The LDS Church would not support the abortion of a fetus with Down Syndrome or cystic fibrosis because such conditions do not constitute "severe defects that will not allow the baby to survive beyond birth." New reproductive technology, however, now gives couples with the necessary means the ability to preselect embryos certifiably free of non-fatal genetic conditions such as Down Syndrome and cystic fibrosis. Many couples not prepared to abort a fetus with a non-fatal, albeit life-changing, condition, may be willing to prevent the conception of one. How do faithful Latter-day Saints reason about this issue?

Full Citation for this Article: SquareTwo Editorial Board (2011) "Preconception Selection," SquareTwo, Vol. 4 No. 2 (Summer), http://squaretwo.org/Sq2ArticleReadersPuzzlePreconception.html, accessed [give access date].

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COMMENTS: 8 Comments

1) Lindsey Hulet

Modern reproductive technologies now present interesting dilemmas for Latter-day Saint couples when it comes to determining what is "right" or "wrong" in light of the restored gospel of Jesus Christ. Regarding how faithful Latter-day Saints can reason about the issue of preselecting embryos that are certifiably free of non-fatal genetic conditions, I can see both sides of the argument.

Some might point out that the ability to preselect embryos for any characteristics at all is a slippery slope. If "preimplantation genetic diagnosis" begins to become more mainstream, how long before the practice of preselecting for the sex of the embryo becomes common place? What about preselection for other physical attributes, such as eye color or height? Messing with the profound power of procreation can feel like trespassing on God's domain.

At the same time, this reader's puzzle regards faithful Latter-day Saint couples, who presumably have a very legitimate reason to seek out this medical technology -- not couples who simply want to have a blue-haired son. Family history of genetic conditions, advanced maternal age, and other risk factors might be a real concern to such couples. We knew when we came to earth to receive mortal bodies that those bodies might, as a result of very natural biological processes, be imperfect and in some instances, partially to severely impaired. Modern medical advancements have blessed us with the ability to eradicate many diseases and treat or mitigate the symptoms of still more. Is preselection of embryos for naturally occurring diseases and conditions any different than treating a condition after the birth of a child? To me, arguing that couples should not interfere with the natural procreative process that might produce embyros with a non-fatal genetic condition because a baby could be "meant" to have that condition feels similar to arguing that a baby/child/adult should not seek treatment or a cure for a treatable illness because they were "meant" to be ill.

Presuming a faithful Latter-day Saint couple has righteous desires to add to their family, and seeks only to provide as healthy and whole of a body as they can for their child's mortal journey, I see no reason for me to declare their decision (also presuming they make that decision carefully and prayerfully) wrong.


2) Janille Stearmer

It is my opinion that the "preselection" process has already taken place when the child is conceived, either through natural processes or medical assistance. There are many trials in life that we may say that had we known how difficult the circumstances would be, we would not choose to go through it again. One particular trial in my life I would not even wish on my worst enemy, because it was so painful for me. Yet even that trial provided me with what I would describe as my most crucial life learning and growth experiences. I still think of that trial in terms of "If only I....." but I cannot deny that God knew better than I the necessary course of my life.

I have sympathy for couples who have difficulty conceiving - surely they wish that their very few chances at having a family will produce a "normal," healthy child. The emotional and physical suffering of infertile couples is enormous. And while I would not say that the choice to pre-select embryos is a selfish choice, I would say that it is self-serving. Given the option, wouldn't most of us choose the smoother, well-traveled path, rather than the difficult, rocky path? I hate to even use the term "trial" to describe a child, but a special needs child brings with it different challenges that are not small or inconsequential considerations. With multiple embryos being implanted at one time, I would be inclined to suggest that couples accept every chance they have, just like a fertile couple and natural conception, whether it leads to an ideal outcome or not.

What is interesting to me is that this technology is available to people with "necessary means" - meaning, you have to wealthy enough to pay for it. Those same people, because of their wealth, would in fact be the best set up to provide for a special needs child. To my mind, the money would be better spent on enriching the actual child's life (and yours in the bargain), not denying it that chance at life.


