Christian Bioethics, 21(2), 135143 2015

doi:10.1093/cb/cbv007

Advance Access publication June 5, 2015

Bioethics and the Family: Family Building in

the Twenty-First Century
ANA S.ILTIS*
Wake Forest University, Winston-Salem, North Carolina, USA

MARK J.CHERRY
St. Edwards University, Austin, Texas, USA

Rapid developments in reproductive technologies and shifts away from

traditional religious commitments have led to significant changes in how
marriage and the family are understood. Family building in the twentyfirst century has become ever more post-modern: morality as it applies to
family life has been fully deflated into various and diverse lifestyle choices.
For many, Christian moral teachings regarding sex, reproduction, and
marriage appear old fashioned and unenlightened. Such norms prudishly prevent persons from engaging in sexual relations, marriages, and
divorces, as well as manipulating nature in ways that each finds pleasurable or otherwise individually fulfilling. Indeed, progressive activists
have long endeavored to redefine the family, so that it would cease to be
thought of as created through the monogamous and life-long bond of the
marriage of husband and wife. The hope has been to bring other living
arrangements, such as same sex partnerships and single motherhood,
as well as artificial reproduction techniques and abortion, fully into the
social mainstream. From homosexual marriage, to commercial surrogacy, preimplantation genetic diagnosis, in vitro fertilization and abortion, each author in this number of Christian Bioethics, diagnoses the
growing cleft between the Traditionally Christian and modern society.
Keywords: artificial reproduction technology, Christianity, family,
homosexual marriage
If there is one thing of which modern man is utterly convinced, it is that he has
reached a state of sexual enlightenment. Gone forever are the days of unhealthy concealment, of absurd Victorian taboos that led to the application of cruel and cumbersome devices to children to prevent masturbation, to prudish circumlocutions about
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*Address correspondence to: Ana S.Iltis, PhD, Professor, Department of

Philosophy, and Center for Bioethics, Health, and Society, Wake Forest University,
P.O. Box 7806, Winston-Salem, NC 27109, USA. E-mail: iltisas@wfu.edu.

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sexual matters, to the covering of piano legs to preserve the purity of the thoughts
of men in the drawing room.for the first time in history we can now enjoy sexual
relations without any of the unnecessary social and psychological accretions of the
past that so complicated and diminished life. No more guilt, shame, jealousy, anxiety,
frustration, hypocrisy, and confusion[Yet] evidence of sexual chaos is everywhere.
(Dalrymple, 2005, 2345)

2384. Divorce is a grave offense against the natural law. It claims to break the
contract, to which the spouses freely consented, to live with each other till death.
Divorce does injury to the covenant of salvation, of which sacramental marriage is
the sign. Contracting a new union, even if it is recognized by civil law, adds to the
gravity of the rupture: the remarried spouse is then in a situation of public and permanent adultery (Catechism of the Catholic Church, 1993).

Despite this official doctrine, many Roman Catholics divorce and remarry.
According to Center for Applied Research in the Apostolate at Georgetown
University, among adult Roman Catholics, some 28 percent of those who
have ever married have divorced at some point (Gray, 2013). This situation
has left some wondering whether the Roman Catholic Church should revisit
its beliefs and practices, updating its moral theology once again for the modern world (Paulson, 2015).

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Rapid developments in reproductive technologies as well as shifts away from

traditional religious commitments, particularly in developed nations, have led
to significant changes in how marriage and the family are understood. Family
building in the twenty-first century has become ever more postmodern: morality
as it applies to family life has been fully deflated into various and diverse lifestyle choices. Traditional Christian norms regarding definitions of the family and
mechanisms for building and dissolving families have been rejected by secular
society as well as by many who self-identify as Christians. For many, Christian
moral teachings regarding copulation, reproduction, and marriage appear as
old-fashioned, unenlightened, and simply beside the point. Such norms prudishly prevent persons from engaging in sexual relations, marriages, divorces,
and remarriages, as well as manipulating nature in ways that each finds pleasurable or otherwise individually fulfilling. In this issue of Christian Bioethics, the
authors critically examine these shifts from various Christian perspectives.
Consider some of the sweeping changes in how many people have come
to understand the building and dissolving of families, changes that reflect a
radical turn away from the Traditionally Christian. Widespread divorce and
remarriage in the West in recent decades has led to blended families and
significant numbers of people related to each other as step relatives or
half-siblings. These practices have become common even within religious
communities that do not recognize divorce and remarriage. For example,
the Roman Catholic Church officially regards remarriage after divorce as a
form of adultery if there has not been an annulment (although this has been
brought into question by the discussions at the Synod on the Family, October
519,2014):

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The number of children born outside of marriage in the United States

exceeds 40 percent, and among African Americans the rate is close to 71
percent (Centers for Disease Control and Prevention, 2015, see Table B and
Table15). Children born out of wedlock once were marginalized, as were
their mothers, yet today such children make up a majority of the youth in
some communities. Given the correlation of being born out of wedlock and
raised in a single-parent household to poverty (Rector, 2010), as well as to
emotional, social, and psychological challenges (Gallagher and Waite, 2000),
such children begin life at a significant disadvantage.

