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Moral Theology — Topic 13. Bioethical Issues of the Beginning of Life.

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Moral Theology — Topic 13. Bioethical Issues of the Beginning of Life.

Given that, from the perspective of Christian morality, conception should take place between a husband and wife, and since these technologies involve the manipulation of living cells and embryos, it is necessary to formulate criteria for the moral evaluation of ART.

The only form of ART unconditionally accepted by the Church is IUI, since “it does not violate the integrity of the marital union, does not differ in principle from natural conception, and takes place within the context of the marital relationship”[1].

Currently, IVF is a fairly common method of treating infertility worldwide, with an average success rate of 47%. In addition, IVF has a number of potential side effects that spark public debate about this technology. Complications in women include: allergic reactions to hormone therapy, temporary immunosuppression due to the use of glucocorticoid medications, ovarian hyperstimulation syndrome (OHSS), the main symptoms of which may include abdominal bloating, an increase in abdominal circumference, abdominal discomfort, nausea, and loss of appetite. However, mild OHSS occurs in 3–4% of cases, and severe forms in 0.1–0.2% of cases, respectively. Some complications are associated with the egg retrieval process. These include sporadic cases of bleeding resulting from injury to blood vessels and intestinal perforation. Additionally, infectious complications in the pelvis and recurrence of previous inflammatory processes are possible. However, it is claimed that the risk of such infections is low. Finally, there are a number of risks associated with the onset of pregnancy. IVF itself usually involves the transfer of one, rarely two, embryos. Multiple pregnancies occur in approximately 25–35% of cases. If three or more embryos are transferred and implant, doctors may recommend what is known as medical reduction, which is essentially an abortion. Additionally, the miscarriage rate is slightly higher (about 30%) than in the general population (about 20%). From a moral standpoint, the most serious complication can be an ectopic (extrauterine) pregnancy, which occurs after IVF in 5% of cases. Additionally, there are consequences of IVF for children, which may include intrauterine growth restriction, birth asphyxia, and neurological changes.

People are often absolutely convinced that the Church opposes all forms of IVF. However, in reality, the Church’s position is more complex, and currently the primary document expressing its stance is “The Foundations of the Social Concept of the Russian Orthodox Church.” In it, on the one hand, the Church acknowledges the possibility of infertility treatment. On the other hand, it emphasizes that human life cannot be treated “as a product that can be chosen according to one’s own inclinations and disposed of on a par with material goods”[2].

While agreeing that procreation is one of the most important purposes of marriage, the Church affirms that “the Church cannot consider morally justified those paths to procreation that are not in accordance with the Creator’s plan for life”[3]. In this regard, the inability to conceive, which is recognized as incurable by any therapeutic or surgical means, must be accepted by the spouses with humility. In such a case, the priest may well recommend the adoption of a child, with the mutual consent of the parents.

At the same time, it cannot be said that assisted reproductive technologies are viewed by the Church as completely unacceptable. The “Fundamentals of the Social Concept of the Russian Orthodox Church” state: “From an Orthodox perspective, all forms of in vitro (extracorporeal) fertilization involving the harvesting, preservation, and intentional destruction of ‘surplus’ embryos are also morally unacceptable.” However, this implies that taking these conditions into account can make IVF morally permissible:

  1. As already mentioned, problems with the gametes of one of the spouses may arise during IVF, which may lead to the use of donor gametes. However, from a Christian perspective, conception must occur within marriage, which implies a prohibition on any procedures that could undermine its integrity. In other words, the use of any donor gametes in IVF is completely unacceptable, since only the gametes of people who are married to each other should be used. The intervention of a third party that disrupts marital unity is unacceptable. Furthermore, in this context, it is worth mentioning the possibility for a woman to give birth to a child through IVF outside of marriage, using donor material. Such actions, as they do not involve marital or family relationships, are also considered unacceptable.

  2. The creation of a large number of eggs, followed by the production of multiple embryos, is advantageous from the perspective of achieving conception. At any stage following in vitro fertilization, an embryo may prove non-viable and may die. In this regard, creating a large number of embryos allows for the selection of the most viable ones to be transferred to the uterus. However, both the creation of a large number of embryos and preimplantation genetic testing are unacceptable due to the recognition of the embryo as a human person. Any conceived embryo, as a human being, has the right to life and should not be treated as biological material. Creating a large number of embryos in advance presupposes a situation in which most of them will either be immediately reduced or frozen frozen until needed , which often means destruction, because in the event of a successful first pregnancy, the frozen embryos may simply not be needed. The Church’s position is that only as many embryos should be created as can be transferred to the uterus without freezing or reduction. It is often pointed out that during natural conception, not all embryos survive; the body similarly selects viable ones and prevents those it recognizes as diseased from developing. Although this is indeed true, the difference between natural processes and a situation deliberately created by humans is enormous. The former differs from the latter as much as an accident differs from premeditated murder. However, in a number of complex cases, freezing an embryo can be the key to its survival if, during the period between in vitro fertilization and transfer to the uterus, the mother finds herself in a situation where the transfer becomes impossible. This could involve illness or injury, complications during IVF, or other situations requiring urgent treatment, followed by embryo transfer once the situation has stabilized.