3) John Mark Mattox

The LDS Church would not support the abortion of a fetus with Down syndrome or cystic fibrosis because such conditions do not constitute "severe defects that will not allow the baby to survive beyond birth." New reproductive technology, however, now gives couples with the necessary means the ability to preselect embryos certifiably free of non-fatal genetic conditions such as Down Syndrome and cystic fibrosis. Many couples not prepared to abort a fetus with a non-fatal, albeit life-changing, condition, may be willing to prevent the conception of one. How do faithful Latter-day Saints reason about this issue?

It may be that the overriding consideration here is the motivation behind the prospective parents’ desire to “ensure” that their offspring is free from non-fatal genetic conditions.  A few questions to the parents might assist them in acquiring clarity:

The answers to these questions do not hinge on the sophistication of available reproductive technology; they could have been posed just as easily 3000 years ago, and an imaginative person (like Socrates imagining the Ring of Gyges) could have opined on the issue.  Moreover, asking one to search his or her motivations on the subject of preconception selection is not at all the same as asking one to search his or her motivations on the subject of, say, murder; for murder (as a distinct case of the taking of human life) is categorically evil, and there is no condition in which murder or even murderous feelings could ever be morally justified.  However, in the light of currently available revelation, it is not clear that a categorical answer can be given to the matter of preconception selection.  Having so said, that does not mean that a clear right or wrong answer does not exist in every case; but it may be that the answer, obtained by personal revelation, would not be the same for every set of parents.
It should also be noted that children with conditions like Down syndrome have proven to be an enormous blessing to persons wise enough to learn from their example of innocence, etc.  While it is difficult to imagine a case in which one would be justified in wishing upon another a physically “limiting condition,” it is not clear, in the eternal scheme of things, that what is commonly perceived as a physically “limiting condition” actually constitutes, in any way, a spiritually limiting condition.  The Lord Himself reminds us that He deliberately gives weaknesses to men (Ether 12:27) for their eternal good.  So, while we need not deliberately court difficulties in this life (we can be sure that there will be enough of those to go around without any prompting from us), we should also consider that difficulties in the form of conditions like Down syndrome could well constitute a divine gift—both to parents and to the child sent to be part of their eternal family—from Him Who knoweth all our needs.


4) Valerie Hudson

My family has three children with cystic fibrosis, so we have thought about this issue quite a lot.  When our first son with CF was diagnosed, we felt unsure what to ask of the Lord: should we ask that he be healed?  Then we were given to know that having cystic fibrosis was John’s plan, and that after presenting it to Heavenly Father, the plan was approved.  The intent of John’s plan, we were told, was to bring about great good.  After this, we understood that it was not cosmic caprice that had inflicted cystic fibrosis on our son.  Our son had chosen this path for a good purpose, and it was our responsibility to honor that choice and support him as he walked that path.  We were also given to know that we would be led to the knowledge we needed to keep him healthy.   After those experiences, we understood that no soul has CF in this life by chance. 

That was a very liberating insight for our family.  Since that time, we have learned things about the experiences of others that reinforce this understanding.  For example, we discovered that CF can occur even when neither parent has a gene for CF.  Scientists had once thought that impossible, but it does happen.  There’s also the amazing story of a couple who used preconception selection to choose an embryo free of CF, only to have the child be born with CF despite those efforts.  After that shock, they decided not to use preconception anymore, and their three subsequent children were born without CF.

While I would never condemn the use of preconception selection by other couples, for our family, it made no spiritual sense.  No soul who hasn’t chosen CF is going to have it; no soul who has chosen CF is not going to have it—or an equivalent affliction if you prevent the soul from its choice.  While the rate of CF and Down’s syndrome births are drastically decreasing due to identification and abortion of affected fetuses, other afflictions are increasing in incidence. Apparently, premortal plans are not that easily thwarted.

