Non-Existence and its Relevance for Medical Ethics and Genetic Technology 

D. GARETH JONES

Department of Anatomy 
University of Otago 
Dunedin, New Zealand 

From: Perspectives on Science and Christian Faith 43 (June 1991): 75-81.
 

The significance of non-existence is explored by reference to a hypothetical family, and in particular to the circumstances surrounding the births of the third and fourth children. From this, various issues are raised, including our moral and theological obligations to non-existent beings, the ramifications of the notion that children are "gifts of God," the role of human responsibility in bringing human beings into existence, and the moral and theological significance of fertilization. Against this background, the discussion is widened to consider the moral responsibilities of a family in which the gene for cystic fibrosis is being passed on to the children. This leads to discussion of induced abortion for genetic reasons, embryo biopsy and in vitro abortion, and gene therapy. 

Non-Existence 

I want to begin with a couple whom I shall call John and Jean. We pick up their story in 1970. By this time their first two children had been born. Up until the mid-1970s John and Jean were still not convinced their family should be extended beyond two children. After all, most of their friends and contemporaries had just two children, and they had already passed the stage of even questioning that decision. John and Jean finally decided to have a third child. A few years later they had a fourth child.  

And so, today, John and Jean have four children - three teenagers, and one a little younger. The first two children, James and Susan, were always contemplated. What though about numbers three and four, Clive and Sandra? They exist today because John and Jean changed their minds about having them.  

Clive and Sandra are unique individuals, both biologically and in God's sight. Very easily, though, they may not have existed - not because of any obvious rebellion or sinfulness on the part of John and Jean, but because of a sincerely held viewpoint. Clive and Sandra almost didn't make it. If they hadn't, they would never have risen beyond the realm of hypothetical beings, with no more substance to their existence than occasional wistful longings on the part of either John or Jean.  

Clive and Sandra bring us face-to-face with a mystery. It is a philosophical and theological mystery, and perhaps in some ways a biological mystery as well. This is the control of fertilization, which is frequently depicted as the absolute dividing line between the absence of an individual and the appearance of a new individual. Consequently, many Christians place a great deal of moral weight on this process. The emphasis is almost always on the moral significance of interrupting the development of an embryo or fetus after the occurrence of fertilization. If this is done, there will be no individual in the future, whether this is due to induced abortion, spontaneous abortion, or some accident during prenatal life. However, exactly the same result is obtained by a decision on the part of the would-be parents against conceiving any future individuals. In this case, fertilization itself has been obviated. 
 In order to explore this further, let us put back the clock to a time when only James and Susan had been born, and let us imagine some alternative scenarios. In the first of these, "Clive" and "Sandra" were conceived, existed for a matter of three or four days as embryos, but then failed to implant in the wall of the uterus. Indeed, Jean may never have been aware that they even existed for that short period of time, and would have been disappointed had she known. According to a second scenario, we can suppose that John and Jean did not want any more children, and to this end Jean was using an intrauterine contraceptive device. By this means, any embryos that might have been produced would have been prevented from implanting.  

A third possibility would have seen John and Jean employing an oral contraceptive, thereby preventing fertilization from occurring. Although John and Jean were quite capable of producing embryos, and of giving rise to a Clive and a Sandra, they decided against this. There is a fourth alternative, according to which John and Jean could have employed a "natural" form of contraception, and thereby once again avoided fertilization. A Clive and a Sandra would not have been given existence, although in this instance no artificial methods of contraception would have been resorted to. Precisely the same result would have been obtained by ceasing to have intercourse, or by either partner being sterilized.  

These scenarios all have the same end-result, and yet they enshrine a range of differences - in motives, in the use or otherwise of contraceptives, in the adoption of natural or artificial forms of contraception, and in the occurrence or non-occurrence of fertilization. Beings whom we now call Clive and Sandra would have been prevented from coming into existence, and would never have become one-with-us in experiencing what "being human" means. Can we conclude from these scenarios that John and Jean would have been morally culpable in those instances in which they decided against conceiving (regardless of the manner in which they accomplished this)? The answer would appear to be "no," unless it is contended that we have moral obligations to non-existent beings.  