  3. A similar argument can be made regarding preimplantation genetic testing. It is performed to identify genetic defects and involves not only the decision not to give birth to an “unsuitable” child but also its destruction. In this case, this approach can unequivocally be called eugenic and is considered completely unacceptable.

  4. Due to the possibility of a multiple pregnancy, there is a risk that a woman will not be able to carry three or more children to term; consequently, the healthiest and most viable embryo is retained, while the others are recommended for reduction, which is naturally unacceptable. Thus, the transfer of one embryo—or, in rare cases, two—may be recommended, given the unacceptability of terminating the life of any of them.

  5. Given the possibilities offered by IVF, it is now possible not only to use donor cells but also to engage in what could be called “reproductive system donation”—that is, surrogacy. The essence of this technology is that a woman who is not the biological mother of the embryo carries and gives birth to it. Legally, the biological parents are considered the parents, not the woman who carried the child. However, in some cases, one of the parents may also be the genetic parent. Under Russian law, however, a woman cannot be both a surrogate and a genetic mother at the same time.

Surrogacy was first used in the United States in 1980. Elizabeth Kane became a surrogate mother, carrying a child for a married couple in which the woman was infertile. Kane received payment for carrying the child.

Surrogacy is completely banned in France, Germany, Austria, Norway, Sweden, and in some states of the United States. In some countries, non-commercial surrogacy is permitted; this is the case in the United Kingdom, Denmark, Canada, the Netherlands, and some states in Australia and the United States. In Belgium, Spain, and Finland, it is not regulated by law but does occur. In most U.S. states, as well as in South Africa, Greece, Russia, Ukraine, Georgia, Kazakhstan, Cyprus, and Colombia, commercial surrogacy is permitted.

The Church’s stance on surrogacy is clearly expressed in the “Fundamentals of the Social Doctrine.” It is viewed as something that is “unnatural and morally unacceptable even in cases where it is carried out on a non-commercial basis. This method involves the destruction of the deep emotional and spiritual bond that forms between the mother and the infant already during pregnancy.” However, the issue of surrogacy can now be considered in a different context. Embryos that remain surplus—either after a successful pregnancy or in the event of the mother’s illness or death—can be either frozen or discarded. Often, this means they are stored for a time and then disposed of. In such a case, as an alternative course of action, the embryo can be adopted at this stage and carried to term by a woman as her own child. This practice is known as embryonic adoption, from a moral standpoint, this technology could be viewed as traditional adoption, with the difference that it occurs before gestation and birth. This would foster a deeper bond between the mother and the adopted child. Currently, this issue is controversial, but it appears to be the only way to save the embryo’s life.

[1] Fundamentals of the Social Concept of the Russian Orthodox Church XII.4

[2] Ibid XII.4

[3] Ibid. XII.4

Conception and the birth of children are a natural process that God intended as a means of multiplying humanity in the world He created. At the same time, cases of infertility are already mentioned in the Old Testament, which were sometimes perceived by the people as a punishment from God (Gen 11:30, Hos 9:11,14). People might have sought to overcome it in various ways, depending on their level of knowledge and culture, or they might have submitted to God’s will, hoping that the situation would change without intervention.

Today, the causes of infertility are often diagnosed quite well and are frequently treatable. At the same time, sometimes there are no obvious causes, and they remain a mystery to the person. In this situation, those around them—including pastors—must remember that it is entirely incorrect to draw direct connections between a person’s sins and their physical or mental condition.

With advances in medicine, it has become clear that infertility is, in the vast majority of cases, associated with a disease or developmental abnormality in either the male or female body and is often successfully treatable. However, in addition to treatment aimed at eliminating the pathology leading to infertility, science has developed methods for overcoming infertility that do not involve curing the disease, but rather overcoming it. These methods are called Assisted Reproductive Technologies (ART).

Currently, ART refers to methods of achieving pregnancy in which conception occurs partially or entirely outside the woman’s body. These methods can be divided into two distinct categories:

First, there is a method involving fertilization within the woman’s body:

· Intrauterine insemination with sperm from the husband, partner, or a donor (IUI).

Second, these are methods involving in vitro manipulation of gametes or embryos:

· In vitro fertilization (IVF);

· Intracytoplasmic sperm injection (ICSI);

· In Vitro Maturation (IVM) or the maturation of oocytes outside the woman’s body. This method involves gentler hormone therapy during egg retrieval;

· Gamete donation;

· Cryopreservation of gametes, reproductive organ tissues, and embryos; transportation of gametes and/or reproductive organ tissues;

· Surrogacy.

In vitro fertilization

Despite the variety of options, IVF can effectively encompass all other procedures, so all other technologies can be examined using it as an example. In vitro fertilization is a type of ART in which conception occurs outside the woman’s body under artificially created conditions, otherwise known as “in vitro” or “in a test tube.” The “in vitro” technology itself has been under development in the United States since 1944. The first successful in vitro fertilization was performed in England by embryologist R. Edwards in 1977.

