The Adoption of Frozen Embryos: Ethical Dilemmas

By Rev. Fr. Dr. Anthony Okechukwu Nnadi

This book discusses the ethical dilemmas relating to the use of frozen human embryos. During an IVF process, after fertilization of the eggs, the embryos that are not needed immediately can be placed in the freezer to be preserved for future use. Regarding the fate of frozen human embryos, the possibilities include: i) donating them for stem cell research or for treatment of disease; ii) using them as a means for treatment of infertility; iii) permitting their destruction; iv) allowing them to thaw and die; v) allowing them to continue to stay in the freezer and vi) utilizing them in a form of prenatal adoption. As the book reveals, it is only the proposal to adopt the embryos that can be considered in terms of moral permissibility because the rest do not respect and protect the dignity, integrity and life of the human embryo. The book focuses on the proposal for prenatal adoption. The anthropological dimension of adoption reveals that the ethics of adoption is based on gift and acceptance and that adoption is a concrete manner of expressing love and solidarity. Thus, an abandoned child is received with love to be permanently a member of the adoptive family. The husband and wife who did not beget the abandoned child, generate him/her through the intrinsic generative power of their love. With this, it was demonstrated in this book that prenatal adoption is compatible with the dynamic of adoption. Prenatal adoption as Dignitas personae reveals is praiseworthy because it protects and saves human lives, but it presents various problems. Based on the declarations of the Catholic Magisterium, there is a prolific Catholic debate on the morality of prenatal adoption. Some agree it is morally permissible, while others disagree. Most arguments in the Catholic debate are centred on whether prenatal adoption separates the unitive and procreative meanings of marriage. This book proposes a reconsideration of prenatal adoption, sticking strictly to the Magisterial prudential judgement.

• Language: English
• Publisher: Xlibris US
• Release date: Sep 16, 2020
• ISBN: 9781664130555

Rev. Fr. Dr. Anthony Okechukwu Nnadi

Rev. Fr. Dr. Anthony Okechukwu Nnadi was born in Owerri, Imo State Nigeria. He is a priest of the Catholic Diocese of Massa Carrara-Pontremoli, Italy. Rev. Fr. Dr. Anthony Okechukwu Nnadi is currently the parish priest of Saints Quirico and Giulitta Church, Barbarasco and the administrator of five other parishes. He is also the delegate for ecumenism and interreligious dialogue for the above-mentioned diocese. Fr. Anthony Okechukwu Nnadi holds the following academic degrees: Bachelor of Arts (B. A) in Philosophy, Imo State University Owerri, Imo state Nigeria, Bachelor of Philosophy, Pontifical Urban University, Rome Italy, Bachelor of Theology, Faculty of Theology of Central Italy, Florence Italy, Licentiate in Bioethics, Pontifical University Regina Apostolorum, Rome Italy, Doctorate in Bioethics, Pontifical University Regina Apostolorum, Rome Italy and Licentiate in Moral Theology Alphonsian Academy (Faculty of Theology of the Pontifical Lateran University), Rome Italy where he is ready for a Doctorate degree in Moral Theology. Fr. Nnadi is a lecturer of Bioethics and Moral Theology in the School of Theological-Pastoral Formation of the Diocese of Massa Carrara-Pontremoli, Italy. Fr. Anthony Okechukwu Nnadi is the author of the following books: “In Difesa della Vita Nascente. Statuto dell’Embrione Umano” ( In Defence of the Nascent Life. Status of the Human Embryo (with presentation by Prof. Dr. Maurizio P. Faggioni), “LibreriadelSanto.it” Padua (2015); “Il Volto Umano della Medicina. Il Rapporto Medico-Paziente” (The Human Face of Medicine. Doctor-Patient Relationship (with presentation by Prof. Dr. Maurizio P. Faggioni), “LibreriadelSanto.it” Padua (2016) and Distribution of Resources in the Nigerian Health Care System. Ethical Considerations and Proposals Applying Catholic Social Teaching, XLIBRIS, Bloomington, Indiana, USA (2020). He was the Editor-in-chief of “The Pointer”, a Philosophy Journal of the Seat of Wisdom Major Seminary Owerri, Imo State Nigeria. He is the author of the articles: «A Biological Proof of the Personhood of the Human Embryo», published in The Catholic Medicare (An academic Journal published by the Federation of Catholic Medical and Dental Students of Nigeria); «Embrioni Crioconservati: Cosa fare di Loro? Una proposta di adozione» (Cryopreserved Embryos: What to do with them? A proposal of Adoption), Vita Apuana, 4 ottobre 2015 and other academic articles.