But do we have theological obligations to non-existent beings? Does God expect married couples to "bring forth" children, and if so, is there any limit to the number of children? Is it more spiritual to conceive ten children than four, or four than two, or two than one, or one than none? Unless one believes that the primary purpose of marriage is the production of children, it is again difficult to understand how Christian couples can have theological obligations to non-existent children. If it is argued that one does have such obligations, it would appear to follow that contraception (whether natural or artificial) is contrary to the purposes of God, with natural forms of contraception being just as objectionable as artificial ones.  

I wish to argue that the number of children conceived is not a simple matter of morality or theology. It is the result of a complex interplay of biology, culture, economics, and peer pressure. If this is the case, in what sense are we (John and Jean in our story) responsible before God for bringing other humans into existence? In what way are Clive and Sandra "gifts of God," rather than the products of human determination?  

In attempting to answer these questions, we find ourselves once more face-to-face with profundity. Christians should approach fertilization in a spirit of awe and reverent wonder, since it is no less than the supreme creative act with which we, as humans, can be associated. We are doubly responsible: first, for bringing into existence new lives, and second, for guiding and directing those children throughout their growing stages until they can assume responsibility themselves for responding to God. As Christians, we view this form of creation as something we do in conjunction with God; we are creating beings who are the icons (or images) of God,¹ in precisely the same way as we ourselves are.  

Clive and Sandra, therefore, are "gifts of God." They are God-like beings, regardless of the manner of their fertilization. They would also have been gifts of God if they had been conceived outside marriage, by AID (artificial insemination by donor), by IVF (in vitro fertilization) or by GIFT (gamete intra-fallopian transfer), or if genetic manipulation had been involved. Whatever we may think of the morality of any or all these procedures, the resulting children are to be treated as we should treat any icon of God.  

But does this mean that, if Clive and Sandra had not been given human expression, John and Jean would have been guilty of rejecting a gift of God (since they would have overridden their biological ability of conceiving)? If it does, most married couples are guilty of that, since at some point and in some way, they have not had as many children as they were capable of having. And what about single women? If we approach their ability to conceive only in biological terms, we shall end up with a moral perspective far removed from any Christian one. The reason we do not move in this direction is that we view child-bearing not simply in biological terms, but within the much broader context of marriage and, therefore, of moral and social obligations.

To emphasize the ability of a married couple to conceive 
at the expense of making responsible decisions, 
is to demean God's gift, just as it is to have a child 
outside the marriage relationship.

The "gift of God" concept does not follow from physiological capabilities alone. It is to be viewed within a framework provided by moral principles (is it within the context of marriage?), human decision (do we want a child? is it responsible in our circumstances?), and physiological capabilities (are we capable of having a child?). Together, these three components comprise God's gift of a child. To emphasize one at the expense of the others is to have a misconstrued view of what God's gift amounts to. In other words, to emphasize the ability of a married couple to conceive at the expense of making responsible decisions, is to demean God's gift, just as it is to have a child outside the marriage (commitment) relationship. The decision to have no children at all within a marriage, in spite of an ability to have them, also has to be looked at very closely, for it too may demean God's gift.  

If, then, human decision-making is of crucial importance in conceiving, it has to be accepted that the bringing into existence of children like Clive and Sandra is a legitimate function of human beings. We are co-creators with God in the creation of human life (as well as of other life), and there is no escape from the consequences of such decisions.

  We are co-creators with God in the creation 
of human life (as well as of other life), 
and there is no escape from the consequences of such decisions.

And so to return to my starting point. Non-existence is something we have to accept. We may not understand it: after all, can I imagine what my own non-existence would have been like? What if my parents had quite deliberately decided not to conceive me, or had been unable to do so? Some have to ask what would have happened if their parents, in an irresponsible fling, had conceived them out-of-wedlock? Others are confronted with the knowledge that their existence stems from gamete donation. How do we cope with the knowledge that we ourselves derive from an activity which we may find morally unacceptable or even morally repugnant?  

Somehow, we have to come to terms with the idea that our own non-existence is a non-question. I can only say that God had purposes for me, and that is why I was conceived, and why two humans "decided" to have me. And here I am as one of God's people (someone who has been created individually by God), with all the possibilities of enjoying God and of extending his kingdom on earth. One can only conclude that God does not have purposes for the unconceived, nor even for the might-have-been-conceived. Or, to use different terminology, he does not have a specific intention² for the unconceived. If this is the case, his intention is not thwarted by the use of contraceptives or simply by a human decision to refrain from having a child (or further children). 