This raises the larger question of whether good could ever come from something we in mortality view negatively, such as a congenital disease.  That is, how could John have viewed having CF as a good thing to be chosen for his life’s plan?  After living with John for so many years, we have fully answered that question to our family’s satisfaction.  It was a good plan.  Heavenly Father was right to approve it.  (A more eloquent exploration of this theme by another LDS CF individual can be found here.)

It also raises the question of whether there is another choice that deserves contemplation in this situation.  When John chose CF, did we, his future parents, then choose to bring him into the world anyway?  And why would we have made that choice?  Could we, at that point, have seen the good that would come from honoring our son’s choice?  When parents undertake preconception selection, it is often because they do not think they could handle the challenge and burden of a child with such a condition.  But is it possible that in another setting, the premortal setting, they did believe they could—which is why they have the genes to conceive a fetus with CF?

All of this invites us to see affliction in a different way.  Yes, one is morally obligated to prevent and relieve suffering. Treating illness is an important and moral act.  But we probably cross a really problematic line when we decree that certain lives are not worth conceiving—without asking the person whose life would not then occur.  My dear friend, Richard Young, who died at age 23 of complications of CF, penned an essay explaining why he was grateful not to be aborted because he had CF. I consider it required reading for anyone thinking about these issues, for while abortion and preconception selection are not the same thing, they do touch on this same issue--do we believe there are certain lives that are just not worth living?


5) George Handley

I am not very confident on that question. While my gut tells me to let nature take its course because that is perhaps the best way to learn from mortal experience, I would be foolish to deny that we have accommodated all kinds of technologically enhanced methods of reducing unwanted suffering, to promote chances for pregnancy, and for extending life into our theology and ethics, so this may not be such a hard step to take. An honest question I have is how different would such an intervention be to one that enables a woman to get pregnant but that significantly increases the chances of twins or triplets. When the triplets are born, can we say that it was merely natural or divine and that no human intervention played any role? At the very least, we ought to admit to the accommodations we have already made to our ethics before entering into this discussion and decide carefully where we draw the line and why. I am not confident I know where that line is.


6) Ryan Decker

The growing medical potential for genetic identification and interventions will have far-reaching consequences ranging from insurance markets to religious doctrinal questions like this one. When a zygote is formed, it comprises one genetic matching out of many potential combinations which could have occurred. Medical breakthroughs which allow greater control over zygote construction simply change the process by which genetic materials from each parent are matched. A matching which occurs naturally excludes many other potential matches, just as a matching which is selected manually excludes other potential matches (probably including the match which would have occurred naturally). As such, one way to approach this dilemma is to evaluate the opportunity cost of replacing the natural matching process with a manual one. Our view of the morality of manual genetic selection will depend on our assessment of the opportunity cost incurred by discarding the process which would occur in the absence of deliberate medical intervention.

Lacking expertise in medical science or biology, I cannot authoritatively describe the nature of the genetic matching mechanism, but I can cautiously opine on the ethical consequences of different processes. First, if the process by which genetic materials from each parent are matched during conception is largely random, interventions which preclude one match in favor of another simply replace one value-neutral screening process with more specific criteria, effectively incurring no opportunity cost. In this case, we cannot attach moral value to the activity which creates the match, and the decision to intervene should only be limited by cost concerns and the likelihood of success. Alternatively, if the natural matching process is largely nonrandom with key genetic characteristics of potential pairs driving the final match, then the opportunity cost of manual selection depends on the degree to which those genetic characteristics are correlated with the potential child’s later health, wellness, and personality outcomes. Such an evaluation lies well beyond my expertise, but it would be incumbent upon parents to weigh this opportunity cost against the potential benefits of manual selection based upon extensive medical advice and prayerful introspection. Finally, if we believe that the genetic matching process is in large part the result of divine guidance, then the opportunity cost of discarding the natural process may be significant. If this is the case, then the decision clearly has considerable moral implications. However, these moral implications may be similar to the moral implications of prayerfully making family planning decisions or employing modern medicine to prevent what we now consider to be premature death. In the absence of clear doctrine on this specific question, faithful Latter-day Saints are likely to approach the issue through a variety of differing interpretations. This author is not yet prepared to suggest one.