Many western European nations have comparably high rates of out-of-wedlock births, with Sweden, Norway, and Iceland approaching or exceeding 60
percent (OECD Social Policy Division, 2011, chart sf2.4.A). Even where the
parents are a couple at the time of birth and remain together, the fact that
they do not see the importance of marrying suggests radical changes in how
many people understand the family.
Adoption of children by single people and by homosexual couples has
become commonplace. Given the shift away from traditional understandings
of the family, adoption agencies have been forced to work with homosexual
couples seeking to adopt children, even when those agencies are run by religious groups, such as the Roman Catholic Church, which recognizes homosexual relationships as sinful (LaPlante, 2014). Often the only alternative these
agencies have to participating in placing children in circumstances they deem
unacceptable is to stop facilitating adoptions altogether (LaPlante, 2014).
The advent of assisted reproductive technologies (ARTs), particularly in vitro
fertilization (IVF), severed the once-necessary connection between sexual relations between one man and one woman, on the one hand, and pregnancy, on the
other. Use of donor gametes and donor embryos severed the necessary genetic
connection between a pregnant woman and the fetus she is carrying. The use of
gestational carriers similarly severed the genetic connection between the pregnant woman and the baby she is carrying. The gestational carrier is expected to
give the baby to the intended parents at birth, and many gestational carriers note
that the babies they are carrying are not theirs. One or both of the intended parents might not have a genetic connection to the baby. Laws vary by states in the
United States, and many countries have laws forbidding or regulating gestational
surrogacy. In some cases, the gestational surrogates name may never appear on
a birth certificate despite having given birth to the baby. The practice has grown

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Children raised in single-parent households are, on average, more likely to be poor,

to have health problems and psychological disorders, to commit crimes and exhibit
other conduct disorders, have somewhat poorer relationships with both family and
peers, and as adults eventually get fewer years of education and enjoy less stable marriages and lower occupational statuses than children whose parents got
and stayed married. This marriage gap in childrens well-being remains true even
after researchers control for important family characteristics, including parents race,
income, and socioeconomic status (Gallagher and Waite, 2000, 125).

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significantly in recent years, though exact statistics are not known (Lewin, 2014).
In some cases, homosexual male couples hire a surrogate and the birth certificate
lists the names of the two men as the parents. Where once commercial surrogacy
was denounced as a practice that exploited the poor and weak, in some quarters
it is now celebrated because it aids homosexual couples to exercise what are
assumed to be their basic human rights to reproductive liberty.
The use of donor gametes and gestational carriers introduces numerous
parties who have some kind of biological relationship to a child. These practices challenge the term biological mother commonly used in adoption to
refer to the woman who both was pregnant and provided the egg that led
to a baby. Awoman who gestates a baby surely is a biological mother in
some sense, even if she is only a gestational carrier. And one who gestates
a baby she intends to raise but who is not genetically related to her in some
sense is a biological mother and in some sense isnot.
Mitochondrial DNA replacement therapy, a more recent development, introduces additional parties with some claim to being biological parents. The technique involves the use of a donor egg and an egg from the woman intended
to be the genetic mother. Nuclear genetic material is taken from the genetic
mothers egg and transferred to a donor egg with healthy mitochondrial
DNA. The result is an embryo with two genetic mothers. The United Kingdom
recently passed a measure allowing the practice (United Kingdom, 2015).
Prenatal diagnosis and abortion have allowed pregnant women to choose
whether or not to give birth to babies with a wide range of conditions, from
being the wrong sex to heart disease, Downs Syndrome, and so forth.
Family building involves less chance than ever before. The expectation is
that through the use of donor gametes, preimplantation genetic diagnosis
(PGD) with IVF, and prenatal diagnosis, women can avoid giving birth to
unhealthy or defective babies. Perfect families can be built and delivered
at the time of ones choosing. Some advocates have argued for a principle of
procreative beneficence, which reflects the very secular view that there may
be important moral reasons for couples to avoid giving birth to defective
children and to select for children who are most likely to have the highest
level of well-being (Bourne, Douglas, and Savulescu, 2012).
Changes in reproductive medicine have been accompanied by the abandonment of traditional Christian understandings of marriage and the family.
Intentionally single-parent families and homosexual families have become
possible through the use of ARTs and gestational carriers, as well as through
adoption laws that disallow various types of discrimination. It is no wonder
that family-building practices occupy a prominent place in the culture wars
(Hunter, 1992; Cherry, 2011; Engelhardt, 2011; Tollefsen, 2011). Questions
about what constitutes a family, who ought to be recognized as parents,
under what circumstances one may become a parent, how children may be
conceived and gestated, and who ought to raise them are of central importance to contemporary Christians. This issue of Christian Bioethics continues
the conversation of family building in the twenty-first century.