IVF is considered one of the most common technologies for treating both male and female infertility. In Russia, IVF is covered by the Mandatory Health Insurance (OMI) system and is performed in cases of infertility that cannot be treated with traditional therapy, or in situations where IVF is assessed in advance as a more effective method than any other. At the same time, as a paid service, IVF can be used for any form of infertility, provided there are no contraindications. Possible contraindications are related solely to the female body and are limited to conditions that are contraindications for pregnancy and childbirth.

The IVF procedure involves the following steps:

- hormonal stimulation of the ovaries to obtain multiple eggs. If eggs cannot be obtained, secular law permits the use of donor eggs. In this case, the donor may provide eggs either altruistically or for a fee;

- puncture of the ovarian follicles to retrieve the eggs and place them in a culture medium;

- collection of sperm, either through masturbation, or via coitus interruptus using a medical condom, or (if the previous methods are not feasible) through surgical intervention. As with eggs, secular law permits the use of donor gametes;

- in vitro fertilization, which can be performed in two ways

— In vitro insemination, in which sperm are added to eggs that are in a culture medium. Fertilization occurs within 2–3 hours.

— intracytoplasmic sperm injection (ICSI), in which a sperm is injected into the egg using special instruments. ICSI is a form of IVF and is performed when indicated due to poor sperm quality;

- Incubation for 48–120 hours. During this time, the number of cells in the embryo increases significantly;

- preimplantation genetic testing to identify viable embryos and screen for genetic disorders;

- Selection of viable embryos for transfer to the uterus;

- Transfer of the embryo to the uterus 2–5 days after fertilization; if transfer to the biological mother’s uterus is not possible, civil law permits the use of a surrogate mother. Currently, the law recommends transferring no more than four embryos to prevent a multiple pregnancy. In practice, however, two are usually transferred.

- Determination of which embryos have implanted and possible reduction (termination) of surplus embryos;

  • Since there are often more than two embryos, viable embryos that are not transferred are frozen (cryopreserved) and stored at a temperature of-196°C. Upon thawing, they can be reused for transfer into the uterus to achieve pregnancy.

For the authors of Scripture, human conception was a mystery in which God and humanity worked together. On the one hand, birth was the fulfillment of a commandment given even in the Garden of Eden, in which the God-like capacity for creation was manifested. On the other hand, birth was often understood as a gift from the Creator. For example, after the birth of Cain, Eve says, “I have acquired a man from the Lord” (Gen. 4:1). In the story of Rachel and Leah, the idea is expressed that it is God who gives—“opens the womb” (Gen 29:31) or “withholds the fruit of the womb” (Gen 30:2). Children themselves are called by David “a reward from the Lord” (Ps 126:3).

Despite the promise, “I will greatly increase your pain in childbirth; in pain you will bring forth children” (Gen. 3:16), God is perceived as the One who sustains the child during its development. He not only sees the child: “My frame was not hidden from You when I was made in secret, when I was woven together in the depths of the womb. Your eyes saw my unformed body…” (Ps 138:15,16), but also cares for its development: “Is it not He [God] who formed me in the womb who also formed him [another person] and fashioned us both in the womb?” (Job 31:15). At the same time, the people of the Bible knew very well that both external and internal factors could influence the course of a pregnancy. For example, it was evident that if fighting men struck a woman, a miscarriage could occur (Exod 21:22). Furthermore, Scripture mentions people suffering from defects even during prenatal development: the man born blind (John 9:1–3) and the man lame “from his mother’s womb” (Acts 3:2). Such things were viewed as part of the general affliction of all creation, which “groans and suffers together” (Rom. 8:22).

It has always been clear to Christian theologians that even before birth, a child is capable of perceiving what is happening outside the womb. First and foremost, of course, the story of John the Baptist was cited as evidence of this, who “leaped for joy” in the womb of his mother Elizabeth when she greeted Mary (Luke 1:13–15, 41–44). Such activity of the infant in the womb has always been understood as a conscious process, indicating that we are dealing with a developing person. In his Epistle to the Galatians, the Apostle Paul writes that God chose him even while he was in his mother’s womb and called him by His grace (Gal 1:15).

In the context of determining the status of an unborn person, the law from the Book of Exodus is often discussed: “If two men quarrel and strike a pregnant woman, and her child comes out unformed (μὴ ἐξεικονισμένον—having no form)—he shall pay a fine: whatever the woman’s husband imposes, he shall pay in the presence of the judges.
But if it is formed (ἐξεικονισμένον—having form)—he shall give life for life” (Ex 21:22–23)[1]. Commenting on this text, some authors have emphasized that it allows us to speak of a change in the embryo’s status and even, as it were, its gradual animation. However, St. Basil the Great, prohibiting abortion in his second rule, explicitly emphasizes: “We do not conduct a precise investigation into whether the fetus has been formed or not”[2]. The point is that gametes—that is, parental sex cells, from the moment of their formation until the moment of fertilization, are living cells, that is, cells that are already animated, since the living is animated. This means that there is no specific moment at which life in the cells ceases, only to begin again later through the action of grace. God does not restart the life of cells at any point in time. On the contrary, in a biological sense, cells are always alive, but at the moment of fertilization they cease to be themselves and unite in such a way that the new unity is not merely the sum of the old parts, but a new, unique personality, which God, in cooperation with humans, brings forth from non-existence. He imparts a rational soul, whereas the animal and vegetative souls are transmitted from the parents, as St. Theophan the Recluse explicitly writes: “Souls are derived from the parents or instilled through natural birth, but the spirit is breathed in by God, Who is everywhere”[3]. Thus, the knowledge that cells are alive and that the DNA of a new person is unique helps us to see this cooperation in action.