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Rev. date: 09/16/2020

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Foreword

One of the most amazing fields of contemporary medicine is that of the technologies that intervene in the transmission of human life and in the development of embryos both by facilitating natural processes, and replacing them. The technique not only mimics biological nature, but has given rise to a new nature formed by the set of objects built by man, a world of artifacts and artificial processes that rivals the world of natural objects and processes. The world of organics and the world of technology meet, contaminate, interact. The boundary between natural and artificial has been blurred more and more in recent decades and in many situations has completely disappeared. In this field it makes no sense to base an ethical assessment or a legal standard on the ancient principle that natural processes must be respected, as they are spontaneous, and it is unlawful to manipulate or replace them with completely artificial processes. The ethical question of procreatics arises today in a completely new way compared to the past. Today we ask ourselves what are the principles which need to be respected in order to govern man’s ability to intervene in the depths of biological processes. The ethical issue is first and foremost a matter of responsibility. We must take responsibility for our actions and their consequences in all involved. Responsibility is a matter of respect, that is, of recognition and promotion of the reality of the other.

Anthony Nnadi’s interesting work that we are honoured to present addresses the problem of freezing and adopting frozen embryos in this personalist perspective and starts from a question about the quality of embryonic existence. After establishing with scientific and philosophical arguments the full humanity of embryonic lives, it focuses on the question of their adoption. We know that there are moral and legal conflicts over in vitro fertilization, embryo freezing and the fate of frozen embryos, but the author concentrates on the questions relevant to their adoption. The matter is very interesting because adoption is an historically ancient practice and it represents a socially accepted method of overcoming a couple’s problem of infertility: a couple or even a single person welcomes as theirs, a child biologically generated by others. Adoption establishes a relationship of parenthood and filiation outside the biological generation. Adoption is a kind of relationship based on affection and legally regulated. Adoption - Roman law taught - imitates nature. It imitates nature, but it is not natural in the biological sense. The institution of adoption bypasses nature to establish emotional and legal relationships between persons, between the person who accepts and the person who is accepted. Adoption implies an overcoming of natural dynamics in favour of personal dynamics. The lawfulness of artificial fertilization and embryo freezing can be questioned, but if a frozen embryo exists and is an orphan, his/her adoption seems the only solution that recognizes his/her humanity.

Fr. Nnadi’s work does not shy away from any problems related to the adoption of frozen embryos and it wisely examines the reasons for and against, indeed, the author courageously accepts the challenge of new procreative technologies. He shows that a person-centered bioethics can give valid answers from an anthropological and ethical point of view to even the most dilemmatic questions. We must be able to face new challenges with new conceptual tools without betraying the authentic and integral good of people. The study we introduce represents a brilliant attempt to walk along new paths ready to be guided by basic and perennial human principles. It is not an ideological question, it is not an abstract question, but it is a question centered on the concrete reality of the person. For this reason reading this book will be useful not only to doctors, lawyers, philosophers and theologians, but also to all those who feel in their hearts the passion for life and love for the human being.

MAURIZIO P. R. FAGGIONI, OFM, M.D., TH.D.

Professor of Bioethics, Alphonsian Academy (The Faculty of Theology of the Lateran University Rome, Italy) and the Theological Faculty of Central Italy, Florence.

Imprimi potest

+ Giovanni Santucci

Bishop of Massa Carrara-Pontremoli, Italy

This book is dedicated to Elia Bianchini, a twin who

departed this life less than one hour after his birth.

Acknowledgements

I thank God for giving me the wisdom and strength to complete this book.

