Injustices Implied in the Assisted Reproductive Technologies Market

Abstract

This article critiques the current theological basis that deems assisted reproductive technologies (ART) as immoral, namely that it dissociates the unitive act from procreation, and that it violates the dignity of the embryo. It is argued that notwithstanding the validity of these moral truths, these issues are of little relevance to couples facing childlessness. Three alternative views are then presented, all based on the injustices related to the ART market: (a) injustices that directly affect the couple and their offspring, (b) unfairness related to the commercial aspect of ART markets, and (c) the overall effects that impinge on society at large. Therefore, instead of burdening childless couples wanting to have children of their own with the culpability of sin for resorting to ART, one must rather make them aware that they are prey to the ART market while calling for better regulation of this system in order to mitigate these injustices. The article ends with some recommendations on how to address these injustices.

Introduction

The birth of the first test-tube baby, Louise Brown, in 1978 opened up new horizons for couples burdened with the stigma of infertility but also unlocked Pandora's box of far-reaching ethical consequences. The first Catholic Church document which dealt exclusively with assisted reproductive technologies (ART), ¹ namely, Donum vitae (DV) put forward two main objections. First, such techniques violate the dignity of the embryo, because from the moment of fertilization “a new life is begun … a new human being with his own growth.” This life demands that it “be respected and treated as a person” (CDF 1987, 1). The second objection is that such techniques dissociate the two meanings of the conjugal act, that is, the unitive meaning from the procreative meaning (CDF 1987, 4).

Both objections have been reiterated by subsequent Church documents which have dealt with the same issues, most prominently, Dignitas personae (2008, 4, 6). The first objection, regarding the dignity of the embryo, has been defended by many other bioethicists although it has also been contested by a number of philosophers and ethicists, ² and will not be revisited here. The second objection, which speaks of the dissociation of the two-fold meanings of the conjugal act, has also been addressed extensively by several authors, including Martin Rhonheimer, who discusses in detail the problem of dissociating the unitive from the procreative meaning of the conjugal act (Rhonheimer 2010, 153–78). However compelling it may be, neither will this objection be pursued in this paper, not because of any doubt about its validity but because of its lack of persuasive power to infertile couples desiring to have a child of their own. Furthermore, the objection to the dissociation of unitive meaning and the procreative meaning of the conjugal act has been criticized as being too physicalist an interpretation of natural law (Lawler and Salzman 2008, 241).

Outside academic circles, most infertile couples would argue that at least at face value, both objections are irrelevant, the first one is because even though embryos might be in some way harmed, their ultimate intention favors life. To the second objection, they would argue that the procreative meaning is not being substituted by the unitive meaning, because they have been, and will continue to, engage in the conjugal act and are seeking ART only in an attempt to make their marital relationship fecund. ³ In other words, both in the academic domain, as on a pastoral level, the two objections offered by DV present serious limitations to dialog.

This paper addresses ART by confronting it with another dimension of bioethics, which has been described as “specifically theological, at once local yet attentive to the global” (Vicini 2012, 170). This approach brings out clearly the “strong links between life ethics and social ethics,” (Benedict 2009, 15) as Caritas in veritate observes, and has been reiterated also by Francis (2015). William Newton, in the light of CV, observes a link between the use of reproductive technologies and our attitude towards the poor (Newton 2012, 451). Throughout his article, Newton shows how the link between life ethics and social ethics gives meaning to the way in which man understands himself. He also illustrates how this connection has implications on the common good, human rights, solidarity with the poor and more vulnerable, the wellbeing of the family as the basic cell of society, increased technocracy, and even the environment.