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Mark J.Cherry contrasts the Traditional Christian conception of the family

(i.e., husband and wife, together with their own biological or adopted children), grounded in an experience of God, with recent attempts to recast the
family in more secular terms. Cherry argues, for example, that marriage as the
union of husband and wife provides for the uniquely appropriate expression
of sexual desire, and the proper union for the blessing and raising of children
(2015, 148). The marital relationship, he argues, should aim the couple and
their family towards God, towards holiness. This means, for example, that extramarital partners, such as gamete and embryo donors or gestational carriers,
are not invited into the family. Surrogate motherhood is incompatible with the
proper spiritual union of husband and wife. Nor is it permissible to eliminate
children from the family when, through prenatal diagnosis, they are found to
be imperfect. Abortion is a deeply sinful act. Marriage and family life is a serious and life-long spiritual endeavor. This concept of the family, however, has
been politically undermined as progressive advocates seek to bring other living arrangements, such as same sex partnerships, with adopted children, fully
into the social mainstream. Traditional Christian sexual morality is routinely
undermined and rhetorically turned on its head, as activists criticize Christianity
as inappropriately discriminatory and homophobic. As Cherry documents, the
goal for many activists is to recast the family through a public critical reassessment of traditional Christianity in favor of a postmodern moralethos.
Here, Cherry draws on weak thought and weak theology as an interpretive framework through which to appreciate recent shifts in progressive, often
postmodern, theology regarding the family. Without God to secure a foundation for reality and morality in being-in-itself, truth is always interpreted through
the lens of a particular sociohistorically and culturally conditioned perspective.
Proponents of weak thought, such as Gianni Vattimo and John Caputo, deny
that such a Gods eye standpoint on reality is accessible. Weak theology, as
an extension of weak thought, involves a radical toning down of theological
claims as well. As a form of postmodernism, weak theology rejects God as an
all knowing lawgiver. Moral theology is appreciated as the product of a particular time and place, and subject to reinterpretation. Moral concerns are deflated
into personal aesthetic projects or the choice of a self-pleasing lifestyle. In such
terms, for example, it becomes plausible to affirm third-party assisted reproduction, abortion, and adoption by homosexual couples, surrogate motherhood,
sexual activity outside of the marriage of husband and wife, and homosexual
unions. Moreover, weak thought and weak theology put solidarity and social
justice prior to truth and dogma. For Pope Francis, for example, this means that
one accepts adulterers and homosexuals within the church prior to underscoring the sinfulness of adulterous and homosexual acts. Of course, this itself fails
to recognize the difference between the love Christians must show to sinners
and the constraints they must impose before someone is allowed to receive
communion. Traditional Christians understand that God is the ultimate lawgiver
and judge, whereas the deflated positions espoused through weak theology
invoke various subjective standards, such as love, inclusiveness, or personal

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conscience, for judging the right, the good, and the virtuous. As a result, while
Cherry appeals to the Gods eye perspective of Orthodox Christianity to underscore rich theological foundations for the Christian family, as well as the thick
religious obligations of marriage and family life, those who live within the
postmodern implications of weak thought and weak theology conclude that no
particular account of morality or of the family can be justified.
Agneta Sutton focuses on the relationship between the use of reproductive
technologies and the commodification of children. Sutton argues that reproductive technologies that make possible reproduction without sexual intercourse have made for new kinds of family not previously envisaged, that
these are designed to satisfy adult desires and aspirations, and that they
raise social, ethical, and legal questions (Sutton, 2015, 166-167). Suttons starting point is her understanding of the dignity of each child, grounded in each
childs creation in the Imago Dei. This, she argues, makes commodification
unacceptable. Any reproductive practice that in some way treats the child as a
commodity is unacceptable. She relies on magisterial teachings of the Roman
Catholic Church and her articulation of what it means to be created in the
image and likeness of God to reject the use of donor gametes or embryos as
well as gestational carriers. In all of these cases, some type of contractual or
commercial exchange is an essential part of the reproductive process, rendering the resulting child a commodity. This, she argues, renders all uses of
reproductive technologies to facilitate reproduction by homosexual couples or
by single individuals illicit. It also makes immoral the use of donor gametes
or donor embryos by married couples. All of this is consistent with Roman
Catholic moral teachings. Sutton parts ways with the Roman Catholic Churchs
teaching on the use of certain ARTs within the context of marriage when the
husband and wife face infertility. She argues that we must judge these technologies based on whether they involve any commodification of the resulting
child or children. Consequently, in her view, husbands and wives using their
own gametes in artificial insemination or IVF may be acting morally, provided
that certain other conditions are met. The couple must ensure, for example,
that IVF does not involve the creation of extra embryos that may be discarded. The dignity of the child, Sutton argues, can be preserved when husbands and wives are assisted in using their own gametes to build their families.
The final three essays take an important turn toward organizational or institutional perspectives on family-building practices. Julie Rubio defends the Roman
Catholic teaching against the use of donor gametes to facilitate reproduction
and articulates the Roman Catholic moral theological grounds for this position.
She also introduces social science data that could be used to support the Roman
Catholic position that donor conception is to be avoided. Despite the teachings of the Roman Catholic Church and the evidence that donor conception
destabilize[s] familial relationships and cause[s] children pain, significant numbers of Roman Catholic couples turn to donor gametes to build their families
(Rubio, 2015, 186). Thus, despite the Roman Catholic teaching prohibiting the
use of donor gametes, families that include donor-conceived children are part of