[1] In the Masoretic text, the wording of the law is less detailed: “If men are fighting and strike a pregnant woman, causing her to miscarry, but no other harm is done, then a fine shall be imposed on the guilty party, as determined by the woman’s husband, and he must pay it through mediators…”

[2] Basil of Caesarea,****Epistle 188, Canon 2

[3] Theophan the Recluse, St. Collected Letters: in 8 vols. Vol. 1. Moscow: I. Efimov’s Type-Lithography, 1898. Letter 106. P. 98.

Modern researchers know much more about conception. The process of gametes uniting to form a zygote is fairly well understood. At the same time, for believers, the biological basis of all these processes and the certainty that God participates in them through His will and gracious help are not contradictory. Modern research on embryonic pedagogy—which suggests that a child begins to behave like a child, and indeed like a human being, very early on, when it becomes evident that they can yawn, smile, explore their hands, and hear sounds as early as 18 weeks—fits perfectly within religious logic.

The embryonic periods of development are distinguished.

The first week is called the embryonic stage. The very process of the union of two sex cells, each possessing 23 chromosomes, into a single cell—the zygote, which possesses 46 chromosomes—can be charted literally hour by hour.

In terms of time, this process consists of the following stages:

- 30 minutes to 3 hours for the sperm to reach the site of fertilization;

- 7 to 10 hours for the sperm that have entered the reproductive tract to fully mature and acquire the ability to dissolve the outer wall of the egg. This process is called capacitation.

- 12 hours for penetration into the egg;

˜ 6 to 12 hours for the formation of the male and female pronuclei. This process can already be called the beginning of syngamy, i.e., fusion.

Thus, 18 to 24 hours elapse between sexual intercourse and the onset of syncytiogenesis. This process, in turn, is completed within 24 to 30 hours. At this point, fertilization is considered complete, as the diploid nucleus of the zygote contains a unique set of chromosomes. After this, the zygote begins to divide into blastomeres (2–16 cells), then forms a morula (16–32 cells), and ultimately a blastocyst, from which the placenta and the embryo itself will later develop. On days 6–7, the embryo implants into the uterine lining.

The second period, from weeks 2 to 8, is called the embryonic period; during this time, the initial formation of all organs takes place. By the end of this period, the embryo has all its organs and systems and takes on a human form, measuring 3–4 cm in length and weighing 4–5 g.

The third period is called the fetal period (fetus). It spans from 9 to 40 weeks, during which all organs achieve full development. Further growth, tissue differentiation, and organ maturation occur during this time.

Currently, the lower limit for survival outside the mother’s body is 22 weeks in terms of gestational age and 500–750 g in terms of weight. However, this can be considered a gray area, as survival is merely possible, but the probability is only about 40%. Critical factors include lung maturity, the level of nervous system development, thermoregulatory capacity, etc.

  • The Sanctity of Life and Quality of Life
  • Conception and the Birth of Man in Scripture
  • Conception as a Biological Process
  • The Moral Assessment of Contraception
  • The Status of the Embryo: Legal, Moral, and Spiritual
  • The issue of abortion, its types, and evaluation
  • Assisted Reproductive Technologies (ART)
  • A Moral Assessment of ART from a Christian Perspective

In the ancient world, attitudes toward the possibility of ending a child’s life in the womb varied. Typically, in pagan societies, no punishment was imposed for this. Moreover, both Plato and Aristotle even recommended abortion if it was deemed necessary for the life of the state.

However, with the emergence and spread of Christianity, abortion became prohibited, and those who performed it were punished by death. The liberalization of abortion laws was influenced by the French Revolution, which freed women from criminal liability for abortion but imposed a 20-year prison sentence on doctors. The first state to legalize abortion in modern times was the Soviet Union, where abortion was legalized in 1920. From 1936 to 1954, abortion was once again a criminal offense, but it became legal again in 1955. In modern Russia, abortions are covered by the mandatory health insurance system.