In this paper, I seek to investigate the injustices involved in the market of ART, and the discussion will be restricted only to the “simple case,” (CDF 1987, 5) of homologous in vitro fertilization with embryo transfer (IVF-ET) in order to avoid the other moral complexities involved in gamete donation, cryopreservation, surrogacy, and other manipulations. The paper will be divided into two main parts. First, the paper addresses the injustices implied in ART, under the following subsections: (a) injustices that directly affect the couple and their offspring; (b) unfairness related to the commerce of ART markets; and (c) the overall effects that impinge on society at large. In a second part is a discussion of what means are at our disposal to respond to these challenges. Given the practical impossibility–and undesirability–of turning the clock of technological advancements backwards, I argue that promoting social ethics, which has good potential as common ground for dialog in the public sphere, will, in the long run safeguard life ethics as well.

Injustices Involved in ARTs

Injustices Directly Affecting the Couple and their Offspring

The first and most obvious injustice that a couple experiencing infertility faces is that despite the technical improvements made over the years in ART, success rates remain relatively low. The CDC report for 2019 does not give the take home baby rate for the first cycle but provides data for multiple retrievals or transfers. Even then, the figure can be over 50 percent for women less than 34 years of age and less than 10 percent for women over 40 years of age (CDC 2021, 26).

The physical and/or psychological health of children born through ART, too, is at stake. Statistics show that babies born from ART procedures stand a statistically significantly higher risk of having nonchromosomal birth defects compared to their non-ART counterparts (Boulet et al. 2016). Prematurity, low birth weight and multiple pregnancy, as well as a higher chance of cerebral palsy, and overall higher morbidity and mortality, have been documented in babies born to infertile couples who have resorted to ART (Barnhart 2013, 299; Steel and Sutcliffe 2009, 21).

Apart from the medical effects, there are also psychological effects. Blank and Merrick argue that unlike before ART where parents would simply receive what nature would have given them, with the advent of ART, parents tend to be less satisfied with what the technology would have provided them with (Merrick and Blank 1995, 101). Jean Porter agrees that one of the main problems with ART is the psychological effect on the offspring, even if subtle. She holds that having children conceived through biomedical technologies would put them on uneven ground with respect to their parents: while their parents were born independently of anyone's wishes, ART-conceived children would be the foreseen product of a technical procedure (Porter 1999, 228).

The mother, too, is at risk of several complications because of the procedure itself, with the greatest risk being ovarian hyperstimulation syndrome, which can be fatal, although some authors have disputed these concerns (Ellison and Meliker 2011). Moreover, medical literature suggests that women who have undergone IVF treatment have a 2.5 times higher risk of borderline ovarian tumors (Stewart et al. 2013, 374).

Finally, ART affects the couple negatively. Drawing on his and his wife's personal experience of infertility and how they resorted to ART, bioethicist Paul Lauritzen laments a loss of intimacy because of the intrusion of technology into the intimate life of the couple (Lauritzen 1993, 19). Although Lauritzen does not think that separating the procreative meaning from the conjugal act is intrinsically dehumanizing, he does admit that it can open the door to treating persons as objects and to putting profit before people (Lauritzen 1993, 25). Even the relationship of couples who do not manage to bear children through ART is often strained, characterized by blame and unmet expectations especially when the spouses are divided about whether to pursue further ART or not (Cahill 1996, 244).

The relatively low success rates urge us to ask three important questions: how is it that ART is acclaimed by public opinion as though it were the only solution to infertility? How ethical is it to fill the couple with high hopes of eventually taking home a healthy child when there is a less than a one-third chance of doing so? Given the relatively low success rate of ART, is it worthwhile for the couple to carry the emotional and financial burden that comes with it? These injustices will become more evident in the discussion of the commercial element involved in the ART market in the next section.

Unfairness Related to the Commerce of ART Markets

Over the past fifteen years, Debora Spar has been drawing public attention to the fact that a global market has developed around ART. As a result, embryos have fallen prey to the laws of economics, opening a can of worms on issues of access to information, equity, legality, cost, and parental choice (Spar 2006a). She argues forcefully that in our commercialized culture, which puts a price tag on practically everything and reduces almost everything to a commodity, even babies have fallen prey. In this system, reproduction is a business—from the several medical interventions aimed at trying to boost fertility, which amount to thousands of dollars, to the actual resorting to ART when other methods fail (Spar 2006b, 15). Although adoption can also be very costly, the ART market is riddled with the intrusion of intermediaries and in certain cases also brokers (Spar 2006b, 15).