But what of fertilization itself? What of all those embryos that were conceived, but existed for a few days or for a week or two, before being unintentionally discarded? They never had the opportunity of reflecting as I have done. They were never even recognized as icons of God. Indeed, they were almost as non-existent as if they had never been conceived. Did God have a specific intention for such as these, and was this thwarted by the spontaneous abortion?  

Some argue that God's general intention becomes specific at fertilization, since the prospect of a specific embryo developing into a person is much higher than that a specific sperm or even a specific ovum will contribute to a person. This is true, and yet there is only a 50% chance that a specific embryo will develop into a fully-developed person. Not only this, but very early embryonic tissue gives rise to the placenta as well as to an individual person of the future, while the mother does not perceive the early embryo as an individual. It is possible to argue, therefore, that the embryo up to approximately 12 days or so of gestation is part-and-parcel of God's general intention rather than his specific intention. In view of this, it is possible to assert the following. 

What of all those embryos that were conceived, 
but existed for a few days before being unintentionally discarded? ... 
Did God have a specific intention for such as these?

There is only limited theological distinction between the two groups, those which were never fertilized and those which experienced no more than a "milli-second" of an existence.³ I freely admit that I cannot be sure about this, and I am only too aware that some of my Christian friends draw a distinction and censure me for not doing so as ¨definitively as they would like. However, perhaps surprisingly, my deep sense of humans as the icons of God precludes me from doing so. In what sense are embryos lost early in development any more a Clive and a Sandra, than a sperm and an ovum which could have united to become a Clive and a Sandra, but which didn't? Either way, Clive and Sandra did not eventuate; they didn't even develop far enough for the mother to experience their presence. They were never one of us; they never became (or even nearly became) one of John's and Jean's family. Their lives as human beings hardly started. I am not arguing there is no difference at all between the two groups, but that we can be in danger of making the differences much larger than they actually are. 

It is possible to argue, therefore, 
that the embryo up to approximately 12 days or so of gestation 
is part-and-parcel of God's general intention rather than his specific intention.

I am also suggesting that, when discussing God's purposes for individuals, we distinguish between retrospective and prospective arguments.⁴ We can be categorical in saying that God has purposes for both Clive and Sandra in our story. As we look back at their lives we can say that God has been with them from the time of their fertilization, and that he even had purposes for them prior to that.⁵ This is the retrospective certainty that applies to all God's people. We cannot, though, say anything about God's purposes for an ovum that failed to be fertilized by a particular sperm (or by any one of millions of sperms). Neither can we say anything about his purposes for an embryo aborted early on in its existence. We may regret that such an embryo failed to develop further (and the loss may be grieved), but to argue prospectively that God had purposes for that embryo, and that these purposes have now been thwarted,⁶ is to assume an unnerving level of theological omniscience. Ethically, we need to be careful about what we do and do not approve even very early on in embryonic development, but we also need to be careful about the theological rationale we use to back-up our ethical perspective.  

A final thought concerns the distinction between the replaceable and the irreplaceable. Clive and Sandra are irreplaceable individuals. They have been with us and we have known them; we have felt and seen them growing and developing, and coming to occupy a place in the human community (within the family, neighbourhood, church and school). Their interrelationships with us affect us and we are changed as a result of them. This is true to a lesser extent when children die at a very young age; it is also true to a limited degree of late spontaneous abortions, and sometimes it may even be true of early abortions. It is not true in anything like the same way of very early natural abortions (within the first two to three weeks of gestation), and it is not true at all of any occurrence prior to fertilization.  

In other words, the younger a fetus/embryo is when it dies, the more it is capable of being replaced by a different individual. This may mean that, in practical terms, many people regard the young fetus/embryo as having fewer of the definitive features of an individual than do older fetuses and children. In these terms, the borderline between replaceability and irreplaceability is not at fertilization. It is later; how much later probably depends on numerous factors. I would suggest, however, that these owe more to biological than to theological considerations. 

Genetic Manipulation 

Against this background, we are in a position to consider some of the possibilities opened up by genetics. Let us once again imagine a couple. We shall call this more modern couple Shane and Sarah. In their first pregnancy there were reasons to be concerned that the fetus may have cystic fibrosis. At 16 weeks an amniocentesis was carried out, and a small amount of amniotic fluid was removed so that some fetal cells could be tested using a recombinant DNA-based gene probe for cystic fibrosis. They knew beforehand that, if this turned out to be positive, they had a choice to make - either continue with the pregnancy knowing that the child would be afflicted with this debilitating and distressing condition, or have an abortion. If their pregnancy had occurred more recently, this testing could have been carried out at 8 weeks, with a chorionic villus biopsy. The choice, however, would have been exactly the same, and probably the chance of a spontaneous abortion would have been higher. 