Prof. Dr. Maurizio Pietro Faggioni deserves my appreciation. I am grateful to him for stimulating discussion and for guiding me while I was writing this book. I thank him for accepting to write the forward of this volume.

I am profoundly thankful to Mr. James McHugh, Mr. John McHugh and Mr. Christopher Lock for painstakingly editing the manuscript.

I also wish to express my gratitude to the lecturers at the faculty of bioethics, Pontifical Athenaeum Regina Apostolorum, Rome for helping me to have a better understand of Bioethics. I am so grateful to Prof. Gonzalo Miranda, Dean of the faculty, Prof. Alberto García Gómez and Mr. Gennaro Casa the Secretary of the faculty.

Equally, my gratitude goes to Prof. Alfonso Vincenzo Amarante, Dean of the Alphonsian Academy (The Faculty of Theology of the Lateran University Rome, Italy) and all the lecturers of the faculty.

I really appreciate the moral support received from Rt. Rev. Giovanni Santucci, the bishop of the Diocese of Massa Carrara-Pontremoli Italy and Rt. Rev. Eugenio Binini, the bishop emeritus of the above-mentioned diocese.

I thank in a special way Archbishop Anthony J. V. Obinna (Archbishop of the Catholic Archdiocese of Owerri, Nigeria).

I owe to my parents all that I am. Thus I am extremely grateful to my mother Mrs Bridget Nnadi, and my father Tobias Nnadi, who is resting in the Lord. I thank Rev. Sr. Philomena Chidinma Nnadi and all my siblings. In the same manner, I appreciate the help offered by the family of Gianni Strani.

I am most grateful to Rev. Fr. Dr. Raph Okechukwu Madu and Rev. Fr. Dr. Jude Chikodi Ike for their immense assistance.

By the same token, I say thank you to my formators in the minor seminary (St. Peter Claver Seminary Okpala, Imo State Nigeria), especially Rev. Fr. Dr. Anthony Onyeocha, and all my lecturers at the Seat of Wisdom Seminary, Owerri Imo State, Nigeria, particularly Rev. Fr. Dr. Jude Uwalaka and Rev. Fr. Dr. Justin Ekennia, I have to thank my rectors in the major seminaries of the Diocese of Massa Carrara-Pontremoli and Archdiocese of Pisa, bishop Alberto Silvani, bishop Gugliemo Borghetti, bishop Roberto Fillipini and Don Severino Pizzanelli. Equally, I thank my lecturers at the Studio Teologico Interdiocesano Camaiore (LU), affiliate of Faculty of Theology of central Italy, Florence.

I am deeply grateful to bishop Martin Uzokwu, bishop Mathew Hassan Kukah, bishop William Avenya, bishop Giovanni Mosciati, bishop Moses Chikwe, Don Alvaro Marabini and Maj Gen Godwin Umoh Rtd (the former Nigerian Ambassador to the Holy See), for their encouragement.

Additionally, my special thank you goes to Mr. Paolo Cittadini, Mr. Federico Castaldi, Mr. Giovanni Punzi, Mr. Vincenzo D’Errico, Mr. Christian Guscioni, Mr. Maurizio Vannini, Mr. Franco Bernardi, Mr. Gino Luciani and Mrs. Anna Maria Bertolucci for their support.

Likewise, I thank my parishioners for their love. God bless you all.

Abbreviations

Contents

General Introduction

Chapter I  Embryo Freezing And Thawing

Introduction

1.1. History of Cryopreservation Technology

1.2. Why are Embryos Frozen?

1.3. How Embryos are Frozen and Thawed

(Freezing-Thawing Process)

1.4. How Long Can Embryos remain Frozen?

1.5. What are the Success Rates of Cryopreservation and

Thawing of Embryos?

1.6. Side Effects/Risks of Freezing and Thawing and their

Implications to the Integrity of the Embryo

Conclusion

Chapter II  Anthropological And Moral Questions

Regarding Human Embryo Freezing

Introduction

2.1 Moral Status of the Human Embryo

2.1.1. Biological Perspective (Proofs of Personhood based

on Biological Reality)

2.1.1.1. Cross-talk

2.1.1.2. Life Continuity and Biological Evidence of

Embryo as Human Species

2.2. Ontological Perspective (Philosophical arguments on

Embryo’s Moral Status)

2.2.1. Is the Embryo a Cluster of Cells or an Individual

Human Being with Complete Moral Status?