Connolly, Hoorens and Chambers (2010) insist that the differences between countries involved in the ART market depend on how much the state is ready to subsidize, making the market highly variegated and still poorly understood. Yet they conclude that the determining factor for couples resorting to ART seems to be strongly dependent on the affordability of the procedure. Connolly, Hoorens and Chambers (2010) therefore bring to the forefront of the debate the economic complexities of ART, including hidden costs and issues of economic affordability for couples. It must be acknowledged that there is something profoundly unsettling in putting a price tag on reproduction. Even more worrying is the creation of two classes of couples: those who are infertile but can afford to undergo ART, and those who are infertile but cannot afford to undergo ART. Although not the ideal solution, regulating the market and offering subsidies by the state could help address this issue however imperfectly.

Among the main adverse effects on society caused by the increased availability of ART, and already foreseen by Merrick and Blank, are that, due to the commercialization of these respective technologies, children may be regarded as “products of increasingly sophisticated intervention methods” (Merrick and Blank 1995, 93). This leads to parents feeling that they could have made a better choice than if they left the birth of their child simply to chance. Moreover, profit is thus being thrust into what was until then a very personal and human realm: the process of procreation. As a result, ART providers are exploiting couples who are vulnerable because they are desperate to have a child. It is clear that in the field of ART, commercial interests have taken over human concerns. In the media, these techniques are described as “successful” when in fact, the “take home baby rate” is very low and governments in certain countries—such as India—take pride in, and continue to support, this rhetoric to portray an image of high medical sophistication in their country (SAMA Team 2009, 31).

Sarojini, Marwah and Shenoi (2011) offer an alarming perspective when they point out that due to the phenomenon of globalization, in particular medical tourism, medical ART has succumbed to the notion of bio-power. Sarojini, Marwah and Shenoi (2011) document this in their findings concerning the ART industry in India. They list three categories of injustice: (1) reported costs, which are already very high, exclude hidden costs which parents who are desperate to have a child would be ready to pay for; (2) promotion which is unfair or distorted, containing exaggerated claims, inflated success rates, package deals, schemes, concessions and camps (aimed at promoting ART); (3) the presence of other hidden players involved, especially in the promotion of reproductive tourism. They note how the market thrives despite all these irregularities simply because it lacks regulation (Sarojini, Marwah and Shenoi 2011, 1–9). These trends are not unique to India, and some of them can also be observed even in the US, and elsewhere, further emphasizing the need for meticulous and robust regulation.

Advertising and marketing of ART serve to inform the public of what is available, but in general they have been found to be unfair because of the way data are presented. Balser and Espenberg had defended the advertising of ART by arguing that marketing reproductive health services in the United States is now mainstream and that it helps patients and the public build a better understanding of the various health care services by providing accurate information and guidance (Balser and Espenberg 2002, 96–97).

Although not specifically classified as advertising, most ART clinics post their information online, knowing that it is the locus of preference among their clients for information and decision-making. A study carried out in Germany shows that such centers rarely state their own or the general take-home-rate and instead quote their pregnancy rates, which are higher. What the clients are really interested in however is the actual “take-home baby rate,” and only 4.65 percent of the centers provided this information (Kadi and Wiesing 2015, 1259). Moreover, some centers differentiate their birth rates according to method, or age, or according to the number of cycles, making it very difficult to compare results between one center and another (Kadi and Wiesing 2015, 1260). A study carried out in Turkey evaluating websites promoting ART services has shown almost all of them to some degree or other had out-of-date information displayed, lacked appropriate citations, or contained claims which would lead to unfair competition (Karatas et al. 2011, 510).