They knew beforehand that they had a choice to make
 - either continue with the pregnancy knowing that the child 
would be afflicted with this debilitating and distressing condition, 
or have an abortion.

How were they to act in terms of the earlier discussion? It is obvious that their choice had to be made at a much later time than anything I have considered. This may or may not be important, but there can be no doubt that we are dealing with a being who has existed for much more than a millisecond. We are dealing with a being of whom the mother, Sarah, is very much aware, especially when amniocentesis is used. From what I have argued previously it is appropriate that Shane and Sarah accept that they have a serious ethical decision to make. There is no escaping from it, and they should not wish to do so as those who have been created in the image of God. Of course, it may be queried whether this sort of decision is one that human beings should be allowed to make. After all, it involves the destruction of a human life, although the emphasis we place on the value of this life will depend on numerous ethical considerations.  

Is this word "destruction" an appropriate one? 
After all, the fetus is aware of nothing at a conscious level ... 
and if an abortion is carried out, that existence will have hardly started.

But is this word "destruction" an appropriate one? After all, the fetus is aware of nothing at a conscious level (due to the relative immaturity of the cerebral cortex even up to 20 weeks gestation), and if an abortion is carried out, that existence will have hardly started. Is there then any ethical difference between the non-existence discussed above, and the non-existence in this case, that is, the destruction of an 8-9 week or a 16-19 week fetus? For most people the answer is definitely "yes," since the existence of a "recognizable" human form and a (potential) human person has been brought to an end.  

Beyond this, there is an additional point that has to be taken into account in reaching a decision, and this concerns the good of the fetus-future child. The medical condition may be so severe that non-existence may be considered to be in the best interest of the child. I believe this is a serious argument in some very extreme cases. However, for the sake of our story, let us assume that Shane and Sarah decide not to abort, although the test for cystic fibrosis is positive. As a result, Catherine is born. 

 If we now move a little into the future, we pick up Shane and Sarah hoping to have another child. Understandably, they are worried about the prospects of another child with cystic fibrosis. On this occasion they are informed that the embryo itself can be genetically tested before it has a chance to implant in the uterus. This is the technique of embryo biopsy. They are told that fertilization will have to take place by in vitro fertilization (IVF), and that one cell will be removed from an early embryo, and will then be tested with the same genetic kit used previously. If this shows that the embryo does not have any indication of cystic fibrosis it will be implanted in Sarah's uterus in the normal way. If it tests positive for cystic fibrosis, it will be discarded and the same procedure will be carried out on a second embryo. This will be repeated until a negative result is obtained. 

This process of discarding afflicted embryos is 
sometimes called in vitro abortion. 
Is this an ethically acceptable decision to make?

What are the two members of our couple to think of this? What are they doing? This process of discarding afflicted embryos is sometimes called in vitro abortion. Is this an ethically acceptable decision to make? Are they taking human life, and therefore in some way sacrificing human life, or are they making the same sort of decisions about non-existence as encountered previously with contraception? How does a preimplantation embryo in the laboratory compare with a preimplantation embryo in a woman's body?  

In terms of the decision facing Shane and Sarah, they either knowingly go ahead using an embryo with a known defect that will result in a child suffering from a serious medical condition, or they decide that that embryo should be allowed to develop no further and they proceed with an embryo that, as far as this particular gene is concerned, is healthy. What is the nature of this choice? Is it choosing between two human beings, as one would choose between two children, or is it the choice between two kinds of potential? I would suggest that it is the latter, and that in Christian terms there is no overriding reason why one should implant a defective embryo. Indeed, I would put it much stronger than this, and suggest that it would be foolhardy and irresponsible to bring such a child into the world knowing that it will be afflicted with a serious ailment. Perhaps it would amount to a form of genetic predestination, since it is known that this three-cell embryo (one cell was removed for the genetic analysis) will give rise to a child with a specific, lethal ailment.  