2.2.2. Is the Embryo a Human Being as well as a Human

Person?

2.2.3. Is the Embryo a Potential Human Person?

2.2.4. Intrinsic Attributes and Special Status:

Implications for the Moral Status of the Human

Embryo

2.2.5. Equality of Moral Status

2.3. Legal Positions of some Countries on the Frozen Human

Embryos

2.3.1. Australia

2.3.2. Austria

2.3.3. Belgium

2.3.4. Bulgaria

2.3.5. Canada

2.3.6. Croatia

2.3.7. Czech Republic

2.3.8. Denmark

2.3.9. France

2.3.10. Germany

2.3.11. Hungary

2.3.12. Italy

2.3.13. Israel

2.3.14. Nigeria

2.3.15. Portugal

2.3.16. Slovak Republic

2.3.17. Spain

2.3.18. Turkey

2.3.19. United Kingdom

2.3.20. United States of America

2.4. Moral Implications of the Legal Positions on the Frozen

Embryos

2.4.1. Abandoned Frozen Embryos and the Permission

to practice IVF

2.4.2. Cryopreservation/Storage of Embryos

2.4.3. Embryo: A Property Case/Theory of ownership

2.4.4. Donation of Embryo for Research/Destruction of

Embryos

2.4.5. Embryos and Human Rights

Conclusion

Chapter III  Ethical Dilemmas Associated with the

ADOPTION of Frozen Embryos

Introduction

3.1. Understanding the Concept of Adoption

3.1.1. What is Adoption?

3.1.2. Historical Highlights of Adoption

3.1.3. Adoption in the Ancient Period

3.1.3.1. Adoption in the Ancient Near Eastern Civilizations of the Second Millennium - Patriarchal Narratives

3.1.3.2. Adoption in the Code of Hammurabi

3.1.3.3. Adoption in the Ancient Greek Culture

3.1.3.4. Adoption in the Byzantine Law

3.1.3.5. Adoption in the Ancient Rome

3.1.3.6. Adoption in the Middles Ages

3.1.3.7. Adoption: 19th Century to 20th Century

3.1.4. The Ethics of Adoption: Anthropological Aspect

3.1.4.1. Adoption: The Ethics of Gift and Acceptance

3.1.4.2. Adoption: The Psychological and Social

Dimensions (Psychosocial Explanation)

3.1.4.3. Adoption: A Concrete Way of Love and Solidarity

3.1. 5. Adoption and the Concept of the Best Interest of the

Child

3.2. Prenatal Adoption: Catholic Debates

3.2.1. What the Magisterium says about Prenatal

Adoption/Related Practices

3.2.2. Arguments Against Prenatal Adoption

3.2.3. Arguments for Prenatal Adoption

3.2.4. Arguments on Circumstances of Moral

Permissibility of Prenatal adoption

3.2.5. Prenatal Adoption and Cooperation with Evil

3.3. Prenatal Adoption a View from the Secular Perspective

3.4. Prenatal Adoption some Clarifications

3.4.1. Prenatal Adoption is not a Treatment for Infertility

(The Embryo is to be considered as end and never

as means to an end)

3.4.2. Prenatal Adoption is not Heterologous Artificial

Procreation/Process and Heterologous Embryo

Transfer (HET)