Injustices That Impinge on Society at Large

The very availability of ART has an effect on society at large, affecting each person, even those who will never use it, even if only by virtue of the very fact of existing (Casalone 2003, 102) or, as Porter puts it, “the meanings that are being institutionalized as we move toward the regular practice of artificial reproductive technologies” (Porter 1999, 228). ART has also reinforced subtle patterns of injustice which are not immediately perceptible, especially—albeit not restricted to—women. So far as ART is concerned, therefore, traditional Church teaching and feminist thinkers seem to form an alliance, although they argue from different perspectives.

First among these effects is that known as pronatality, i.e., a culture that coerces women to bear children at all costs. Admittedly, several factors are responsible for a couple's desire to have their own offspring at any price, ranging from necessary anthropological factors to contingent ones. In fact, as early as ancient times, reproduction was considered as a means of leaving a legacy, thus ensuring immortality after death. The developmental psychologist Erikson (1950) had articulated this phenomenon observing that when a person reaches middle adulthood, he or she passes through the psychosocial developmental stage characterized by the generativity-stagnation dichotomy, at which point the desire to have one's own offspring is very strong, but which can also be addressed through other means of “productivity” or “creativity”. ⁴

Some feminist theologians, however, point out that ART reinforces pronatality. One such voice is that of Lisa Sowle Cahill, who notes that the availability of ART is the result of

a dearth of resistance to patriarchal socializations of embodiment, including men's need for guarantees of biological paternity; women's social- and self-definition through motherhood … as well as of the “services” of economically disadvantaged women. (Cahill 1996, 219–20)

After surveying the firsthand accounts of women who underwent ART and the work of several feminist bioethicists, Cahill concludes, “it is difficult to dismiss the argument that infertility medicine is inherently coercive, especially for women” (Cahill 1996, 245). Lauritzen agrees with this analysis and, speaking from his perspective and that of his wife after they resorted to ART, notes how reproduction has been taken over by technology, leading to what he calls the tyranny of technology, with two subsequent, freedom-limiting effects. The first is the coercive offer, where, because of the pervasiveness of ART, infertile women are granted the choice of having a child, yet it is known that the choice is no choice at all since it is still not readily available to any woman. The second is coercive threats, where ART will eventually become the norm for any reproductive process, thus restricting the freedom of those who would rather not opt for ART (Lauritzen 1990, 39–40). ⁵

The wide availability of ART and the readiness of many governments, including some in developing countries, to subsidize costs is pushing such treatment to become “part of routine expectation,” leading to a “third phase” in reproductive medicine (Simpson and Hampshire 2015, 3). ⁶ The issue is further complicated by the fact that resource-poor settings tend to exhibit higher levels of infertility. The impetus towards pronatalism and the way that ART responds to it, the authors insist, is found to be not merely biomedical but also cultural, moral, and economic (Simpson and Hampshire 2015, 6).

Neither the wide availability of ART nor government financial subsidizing is sufficient to eliminate injustices, leading Shelee Colen to observe the emergent reality of what she calls “stratified reproduction.” By this, she means that it is largely position in society such as class, race, ethnicity, and place in the global economy that dictates how reproductive tasks are assumed. This further outlines how ART accentuates the problem as commodification of reproductive labor sets in (Shelee 2006, 380–1). Similarly, Deborah D. Blake insists that the discrepancy between those who can afford ART treatment and those who cannot leads to a type of poverty called reproductive marginalization, and therefore “lack[s] solidarity with the poor and personal complicity in an unjust structure” (Blake 1997, 163).