Currently, abortion is completely banned in Andorra, Honduras, Nicaragua, El Salvador, Malta, the Philippines, and the Vatican City State. It is completely banned, except in complex cases (related to saving the mother’s life), in Afghanistan, Iraq, Iran, Syria, the UAE, and most Islamic countries worldwide. Additionally, the same approach applies in the states of Alabama, Arkansas, Louisiana, Missouri, Oklahoma, Tennessee, Texas, and South Dakota. Abortion is permitted for medical reasons, in cases of rape, or when there is a serious risk to the woman’s life in Algeria, Brazil, Mexico, Pakistan, Poland, Saudi Arabia, and Chile. Abortion is permitted for medical and socio-economic reasons, as well as in cases of rape, in England, Israel, India, Finland, and Japan. In countries such as Australia, Austria, Albania, Argentina, Bulgaria, Belgium, Germany, Greece, Denmark, Ireland, Iceland, Canada, Russia, Italy, China, France, the Czech Republic, and others—including most U.S. states—abortion is permitted simply at the woman’s request.

In 98% of countries, abortion is permitted to save a woman’s life; in 75% of countries, abortion is permitted to preserve her health; in 55%—following rape or incest; in 60%—due to a fetal defect incompatible with life; in 30%—for socioeconomic reasons; and in 40%—at the woman’s request.

Over the past 30 years, there has been a clear trend toward the liberalization of abortion laws worldwide. The only exceptions are Poland and certain U.S. states.

In modern medical practice, the following types of abortion are distinguished:

- Medical abortion is performed between 6 and 10 weeks of gestation using medications that block the hormone progesterone and expel the embryo through strong uterine contractions.

- Vacuum (mini-abortion), which is performed up to 4–6 weeks using a vacuum device to detach the embryo from the uterine wall and remove it.

- Surgical abortion (dilation and curettage) is performed between 6 and 12 weeks, and in some cases up to 22 weeks. From 6 weeks after a missed period, a woman realizes she is pregnant. This type of abortion is performed by scraping the inner lining of the uterus with a special instrument called a curette. The fetus is dismembered piece by piece using special forceps, and the uterus is scraped.

- Late-term abortions are performed after 12 weeks in most countries exclusively for medical or certain social reasons (such as rape). In this case, the abortion is performed through induced labor or a minor cesarean section.

Among the indications currently recognized in Russia, abortions are performed:

  • up to 12 weeks at the woman’s request

  • from 13 to 22 weeks for social reasons,

  • regardless of gestational age, if the mother’s life is at risk or the fetus is nonviable, or in cases of severe fetal illness, to spare the fetus from suffering.

Traditionally, several types of reasons for having an abortion are discussed.

The first such grounds traditionally include the woman’s desire, which is driven by a difficult life situation that already exists or may arise in the future. These can be difficult situations related to psychological crises, job loss, a certain lifestyle, or concerns about losing one’s figure. In such situations, the sanctity of life is incomparably greater than all these circumstances. The conceived child, who could have been born, is not at fault and should not suffer. Furthermore, the psychological circumstances often cited pale in comparison to the difficult circumstances following an abortion and so-called post-abortion syndrome.

The second group of justifying reasons relates to incest and rape.

It is worth noting that, according to current data, pregnancy resulting from rape occurs in approximately 5% of cases. Traditionally, public opinion supports the option of abortion, although in reality these cases usually do not involve a deranged rapist, but are committed by acquaintances who cross the line under the influence of alcohol and other substances that affect their emotional and volitional control. It should be noted that the focus should not be on abortion after rape, but on preventing pregnancy in the first place. It is important to remember that gamete fusion begins 18–24 hours after sexual contact, which gives the victim the opportunity to seek help at a medical facility where she can receive immediate assistance and prevent conception. Incest is a sexual relationship between close relatives. However, in the vast majority of cases, this involves not blood relatives, but step- relationships—such as between a stepdaughter and stepfather or a stepson and stepmother. Despite the sinfulness and immorality of incest, in the event of pregnancy, there is no risk of the child being born with genetic defects associated with relationships between close blood relatives. Incest is a difficult situation in which the victim cannot stop the abuser. In the vast majority of cases, the victim wants it to stop because such a relationship destroys her life. In this sense, pregnancy and the birth of a child provide an opportunity to speak openly about the situation, bring it to light, and end the relationship. In both cases of incest and rape, abortion cannot be justified from an Orthodox perspective, because the conceived child is not at fault; it is a living being and has a right to life.

The third group of cases involves the presence of genetic defects in the child. Genetic defects come in various forms; some are very rare, while others are common. The female body has an innate ability to reject diseased, genetically defective embryos in advance. This process is called natural embryonic loss[1]. In this case, the woman does not notice any changes; she does not experience a delay in her menstrual cycle, meaning that the embryos are eliminated by the body itself at the very earliest stages. The most common genetic abnormality is Down syndrome. The severity of Down syndrome varies, but modern methods fully enable such individuals to socialize.

As for physical defects, it should be noted that medicine is advancing, and while abortions were previously the standard response in such cases, today—with the advent of ultrasound and various therapeutic methods—it is possible to save the child. However, there are clearly situations in which genetic or physiological problems are so severe that there is a high probability the child will die in utero, which classifies the case as a so- called threat to the mother’s life and health. In Orthodox circles, one sometimes hears suggestions to abort severely ill children whose lives will be very short and fraught with the most severe suffering, but such suggestions do not find support within the wider Church. The experience of giving birth to even very sick children can vary; among other things, it can be associated with the opportunity to show love and care for a seriously ill child. Furthermore, for the Orthodox mindset, the most important basis for prohibiting such abortions was the possibility of baptizing these children.