3.4.3. Prenatal Adoption is not Surrogate Motherhood

3.4.4. Distinction between Embryo Adoption and

Embryo Donation

3.5. Further Considerations

3.5.1. Real Risks of Prenatal Adoption

3.5.2. Arguments for Open Question and a call for Prudence

3.5.2.1. Prenatal Adoption: An Open Question

3.5.2.2. A Call for Prudence

Conclusion

General evaluation and conclusion

General Bibliography

General Introduction

This book examines the ethical dilemmas relating to the use of frozen human embryos. One major question that is consistently asked about the millions of embryos currently in the freezers is: «What to do with them?»¹. The questions about the fate of human embryos becomes really dramatic when we think about to whom we are referring as ‘them’ and the horrible condition they are facing². Regarding the fate of human embryos, the possibilities include: i) donating them for stem cell research or for treatment of disease; ii) using them as a means for treatment of infertility; iii) permitting their destruction; iv) allowing them to thaw and die; v) allowing them to continue to stay in the freezer and v.) utilizing them in a form of prenatal adoption. We will focus on the proposal for prenatal adoption. As we will see in what follows, it is only the suggestion to adopt the embryos can be considered in terms of moral permissibility because the rest are condemned³. The Nightlight Christian Adoptions is the maiden association that ventured into embryo adoption in 1997⁴. Prenatal adoption is considered by the magisterium as a proposal that is praiseworthy because it is inspired and oriented by the intention to respect and defend human life. However, this proposal according to magisterium present some problems similar to those found in the condemned practices⁵.

We will address the question set by this work firstly by critically analysing the practices of freezing and thawing of embryos. We shall study its history to know why and how it started. Immediately after this, we will address the questions regarding why and how embryos are frozen and thawed. An appriopriate knowledge of the freezing-thawing process will help us understand how long embryos can stay frozen, the success rates of freezing and thawing of embryos and the side effects of the processes on the integrity of the frozen human subject. All these will be discussed in Chapter one.

The second chapter will focus on anthropological and moral issues concerning the freezing of human embryos. In this section, we will study the biological and philosophical perspectives of the moral status of the human embryo. This will enable us to consider properly the legal positions of various countries we chose to treat in this work, with reference to issues regarding medically assisted procreation and in particular, on embryo freezing, thawing and transfer. The way the legislators of countries address the afore-mentioned matters is based on their conception of the moral status of the human embryo. Thus, the question regarding the dignity and personhood of the human embryo will be at the centre of many debates in the last part of chapter two where we will establish the moral vision of the aforesaid countries’ legal decisions on the constitutional rights of the frozen human embryo.

The third chapter goes precisely to the main issue of this book: the ethical dilemmas regarding the adoption of frozen embryos. In this part of our work, we will consider the meaning of adoption, the history of adoption, the anthropological aspect of adoption and the importance of the concept of the best interest of the child in adoption. The insight from the examination of the concept of adoption will facilitate our judgements on the various positions on prenatal adoption. We will move on to study what the Magisterium teaches with regard to prenatal adoption and other related practices. Along with this, we will look at the views of various authors on the magisterial positions. Different authors, as the present chapter reveals, offer different interpretations of the declarations of the document Dignitas personae about prenatal adoption. Some agree it is morally permissible, while others disagree⁶.

Many in the secular world prefer using the term donation to adoption when referring to the embryo because of the legal/ethical implications attached to the concepts. Donation applies to things while adoption applies to persons. Since most people deny the personhood of the human embryo, they use donation of embryo instead of adoption embryo to avoid ethical discussions. So, in most cases as this work will reveal, the secular mentality refers to the embryo more as a property than as a human being with constitutional rights.

Because of the mix-up that is often witnessed in debates in both the Catholic and secular arguments on prenatal adoption, this book will offer some clarifications highlighting the various differences between prenatal adoption and heterologous artificial procreation/IVF process and Heterologous Embryo Transfer (HET), prenatal adoption and surrogate motherhood and distinction between embryo donation and embryo adoption.

On account of the risks and circumstances surrounding prenatal adoption, some theologians and bioethicists have argued it is intrinsically immoral claiming that Dignitas personae outrightly condemns it. As a result, we will need to consider whether the Magisterium, with its declarations, has definitely closed the door to prenatal adoption or has left the door ajar, giving room for further reflections.

This book will conclude by affirming the personhood of the human embryo, thus condemning any form of procreation that separates from the conjugal union. Moreover, this section will bear our position in support of those who think that the Church has not made a definitive decision on prenatal adoption because the declarations of the Magisterium on this issue are an invitation to be prudent in approaching such a delicate matter.