In stark contrast with what has been discussed so far, the work of anthropologist Marcia C. Inhorn stands out. After years of studying infertility in the Middle East, especially from the male perspective, she reaches the conclusion that the current generation of Arab men, whom she calls the “new Arab men” are rejecting their forefathers’ “four notorious Ps: patriarchy, patrilinearity, patrilocality and polygyny (having more than one wife),” (Inhorn 2012, 302) and argues that this is what is leading to the flourishing of the ART market in the Middle East and many other Muslim countries. Consistently throughout her writings, she argues that injustices due to inaccessibility based on social status can be addressed by further promoting ART in low-income countries as a reproductive right. Inhorn argues that childlessness in certain countries, especially sub-Saharan Africa, the Middle East and Southern Asia, often leads to community ridicule and social ostracism, which affects not only females but also males, with a very strong tendency to stigmatization (Inhorn 2009, 172–3). She mentions Egypt as a case in point where people have a right to control or to facilitate fertility where this is threatened thanks to political will and availability of ART technologies. Other low-income countries, Inhorn suggests, can follow suit (Inhorn 2009, 174). Inhorn's insights bring to the fore the more complex realities that are deeply ingrained in culture and which cannot be dismissed lightly. The differences between cultures and the implications on ART highlight the need for subsidiarity. This principle, adopted from Catholic social teaching, suggests that decisions must be taken as close as possible to the community in question rather than by higher authorities.

As well as for the economic concerns, many authors, especially from the feminist tradition insist that ART contributes to the commodification and objectification of women. Lauritzen, among others, refers to the medical terms used—e.g., “eggs harvested” and “hostile body”—and how the women's body is monitored, drugged, and confined (Lauritzen 1993, 31). In this regard, many critics point out that ART reduces the woman to a patient, and reproduction is medicalized even though she might have no medical condition requiring treatment (Merrick and Blank 1995, 103). In one-third of the population of those who sought ART for infertility in 2019 in the United States, the medical problem was the male factor (CDC 2021, 26). Notwithstanding the male factor, it is the woman who is “medicalized” and “pathologized.”

Barbara Katz Rothman's analysis of the situation is that our society, including our medical system and childbearing, is dictated by a triad of a patriarchal society, and the ideology of capitalism and technology (Rothman 1989, 251). She proves this by stating, “infertility treatment embodies all that is bad in our medical care, it is available only to the well-to-do, it is male dominated, and it is offered in a way that is totally divorced from the context of one's life” (Rothman 1989, 251). Later on she adds, “if a man has a high sperm count the infertility problem is treated entirely as the woman's, whereas if the man has low sperm count, the problem is still treated largely as the woman's” (Rothman 1989, 149). Addressing these three realities of patriarchy, technology, and capitalism is not a simple endeavor. Doing so would require education, structural changes to our health care system, and a comprehensive approach on several fronts.

The open-endedness of ART has led to a revolution of family structures in that families need not fall under the description of mother, father, and one or more naturally conceived children for it to be called a family. Rothman puts forward the idea that ART's have brought about a new reality: whereas until then, fathering meant the introduction of his seed into the body of a woman, with the advent of ART, for the first time the egg was extracted from the woman, fertilized and “replanted” in the woman, or any other woman in the case of heterologous IVF-ET. To some extent, therefore, even she “fathers” the child (Rothman 1986, 236–7). Even though in this paper the simple case of homologous IVF-ET is being considered—and therefore we will not examine the complications of heterologous IVF-ET as done by for instance, homosexual couples—it cannot be excluded that IVF-ET does change the intrinsic organizational structure of the family, as Rothman indicates. Whether these changes raise any ethical questions or whether they are only the effects of innocuous diversity is not the aim of the current discussion.