Finally, the last category of cases involves a threat to the mother’s life. In this context, of course, one must distinguish between a threat to health and a threat to life. From the Church’s perspective, a threat to health is not considered grounds for abortion, although the nature of the threat may vary. The question is whether the mother would sacrifice her own health in a difficult situation where the child can be saved. Usually, if the child has already been born and is alive, parents sacrifice their own health to save the child, because the value of a loved one’s life is more important than their own well-being. In this case, the Church sees no reason to distinguish between the value of the life of a born child and that of an unborn child.

In turn, there are two types of situations where the mother’s life is at risk. In the first, the mother must choose between her own life and that of her child. For example, a cancer diagnosis and the need for accompanying chemotherapy and radiation therapy necessitate the termination of the pregnancy. However, the mother may make any decision, including allowing the child to be born, even while understanding that the disease will most likely progress. In the second case, the mother survives at the cost of an abortion. This primarily refers to an ectopic pregnancy, in which the embryo attaches not to the wall of the uterus but to the wall of the fallopian tube and develops there. However, unlike the uterus, the fallopian tube is not designed for this; given the embryo’s growth, the tube ruptures as early as 6 to 8 weeks, and the embryo dies, and the mother dies from bleeding as a result. Currently, research is being conducted in various countries around the world on the possibility of transferring such an embryo to the uterus, though no success has been achieved yet[2]. In addition to ectopic pregnancy, a threat to the mother’s life is associated with HELLP syndrome, severe preeclampsia, and eclampsia, and, extremely rarely, with severe fatty liver disease. However, the latter conditions listed above lead to the death of the child if they occur before 22–24 weeks, since after that point the child may survive if a cesarean section is performed and the child is placed in intensive care.

When it comes to cases involving a threat to the mother’s life, the Church cannot grant a blessing for an abortion, but it does not condemn a woman for any decision she makes and does not excommunicate her from receiving Communion if she chooses to do so. Usually, the goal of an abortion is to kill the child; however, in such a situation, the goal of terminating the pregnancy is to save the woman’s life, which may be all the more important if she has other children and relatives. The death of the child is a tragic consequence of this procedure, but it is not the goal.

[1] Tarabrin, R.****“Bioethical Problems of In Vitro Fertilization in the Russian Orthodox Discussion” // State, Religion, Church in Russia and Abroad. 2021. Vol. 39. No. 4. Pp. 142–168.

[2] Buskmiller, C., Camilleri, C., & Sammut, S. Transuterine relocation of a pregnant uterine horn segment in an exploratory rat model with implications for tubal ectopic pregnancy. Sci Rep**** 14, 26738 (2024). https://doi.org/10.1038/s41598-024-76986-7

The issue of family planning and birth control remains controversial and is often resolved in the tension between theological rigor and pastoral economy.

Although the Old Testament Scripture twice repeats the call to be fruitful and multiply (Gen 1:28, Gen 9:1) and children are perceived as a reward from the Lord (Ps 126:3), it is impossible to trace a direct connection between childbearing—and even more so, having many children—and salvation. Among the righteous, we see the childless John the Baptist, Isaac and Moses, who each had two children, and the large families of Jacob and Eman (1 Chr 25:5).

Sometimes, in connection with the topic of family planning, people recall the story of Onan, the son of Judah, who was required to fulfill the law of levirate marriage and restore the seed of his deceased brother. According to Moses’ account: “Onan knew that the offspring would not be his, and so whenever he went in to his brother’s wife, he spilled his seed on the ground so as not to give offspring to his brother. What he did was evil in the sight of the Lord; and He put him to death as well.” (Gen. 38:9,10). It is clear that the word “evil” can refer both to the spilling of the seed and to the refusal to fulfill the law. Some authors, both in ancient times and today, have argued that the cause of the punishment was the spilling of his seed itself; at the same time, others note that he did this not because he fundamentally did not want to have children, but because he knew that “the child born would not belong to him” ([1]).