Moreover, we will assert that our support for a reconsideration of prenatal adoption is not based simply on the fact that numerous embryos are currently frozen, but most importantly because of our desire to respect and protect the dignity of vulnerable human life. No life is more vulnerable than that of a frozen embryo.

Chapter I

EMBRYO FREEZING AND THAWING

Introduction

Embryo freezing is a procedure through which embryos are stored for later use. It involves a process of preserving embryos by freezing them in liquid nitrogen⁷. The process includes using hormones and medications to stimulate ovulation. The produced eggs are subsequently extracted from the ovaries for fertilization. For this to be done accurately, the doctor can use an ultrasound machine. The fertilization of the eggs can be done through in vitro fertilization (IVF), a procedure that involves exposing the eggs to sperm in the laboratory for fertilization to take place, or intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg extracted from the ovaries. After fertilization of the eggs, the embryos that are not needed immediately can be placed in the freezer and preserved for future use.

For various reasons today, the processes involved in the freezing and thawing of embryos are applied by many doctors in health sectors and health facilities for Assisted Reproductive Technologies (ARTs). Some authors acknowledge that: «Frozen–thawed embryo transfer (FET) has become an essential part of IVF/ICSI treatment, increasing the cumulative pregnancy rate (PR) after ovum retrieval. Used with elective single embryo transfer (eSET), it keeps the multiple birth rate low and minimizes overall costs of treatment»⁸. The statement above shows how the freezing and thawing of embryos for transfer has become, for some doctors, necessary processes for IVF/ICSI treatment.

Similarly, some are retained for frozen embryo transfer (FET) an assisted reproductive technology procedure which involves the thawing of a previously frozen embryo, transferring it into a uterus hoping to have a baby. Frozen embryos are those embryos which are not used for IVF cycles. The doctors usually consults with the genetic parents and decide whether to freeze or cryopreserve quality embryos which may be thawed and transferred later when they are needed. Scientists maintain that not every IVF cycle produces quality embryos that can be frozen. The freezing of human embryos can be carried in the following developmental stages: «Zygotes, cleaved embryos (day 3 embryos, will be referred to as D3 embryos) or blastocysts»⁹.

In this chapter, we will consider the essential elements in the history of cryopreservation in order to be better acquainted with its evolution. The present chapter will also highlight the reasons behind the practice of cryopreservation/thawing of human embryos. It will further investigate the procedures of freezing and thawing of embryos, showing why the new techniques are preferred to the ones that were previously in use. Also in this chapter, we will look at issues concerning how long embryos can stay frozen noting that since freezing of embryos commenced in the 1980’s, the oldest frozen embryos are no older than about 40 years. Furthermore, matters relating to the success rates of the cryopreservation of embryos will be considered to allow us to make an evaluation of the risks of freezing and thawing processes, thus, underlining their implications to the life and integrity of the human embryo.

1.1. History of Cryopreservation Technology

The origins of the science of cryobiology, go back as far as 2500 BC; the era in which cold was first applied to medicinal issues. But the process of cryopreservation of cells is recent and can be traced to the middle of the 20th century. A brief historical outline of cryopreservation reveals that at the initial stage, cryopreservation processes did not give the desired results because the simple cooling techniques damaged rather than preserved the cells. There was often the occurrence of intracellular ice formation. In the 1940s studies revealed that glycerol could prevent sperm damage during cryopreservation and thawing. The first human birth from frozen sperm was reported in 1953¹⁰.

S. D. Howell reports that «fertility experts have been able to create human embryos outside the body since the 1970s»¹¹. In the 1970s other cryoprotectants such as propanediol, ethylene glycol (EG), and dimethyl sulfoxide (DMSO) were identified and found to minimize cellular damage. In addition, slow-freeze techniques using programmable freezers were developed to allow freezing to occur at a rate slow enough rate to permit sufficient cellular dehydration to minimize intracellular ice formation. Consequently, cryopreservation was introduced «as a standard method offered by virtually every full-service IVF program world-wide»¹². Certainly, history confirms that in 1978, Louise Brown, the test tube baby, and the first procreation in vitro was born in England¹³.

The process of freezing embryos started around the 1980’s, so it is