Children too are susceptible to commodification and commercialization, thus leading to them being viewed as commodities subject to a “creation of a value context” (Rothman 1986, 103). The commodification of children has been described as “pushing [children] into the property end of the person/property spectrum” (MacCallam and Widdows 2012, 280). Two key features are identifiable in this process: (1) objectification: persons become things onto which desires can be projected, and (2) contract and sale, which now become the framework of the relationship. For Benoît Bayle, the commodification of children is the result of the “procreative society” instigated by the ART revolution. The characteristics of this new society include: (1) the new definition of health by the World Health Organization, which places emphasis on the “complete well-being, physical, mental and social,” not only the absence of sickness or infirmity; (2) sexual freedom, which is believed to be necessary for the well-being of the individuals; (3) “l’enfant désiré” (the desired child), i.e., that the child conceived at the right moment as desired by the parents will be all the more loved because he or she responds to their desires, and thus assuming that he or she will be a happier child; (4) the belief that some lives are worthy of living and others are not if they are condemned to a life of suffering; (5) “la différence prénatale,” which refers to the belief that there is a gradual difference in the status of the fetus during the gestation period, hence the belief that their removal and instrumentalization is possible, under certain circumstances. Bayle concludes that ART has therefore led to the promotion of a new moral order, and its own systems of beliefs (Bayle 2009, 110–1).

Some authors insist that most of the factors discussed above fall within the narrative of biopolitics as described by Foucault:

since the post-war period of the twentieth century, reproduction has been subject to ever-increasing technologization and a correlative commercialization, both of which take place against a backdrop of the expansion of neoliberalism and the dismantling of the welfare state (Mills 2017, 283).

This is so true that some IVF companies have also been seen listed on the stock exchange (Mills 2017, 283). In Foucauldian terms, there is a privileging of one group over another, creating a flow of power centered on the body, what he would call “biopower,” and which continues to shape our society: industrial capitalism, sovereignty, law and coercion (Sarojini, Marwah and Shenoi 2011, 1). Here, one cannot miss noting the paradox that, technological advances and requests for their availability are made in the name of “reproductive liberty” but which in turn further leads to the loss of freedom of those same people who advocate them.

Responding to the Challenges of Social Injustice

It is the responsibility and mission of the Church to work in favor of justice and the common good. As I have tried to argue above, ART at least as it is practiced so far around the world reinforces a “dominant social ethos … fundamentally in conflict with the social ethos presented by the Roman Catholic [values]” (Blake 1997, 151). This reality makes us aware of how our personal choices affect our social reality and community life and therefore also includes our complicity and indirect support of particular social arrangements. Patricia Beattie Jung specifies that the question here is one of resource rationing: not whether we should ration health care but rather, what values and norms must dictate how to ration our health care (Jung 1997, 169). She believes that the relative priority of the needs of infertile couples in relation to other demands on the health care system ought to be discerned in a communal process. Only in such a “deliberative process, would the extent of the other, presently unmet needs for primary, preventive and curative health care dwarf the need for IVF” (Jung 1997, 169).

Both in the context of policy making, as in the field of medical research, priority should be given to the prevention of infertility. One of the main causes for this, among those who seek ART, is delayed childbearing, usually for academic or career reasons. Women are “falsely reassured by popular beliefs that advances in [ART] can compensate for the age-related decline in fertility” (Balasch and Gratacós 2011, 271). Moreover, studies show that most women use hormonal contraception to delay childbearing, which in turn makes it even more difficult to have children when they are desired (Szewczuk 2012, 441–2). Despite these two factors, it is not fair to further burden women with the blame of delayed childbearing or use of hormonal contraception because this is not always their free choice after all.

Green et al. therefore highly recommended educational campaigns to encourage women not to delay childbearing, thus avoiding the difficulties associated with ART, such as the inability to bear children or risking the higher probability of having a child with disabilities due to ART (Green et al. 2015, 1892–3). It has been proposed that public health campaigns be conducted to educate women about the risks of delayed childbearing while putting in place policies that would facilitate women pursuing academic or professional careers to consider childbearing at a younger age (Lemoine and Ravitsky 2015, 37). The Church has a responsibility to advocate for such policies that enable young mothers to pursue their careers without risk of prejudice.