The New Testament statement by the Apostle Paul that a wife “will be saved through childbearing” (1 Tim. 2:15) has also almost never been interpreted either as a strictly mandatory path to salvation or as a call to have many children. The latter is not mentioned anywhere as a particular virtue and is a natural feature of many patriarchal societies. While honoring the feat of motherhood, including having many children, church authors criticize contraception not for the very attempt at “family planning,” since such planning is entirely permissible through abstinence. The basis of the criticism is the idea that the artificial separation of childbearing and marital relations is unacceptable. However, the prohibition against such a separation is not specifically Christian. Even Plato, in describing the ideal state, wrote that marital relations in it would be conducted strictly for the purpose of conceiving children[2] . Many Church Fathers reasoned in a similar way. For example, St. Justin Martyr, Blessed Augustine, St. Epiphanius of Cyprus, and others. At the same time, St. John Chrysostom views the purpose of marital relations more broadly: “Marriage is given for procreation, and even more so for the quenching of the natural flame.” Paul testifies to this, saying: ‘Because of fornication — (to avoid fornication) — let each man have his own wife’ (1 Cor. 7:2). He did not say: for procreation. And then he commands them to “come together” (1 Cor. 7:5) not so that they might become parents of many children, but for what? “Lest Satan tempt you,” he says. And continuing his speech, he did not say: if they desire to have children, but what? “But if they cannot exercise self-control, let them have sexual relations” (1 Cor. 7:9). At first, marriage had, as I said, the two aforementioned purposes, but later, when the earth, the sea, and the entire universe were filled, only one purpose remained—the eradication of intemperance and debauchery; for people who even now still indulge in these passions, wishing to live like swine and corrupt themselves in unchaste havens, marriage is quite beneficial, freeing them from impurity and such desires and preserving them in holiness and integrity…”[3]. And while one may occasionally find, in both ancient and modern authors, references to the sinfulness of feelings that become an end in themselves, St. John clearly states that those same feelings, within a lawful marriage, can be purified. Especially if, following the command of the Apostle Paul, spouses in their relationship strive not so much for their own good, but for the good of their neighbor (1 Cor 7:3-5).

Currently, there is a large amount of material in which a wide variety of viewpoints are expressed. Many authors point out the absence of canons that would regulate marital relations. At the same time, this does not mean that, when discussing birth control, we are entering—in a canonical and theological sense—a field where there are no rules at all for a believer to follow. The primary document in which the Church’s ethical teaching is formulated can be considered the “Fundamentals of the Social Concept of the Russian Orthodox Church.”

First, the document distinguishes between abortive contraceptives, the use of which leads to the death of embryos, and non-abortive contraceptives, which might otherwise be called barrier methods. The former, are considered strictly prohibited, since their use is equated with abortion; the latter are viewed as conditionally permissible.

Before expressing a specific position on the use of contraception, the “Fundamentals” emphasize that “the continuation of the human race is one of the primary goals of the God-established marital union.” In turn, this means that “the deliberate refusal to have children out of selfish motives devalues marriage and is an unquestionable sin.” At the same time, while emphasizing that “decisions in this area must be made by spouses by mutual consent, with the counsel of a spiritual father,” the “Fundamentals” state that the spiritual father himself “should, with pastoral prudence, take into account the specific circumstances of the married couple’s life, their age, health, degree of spiritual maturity, and many other circumstances, distinguishing those who can ‘meet’ the high demands of abstinence from those to whom this is not ‘given’ (Matt. 19:11), and caring above all for the preservation and strengthening of the family.”

While spiritual maturity, financial status, and living conditions are subjective categories—and in these areas, a person can sometimes be called upon to undertake spiritual work and feats—health status is an objective category, where the risks discussed are not hypothetical but very real. For example, approximately 20% of pregnancies worldwide end in a cesarean section. In Russia, the figure is about 30%, in Europe 27%, and in the U.S. 32%. After the surgery, the incision must heal, and the optimal interval before the next birth should be 2–3 years. Furthermore, there are medical conditions in which pregnancy should not only be postponed until a certain time but is also contraindicated.

[1] Cyril of Alexandria. St. Works, vol. 2 — Pilgrim. — Moscow, 2001. — p. 192.

[2] Plato __ Laws 838e5–6, 783e4–7, 838e4–39a6, 837e9–38e1

[3] John Chrysostom st., On Virginity 19

The topic of marriage and marital relations naturally leads to the topic of childbirth. Traditionally, this topic was considered within the framework of biblical teaching and was of a descriptive nature. Theologians and exegetes, who regarded Scripture as authoritative, viewed childbirth as a natural process. There was no mention of any serious medical intervention to aid conception in their time, while abortion was strictly prohibited. However, the development of medical technology has led to new possibilities in the field of human reproduction, and with this, to new questions that require answers from the perspective of moral theology. In turn, this means that alongside specific theological questions, which can be answered by drawing on Scripture and Tradition, there are a number of problematic issues that require reference to the findings of modern science for their discussion.

It should be emphasized separately that laws concerning bioethical issues not only vary from country to country but also change regularly within the same countries. The reasons for these changes may include both society’s gradual realization of the potential undesirable consequences of current regulations and the emergence of new technologies that offer new possibilities for solving practical problems. In this regard, we will examine the most general approaches and recommendations that remain relevant in most complex cases.

When comparing theological and biological approaches, it is important to remember the difference between Christian and secular ethics, which was discussed above. Secular society’s orientation toward science does not allow for unambiguous answers to questions that go beyond the scope of natural scientific research and concern such an area of human existence as axiology. Values constitute a world that seems unshakable and absolute to some, while to others it appears relative and contrived, constantly changing. The methodology and tools of the natural sciences do not allow for appeals to categories such as good and evil, yet without an understanding of these, society’s life can descend into chaos.