7) Russell Ray

I read this puzzle with fascination and found that I can't just leave it without commenting.

Our family has been blessed with a child with Cystic Fibrosis. We have also been blessed with three wonderful children from preconception screening. It was not a decision reached easily or without financial burden.

Our first child has CF, she is 24 and is amazing. Abortion would be a truly horrible, sinful, and selfish thing to do. She has struggles that I am daily amazed to watch her overcome and deal with that I wonder if I could rise to the occasion as well as she has done. We then proceeded to have two more children the "natural" way, they are carriers of CF but do not have CF. Some in our good LDS families were surprised we did that since the thought of bringing another child into the world with CF was not a right choice in their view.

We always wanted 5-6 children in our family. We decided to try for one more and did so for two years without any success. We had also had problems with the 2nd and 3rd children coming into our families. We then decided to try IVF (genetic screening).

At the time, you could only screen for two genetic diseases and there were no guarantees that even after the screening that a CF-less child would be ours. To our surprise, we were blessed with triplets. Financially we did not have the money to do the procedure, but after my wife pointed out that we would finance a car, why not our family, I didn't have a financial argument against it.

My view on the decision is this:
1. God and the couple make the decision, no one else
2. The couple has to do some serious soul searching, prayer, and be confident in the answers to their prayers. It is not a light matter.
3. Once those are done, the decision is theirs to carry out, either for or not, based on their personal revelation, and not on my view into their world.

Those three items are for anything going on in a family's life, not just preconception.

Our decision was based on our personal revelation from our Heavenly Father. Some were supportive, others were not. We were ok either way because we knew what our Heavenly Father had revealed to us.


8) Emily Powers

I find this issue very interesting because of my daughter.  She was born with a fatal genetic disorder.  At three months old, she had to begin chemotherapy.  The only way to save her life was to change the genetic code in her immune system through a bone marrow transplant.  An anonymous woman in Germany was a match and provided the life saving marrow.  So now the DNA in my daughter’s blood does not match the DNA in the rest of her body. 

As you can imagine, this has caused all kinds of problems as well as pain and suffering for both her and all those who love her.  Her life, though, is infinitely valuable.  I would not trade her for anything, not even a different, healthy baby.  And I know that because our sweet darling is adopted.  Our lawyer was surprised that we were going through with the adoption.  He said in his experience most couples actually reject the adoption once a disorder like this is discovered.  We love our daughter and we know that this is the path she needed to walk, and one we needed to walk with her.  We absolutely would not trade a moment, even the fearful and dreadful ones, which we have had with our daughter.  However, the issue of pre-implantation selection will be one that our daughter will face, and I have mixed feelings on the subject.

If my daughter is able to conceive children, she will be faced with the question of whether she will pass this fatal genetic disorder on to those children.  We are told that at minimum, she will have a 50% chance of passing it on to a child, but depending on who her spouse is, it could be higher.  This is where modern science complicates the debate she will have.  If she gives birth to a child with this genetic disorder, that child will have to have his or her genes replaced by someone else’s DNA in order to survive.  This begs the question, Is pre-selection of an embryo without the disorder the moral equivalent of changing the DNA before birth?  If the DNA must be changed for a child’s survival, is there then a moral imperative to ensure that the DNA is tinkered with before birth, and hence before the suffering of chemotherapy and all its accompanying trials?  Or, does selecting certain genes before birth change what spirit comes into the home?

Like Valerie Hudson, we too have had confirmation that this was a path that Evelyn chose to walk for a very specific purpose.  And the choices regarding her reproductive options will also be hers.  While she has no memory of the chemotherapy, treatments, and transplants, these things have affected her greatly.  She is powerfully compassionate.  Hopefully that compassion will lead her to the right choices regarding her own children.