Although there is a difference between having one's own child and adopting one, adoption is still a possibility to be considered. Several authors including Cahill and Casalone advocate for this option. Cahill speaks of her positive experience of adopting three children from Thailand, while Casalone suggests that the challenge of infertility that some couples face might lead them to considering adoption as a valid alternative. In taking on themselves the responsibility of a child in precarious circumstances, they find a means of expressing their own fertility (Casalone 2003, 110).

The strong desire of couples to have their own children, whether it derives from anthropological, psychological or social pressures (such as pronatality), cannot go unaddressed by the Church. There is a strong need for the development of a theology of infertility and all current attempts in this regard deserve commendation but are nonetheless sparse. One such attempt has been done by Kathryn L. Cox who proposes that such a theology would involve three components: societal (our attitudes in our daily encounters with people, especially infertile couples), ecclesial (how does the Church as the Body of Christ influence the culture and stigma of infertile couples), and theological, especially Karl Rahner's “theological concupiscence”, acknowledging the tension between nature and its finitude, and the human person, with his or her freedom (Cox 2013, 45–51).

The economic issues presented above must be addressed through sound policymaking. In an extensive study on reproductive stratification, the authors advocate for more concerted efforts to reduce ethnic inequalities in health status and for public policies that address the avoidable causes of infertility, as well as for a more equitable access to ART for minorities and racialized groups, as well as support and counseling (Culley et al. 2009, 10). In her extensive work specifically on “ethics and the economics of assisted reproduction,” and speaking from firsthand experience, Maura A. Ryan advocates for restraint in the research and use of ART, in ways that would contribute to the common good, also reflecting a preferential option for the poor (Ryan 2001, 61).

No one can be exonerated from shouldering responsibility in the injustices and coercion which reinforces a culture that leads to ART. Gay Becker blames the consumer culture for the commercialization of ART and believes that it is the result of the economic values based on individualism, and the desire to be in control of the situation at all costs (Becker 2000, 122–3). Therefore, if Becker's analysis is correct, unless the values of consumerism and individualism in the Western world are changed, we can never hope to overcome the societal and justice challenges bound to ART.

Conclusion

Questions about the moral permissibility of the techniques of ART arise very frequently either pastorally or in public policy drafting. Rather than starting from the impermissibility of the act from the traditional perspectives proposed by DV—i.e., the moral status of the embryo and the dissociation of the unitive from the procreative meanings of the conjugal act, one can analyze ART from a social justice point of view. The approach proposed by DV discusses the intrinsic value of the embryo and of the conjugal act, while the approach proposed here discusses ART by examining these technologies in the social context and by discussing what leads to them and what are their consequences.

The present discussion therefore underscores the importance of the “strong links between life ethics and social ethics,” and that they must be addressed through respect, reasonableness and responsibility (Fullam and O’Neill 2010, 181). In a pluralistic world where intrinsic value is no longer perceptible by many and where there is lack of consensus on the moral status of the embryo, addressing the problem from this social justice point of view “permits the Church to make its strongest public case” (Fullam and O’Neill 2010, 189) and bioethics has at its disposal a rich array of ethical resources to address the issue convincingly from several angles and in a spirit of dialog.

One can hope that one day we would see an end to the injustices outlined here in the domain of ART, that humanity will embrace its limitations, including infertility, seeing them not as illnesses but as variations of the uniqueness of every person, and that technology and economy will continue to develop at the service of the human person and the flourishing of the common good.

Biographical Note

Carlo Calleja, SThD, read for his bachelor's degree in theology at the University of Malta and obtained his licentiate from the same university in 2016. He embarked on further studies in moral theology, obtaining his Doctorate in Sacred Theology from the Boston College School of Theology and Ministry in 2020. His doctoral thesis is titled "Kinship as a Political Act: Responding to Political Exclusion through Communities of Solidaristic Kinship". He is a resident academic at the University of Malta in the areas of ethics and social justice.