In the case of bioethical issues, these secular and religious approaches traditionally focus on two questions of paramount importance to each: “the sanctity of life” and “the quality of life”[1]. Here, sanctity implies that the gift of life belongs to God as its source. If God “wants all people to be saved” (1 Tim 2:4), if, having created man, He “remembers him” (Ps 8:5, Job 7:17), then the life of each of us acquires absolute value. Accordingly, quality of life refers to the alignment of life forms with the level of comfort that an individual or society as a whole considers acceptable for itself. Thus, the assessment of the same situations by believers and non- believers may either coincide or differ in the most obvious ways, depending on how these criteria are weighed.

Given today’s social atomization and focus on comfort, the sanctity of life—which is not grounded in quality—is often called into question or denied altogether. Evidently, within the framework of an atheistic worldview, the very concept of the sacred has long since become a meaningless abstraction. In turn, the concept of quality of life, though it appears more concrete, is relative, which in the long run makes focusing on it problematic and dangerous, since objective criteria for a decent quality of life do not exist and cannot exist. Christianity, of course, also speaks of quality of life and does not forbid people from striving for certain forms of comfort. At the same time, Christian authors emphasize that the question of quality of life in a world where death exists is, to a certain extent, discredited. Life in a world that lies in evil cannot possess the same qualities that God originally imbued it with, and the pursuit of comfort at any cost cannot be justified in any way. True comfort, like true happiness, can be attained only in the Kingdom of Heaven.

The relationship between sacredness and quality is important both when discussing issues of the beginning of life, in which the status of the embryo is debated in terms of “not yet a human/already a human,” and when discussing issues of the end of life, in which the status of the dying person is debated in terms of “still a human/no longer a human.” The current pace of development in biomedical technologies suggests that two additional points of tension may emerge in the very near future, tentatively designated by the oppositions “human–machine” and “human–animal”[2]. The first relates to questions of personal identity, whose consciousness and behavior are influenced by a technical device. For example, how does a neural implant affect human behavior, freedom, and responsibility? What if implants can be hacked today? Will the emergence of expensive implants lead to such a biological divide in society? The second issue relates to what is known as xenotransplantation, that is, the transplantation into humans of organs grown in the bodies of animals. Many questions in this case are similar, but additional ones arise regarding the moral status of animals, their instrumentalization, the emergence of new diseases in humans that are characteristic of animals, and so on.

[1]Breck I., Protopr., The Sacred Gift of Life.

[2] **Yudin, B. G.****The Limits of the Human Being as a Space for Technological Impacts // Issues of Social Theory.**2011. Vol. V. P. 106.

In all societies, the killing of an innocent person has always been perceived as a grave crime. At the same time, it is important to understand that when discussing the permissibility or impermissibility of abortion, people are not discussing the permissibility or impermissibility of killing a human being, since the answer is obvious. The reason for the controversy over the permissibility of terminating a pregnancy is that there are differing positions on the question of the embryo’s status: whether it is a human being or not. Traditionally, three approaches are discussed: conservative, gradualist, and liberal.

From the perspective of the conservative approach, the embryo possesses human status from the moment of conception, and its life is sacred. It is generally believed that this approach is characteristic of all religions, although in reality it is more characteristic of Christianity. In biblical times, judging by the texts cited above, the child in the womb was regarded as a human being, and the commandment “Thou shalt not kill” applied to its life. One of the earliest monuments of Sacred Tradition, the “Didache” (The Teaching of the Twelve Apostles), prohibits abortion: “Do not kill the child in the womb”[1]. The same call can be found in the Epistle of Barnabas, as well as in the works of the apologists Athenagoras and Tertullian. Later, St. Basil the Great, in his Canons 2 and 8, equates abortion with murder. It is similarly assessed in Canon 91 of the Council of Trullo. From a legal standpoint, the embryo is a subject of law from the moment of conception.

From the perspective of gradualism, the status of the embryo changes gradually. Up to a certain stage (for example, before the formation of the nervous system on the 14th day, or before the ability to feel pain after 20 weeks), the embryo is considered a potential human being who does not possess full human rights. They base this on the natural loss of embryos. In addition, they propose that prior to implantation, it is more accurate to speak of a pre-embryo, any cell of which, being totipotent, can give rise to new life. The consequence of this position is the authorization of experiments on embryos up to 14 days and the authorization of early-term abortions. Legal status shifts from an object of law to a subject of law.

In contrast, the liberal position holds that a child’s life begins at the moment of birth, and that an embryo has only negligible moral value, if any at all. Proponents of this position emphasize the embryo’s lack of consciousness and other personality traits, and also stress a woman’s right to control her own body. This position leads to the legalization of abortions and the destruction of surplus embryos in IVF procedures. From a legal standpoint, the embryo is regarded as an object of law[2].

From the Church’s perspective, manipulation of the embryo is permissible in only one case. Only therapeutic actions of a supportive, medical nature may be performed on the embryo, excluding experimentation and destruction.

[1] Didache 2

[2] Unfortunately, from the perspective of the Russian Constitution, Chapter 2, Article 17, fundamental human rights and freedoms are inalienable and belong to a person from birth.

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