their morality, and offer a Conclusion.

 

Gift and IUI described
In GIFT the wife’s ova are removed by the doctor.  An ovum or ova are put into a catheter with sperm (provided either by masturbation or by using a perforated condom during previous marital acts) that have been treated and “capacitated.” An air bubble is used to separate ovum (ova) from sperm in the catheter while outside the wife’s body. After the catheter is inserted into the wife’s body, the ovum and sperm are released from the catheter, and fertilization and conception can then take place within the wife’s body.  IUI, however, is simpler. The sperm (retrieved in the same ways), after a rapid procedure to “capacitate” them, are put inside the woman’s reproductive tract with the help of a plastic catheter, and fertilization can then take place. It is simpler than GIFT because there is no need to remove the wife’s ovum or ova from her body.

The Moral Issue
Many Christian ethicists/bioethicists, Protestant (e.g.¸ the late Paul Ramsey and Gilbert Meilaender) and Catholic (Germain Grisez, E. Christian Brugger, John Finnis) reject “reproducing” babies in the laboratory through new “reproductive methods,” such as in vitro fertilization, as dehumanizing and a violation of marriage insofar as they—along with pro-life people—believe that human babies ought to be “begotten” by husband and wife in the conjugal act, not “made” in the laboratory.

Nonetheless, the desire of a married couple to have a child(ren) of their own is natural and good, and they suffer if they cannot beget children because one of them is sterile. A passage in the 1987 Vatican Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation, called Donum Vitae (DV) in Latin, offers them some hope, declaring: “If the technical means facilitates the conjugal act or helps it to reach its natural objectives, it can be morally acceptable. If, on the other hand, the procedure were to replace the conjugal act, it is morally illicit” (DV, II, B, 7). Several ethicists/bioethicists think that GIFT/ IUI are technical means that “assist” the conjugal act in achieving its procreative end and is therefore morally acceptable, whereas others disagree and argue that these procedures substitute for the conjugal act and are hence morally unacceptable.

Arguments for and against GIFT and IUI
GIFT and IUI “assist” the conjugal act achieve its procreative end and are morally licit

The basic argument claims that these procedure are morally legitimate if the sperm have been procured by using a perforated condom during a marital act and not by masturbation.  Because, in contrast to IVF and other procedures which replace the conjugal act, fertilization itself takes place within natural conditions that are essentially the same as those in which a pathology, in this case sterility, is not present. It helps the conjugal act, an act open to the transmission of life but functionally impaired because of sterility, to generate life; the intentions are good, and the act is a unified whole.[1]

GIFT/IUI do not “assist” the conjugal act to attain its procreative end but “substitute” for that act: The basic argument up to 2011.

The basic argument is that sperm used in GIFT/IUI have been deliberately, (i.e., intentionally) withheld from a marital act or series of marital acts. They were not deposited in the wife’s body during the marital act, but in the condom. In GIFT they are then retrieved by technicians, washed and “facilitated” and then placed in a catheter and separated by a bubble from the wife’s ova, while in IUI the sperm deposited in the perforated condom are “facilitated” and place directly into the wife’s body through the cervix. In both cases they have been deliberately withheld from a conjugal act. Thus they cannot be said to be integral to the marital act, so how can they “assist” it? The spouses are not the major causes of fertilization; they simply provide the “products” (sperm and ova) used by technicians to arrange for their coming together in future human acts that may, in fact, never occur. [2] 

Helen Watts’ 2011 argument against GIFT/IUI
British bioethicist Helen Watt stresses that conceiving a child as a result of engaging in the marital act “is designed to give parents an experience of a real, though partial and cooperative, causal involvement in the child’s creation.” The fact that they do not directly bring  a child into existence in “giving and receiving each other,” but  receive it as something in addition to their own bodily act, “protects them from feeling an excessive God-like responsibility for the child.” But “non-sexual conception [as in GIFT, as Watt makes clear] involves and encourages an excessive power and control over the child, even if this power and control is in practice exercised by doctors on their behalf.” It is like buying a child and “begins the parent-child relationship in a way which has entirely the wrong symbolic connotations” (pp. 202-203).

She refers to a normative passage, originally found in a Discourse of Pope Pius XII on September 29, 1949 to an international congress of Catholic doctors and quoted verbatim in DV, II, A, 7: “A medical intervention respects the dignity of   persons when it seeks to assist the conjugal act either in order to facilitate its performance or in order to enable it to achieve its objective once it has been normally performed.” She identifies the “proper end” or “objective goal” by saying: “The procreative end is surely that sperm and ovum be brought together by means of the act…. The child should be the fruit of the sexual act ‘normally performed’, not the fruit of  a withholding from the couple’s marital union, followed by the withdrawal and reinsertion of the sperm” (p. 204).

Watt’s argument against GIFT (she does not seem to be aware of IUI, but the same argument against its use can be given) is basically the same that has just been presented.

Conclusion
This essay has presented different and contradictory assessments by well known and respected ethicists/bioethicists of the morality of GIFT/IUI.  In my judgment the argument against these procedures is better than those for using them. I make this judgment because GIFT/IUI requires  use of a perforated condom by the husband in a marital act prior to employing either of these means to “help” the conjugal act achieve its procreative end. That marital act has ended, and the sperm subsequently used to fertilize the wife’s ovum (ova) are sperm that have been intentionally withheld from the prior marital act which is in no way continued.

It is significant that Dr. David S. McLaughlin, a pioneering advocate of  GIFT, originally obtained the husband’s sperm by masturbation; when informed that masturbation for such purpose is regarded as intrinsically evil by the Catholic Church, he then said that the husband should use a perforated condom in order to retrieve his sperm in a way morally acceptable by the Catholic Church. [4] This indicates that GIFT (and IUI) are procedures that cannot be regarded as “assisting” a conjugal act achieve its procreative purpose but rather “substitute” for it.

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[1] This is the basic argument given by such scholars as Rev. Donald McCarthy, Peter Cataldo, Dr. José Florez.
[2] This argument or one similar is given by Germain Grisez, Donald DeMarco, John Doerfler, E. Christian Brugger and others.
[3] Watt, “Ethical Reproductive Technologies: Misplaced Hope,” in Fertility&Gender, pp. 201-212 .
[4] See David S. McLaughlin, M.D., “A Scientific Introduction to Reproductive Technologies,” in  Reproductive Technologies and the Church aintree, MA: The Pope John Center, 1988, pp. 55-56; see also Rev. Donald McCarthy, “Catholic Moreal Teaching and TOT?GIFT, in ibid., pp.140-145.

(c) 2011 Culture of Life Founation. Reproduction granted with attribution.