Of course, there are many arguments about whether a couple, such as Shane and Sarah, should opt for IVF under these circumstances, the dangers of quality control in this type of procedure, and the push towards allowing into the world only the healthy with the repercussions this could have for our treatment of the unhealthy. I think these are important points, and under no circumstances should a couple (or society for that matter) go unheedingly or even quickly in this type of direction. However, if this procedure is made available, Christians have to work out substantial theological and rational arguments either for or against it. I am not convinced that theologically convincing arguments exist against it at present; implicit within such arguments would be the lack of any moral distinction between the fate of a three-cell embryo carrying the gene for cystic fibrosis and of a child suffering from cystic fibrosis.  

There is just one final scenario for Shane and Sarah, a scenario that pushes them yet further into the future. This time they are again advised to use IVF, but the emphasis on this occasion will be on testing the embryos with the intention of correcting any genetic defect that may be found. Hence, there will be no question of an in vitro abortion; instead, if the first embryo tested is positive for the cystic fibrosis gene, that gene will be replaced or will be overridden in some way by inserting some other gene. This is the realm of gene therapy. 

What is the nature of this choice? 
Is it choosing between two human beings, 
as one would choose between two children, 
or is it the choice between two kinds of potential?

In practical terms it has to be admitted that gene therapy would be far more difficult and far more costly than refraining from implanting defective embryos. That, however, is not relevant in the present context. If gene therapy were feasible, what objections could there be to it? It appears to be an extremely sophisticated means of overcoming a deficiency. The problem is that it would also affect subsequent generations if done at this stage, so that its effects would not be confined to this one embryo. This far-reaching perspective is daunting, and takes medicine out of its accepted domain. Quite apart from this, it is difficult to see why one would want to go to these lengths when the option is the far simpler one of choosing to implant an embryo shown to be free from the particular genetic defect.  

And so our couple has made their choices. They have two children -Catherine who has cystic fibrosis, and Rebecca who hasn't. Rebecca was the result of implanting a healthy embryo following gene testing. Two embryos were discarded prior to this. Should they have any theological qualms? They could have avoided the birth of Catherine, who is now 13, is far from well and has a poor life expectancy. That would have meant a late abortion. Two non-existent beings could have existed, but did not. If they had existed they would have had cystic fibrosis. Rebecca is a delight. Both children are icons of God, and both are deeply loved and cared for. In a different age, and with different medical technology, the situation would be very different, but that is not something which either of our couples, or even we, are responsible for. 
 
Conclusions 

The thrust of this article has been that we repeatedly make decisions about existence and non-existence, and most of us accept that this is an integral part of responsible human (and Christian) decision-making. And that is as it should be, since such decisions are part-and-parcel of our responsibility as those who are co-creators with God. It should not surprise us, therefore, when we are confronted with comparable decisions shortly after fertilization. These decisions do not allow us to do anything we like with early embryos (we have to make ethical decisions and we have to demonstrate our commitment as faithful servants of God), and we may decide to protect them under every possible circumstance. Nevertheless, there are decisions to be made, and my argument is that these decisions have more in common with decisions that are made prior to fertilization than has traditionally been thought.  

More specifically, within the context of genetic technology, non-existence is a concept with which we should be grappling as we aim to come to terms with the burgeoning facets of the genetic debate. This form of technology confronts us with new decisions, and yet they have far more in common with conventional decisions than is generally realized. A major obstacle stems from our lack of analysis of the nature of our day-to-day decision-making in the reproductive area, the result being that we are unprepared for the very precise decision-making now being demanded of us. This is a challenge to our theology, as much as it is to our ethics and science. 

©

Notes
 

¹N. Wolterstorff, "The wounds of God," The Reformed Journal, 37: 14-22 (1987). 
²Robert N. Wennberg, Life in the Balance (Eerdmans, Grand Rapids, 1985), pp. 106-115. 
³Although my argument is not the same as that used by Donald MacKay a few years ago, there are similarities. See his argument in "The beginnings of personal life," In the Service of Medicine, 30(2): 9-13 (1984). 
⁴This point was touched on by Duncan Vere in his article, "When is a person?," Journal of the Christian Medical Fellowship, 34 (3): 18-23 (1988). 
⁵See the discussion in my book: Manufacturing Humans (Inter-Varsity Press, Leicester, 1987), pp. 125-128. 
⁶For example, Martin A.K. Allaby, "When is a person?; reply to Duncan Vere's article," Journal of the Christian Medical Fellowship, 35 (1): 27 (1989).