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parish life. As always, illegitimate children have been embraced by the church.
It is this reality that Rubio thinks requires an institutional response to donor
conception beyond the moral theological teachings of the church that focus
on reproductive technologies. Rubio argues that the Roman Catholic Church
should draw from some of its other resources to develop an appropriate pastoral response to donor-conceived families, to infertility, and to other forms of
family formation. As an institution, she argues, the Roman Catholic Church must
make an effort proactively to think differently about infertility, to make room
for childlessness in theology and parish life, and to help couples think beyond
blood and genes (Rubio, 2015, 194). Second, the Roman Catholic Church must
acknowledge the presence of families built in diverse ways and find ways to
welcome them, including single parent, adopted, divorced, and blended families, as well as donor-conceived families (Rubio, 2015, 194). Rubio argues for
the Roman Catholic Church to continue its strong teachings regarding marriage
and sexuality while ensuring that the negative moral evaluation must be accompanied by an invitation to a recognition of the humanity that persists even when
people are trapped within sinful social structures (Rubio, 2015, 195). Rubio
does not underscore that Christ is not speaking to undermine the family, but
to relocate it in right belief and right worship aimed at God, so that the family
becomes the domestic assembly of believers, the domestic church, a point often
emphasized by St. Paul. One must relocate expressions such as the following
by Rubio: Yet, he [Jesus] challenges his hearers by calling them to hate their
families (Luke 14:26) and by asking them to leave their families behind for his
sake and their own (Mark 10:2930) (Rubio, 2015,191).
Kevin Voss (2015) examines the Lutheran Church-Missouri Synods teachings on the moral status of the human embryo, reproduction, IVF, and prenatal
genetic testing by evaluating the churchs authoritative documents. Voss also
reports survey results of clergy regarding reproductive counseling practices.
Because many parishioners facing infertility and other reproductive issues are
likely to seek guidance from their clergy, it is important to understand what
such counseling entails. Voss argues that clergy need better education in
reproductive matters to help them understand and communicate the Lutheran
Church-Missouri Synods teachings related to family building. He offers specific recommendations for education of future clergy in seminaries.
Mark Carr (2015) examines the relationship between secular society,
Seventh-day Adventist health care organizations, and reproductive technologies. Throughout his analysis, he notes a difference among what he calls three
subcultures within Adventist health care; namely, the clerical, medical, and
business subcultures. These differences, which sometimes lead to tensions, are
especially evident in the area of reproductive medicine where we see a distance between the formal position statements of the Church and the various
policies and practices of its healthcare institutions (Carr, 2015, 215). The clerical group, which maintains control of doctrine and of ecclesiastical functions
of the Church (Carr, 2015, 218), may articulate the Seventh-day Adventist
position on a medical intervention, such as a type of reproductive technology,

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Progressive activists have long endeavored to redefine the traditional family, so that it would cease to be thought of as created through the monogamous and life-long bond of the marriage of husband and wife. The hope has
been to bring other living arrangements, such as same-sex partnerships and
single motherhood, as well as artificial reproduction techniques and abortion, fully into the social mainstream, permitting individuals to achieve their
own values and goals. From homosexual marriage to commercial surrogacy,
PGD, IVF, and abortion, each author diagnoses the growing cleft between
the Traditionally Christian and modern society. Together the authors in this
issue of Christian Bioethics draw out the rapid technological and cultural
shifts in family building, laying each development bare for careful, theological exploration. How should we think of family building in the twenty-first
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