The Gospel and Fertility Podcast Series

Dr Megan Best's Path to Bioethics and Christian Healthcare Welcome to this episode of the Gospel and Fertility, a podcast series published by the Presbyterian Church of Queensland's Gospel in Society Today team. You can find out more about our work at gist.org.authatsgist.org dot AU. Please note that the views expressed in this episode do not necessarily represent those of the GIST team, the Presbyterian Church of Queensland, or PCQ churches and congregations. In this episode, Robin Bain speaks with Megan Best about infertility, artificial reproductive technology, and contraception. Hello and welcome to our GIST podcast series on the gospel and fertility. And today I'm very glad to be talking with Doctor Megan Best. Megan is a palliative care doctor, a researcher and a bioethicist at the University of Notre Dame, Australia. And she's had a long term interest in ethics, well, at first of all at the end of life, and she's written extensively in that space. But she's also has developed a special interest in ethics at the beginning of life. And she's the author of two books in that area, which we'll come to talk about at the end of this podcast. Megan's also the director of Ethicentre, a centre for Christian ethics based in Sydney, and she's part of a church family in Sydney eastern suburbs. Welcome, Megan. Speaker 2 Good morning, Robin. Speaker 1 You began your career as a palliative care doctor, So what ignited your interest in ethics at the beginning of life? Speaker 2 Well, I was always interested in ethics. Sadly, we didn't have much training when I was a medical student. Ethics is is studying how we decide what's right and wrong. And I was particularly interested in how we do that when we have a medical dilemma, when knowing the right thing to do can at times be quite difficult to assess. And I wasn't a Christian at that time. I became a Christian a couple of years after I became a doctor and while my children were at school, I trained in ethics in healthcare and started teaching medical ethics at university. And I think as a result of that expertise, I was asked to represent the church on government committees which were looking into legislation in healthcare. And that included some committees focusing on issues at the beginning of life. So that's actually how I got to know a lot about it. And while initially I was interested in medical ethics because I was aware of of the moral dimension of health care for everyone, over time, as our society has moved away from its Christian roots and new technologies manipulating the human embryo became available, I became aware of the challenges, particularly for Christians, in medical ethics. And that led me to do more teaching, writing and speaking to help Christians live their lives authentically by making health care decisions that align with their beliefs. Speaker 1 And have you? The more you look into some of the more complex corners of life, the more you see how God's gracious wisdom extends. Speaker 2 Absolutely. It's quite interesting that in all the years I've been looking at medical ethics as a Christian, when I have been promoting a Christian approach, there's never been an issue where secular research didn't support the view I was promoting. And I think that makes sense, because if God created us, he knows the conditions under which we're most likely to flourish. How Modern Culture and Consumerism Shape Fertility Views Yeah, that's fascinating, isn't it? And I mean, modern biotechnology has, it's exploded over the last 50 years or so, hasn't it? It's caused. I don't think it's understating it to say it's caused something for revolution. Speaker 2 Absolutely. Speaker 1 And thinking about the beginning of life, it's not only changed our ability to conceive babies, but modern biotechnology in conversation with our modern culture has profoundly shaped the way we think and we feel about having babies. Are there certain ways that you see that influence at work as you talk to people? Speaker 2 Yes, absolutely. It's a huge topic. I think a very prominent theme is that our society focuses on the individual and a culture of consumerism has taken over healthcare. And in this way of thinking, it's the customer who decides and it's our job as professionals to make sure we meet people's needs. And this idea is very strong in assisted reproductive technology. That's the umbrella term for all the different technologies within an IVF clinic. So ART. Most fertility clinics these days are run by big business and moral relativism, the idea that there's no absolute wrong or right, but that truth is relative to our own context. That means that our personal choices, whatever they are, are validated because there's no absolute right or wrong anymore. So, you know, how can we say that somebody's choice is wrong? So the options in ART have expanded overtime so that people who would never have dreamed of having their own child in the past, not just couples with infertility, but also single women, gay couples, they now have this expectation that they can have their own child. In a way, the supply has created the demand and we expect technology will solve all our problems. And not only that, but that we can control the deliverables. So we use donor eggs and sperm to get over the problem if we don't have them for ourselves. We do genetic screening of embryos to make sure our baby meets our expectations. And healthcare tends to approach ethical problems by deciding whether something's right or wrong depending on the outcome. That the end justifies the means, which isn't a biblical approach, but it means that some of the practises involved in ART will be an ethical problem for Christians. But often they're not treated as as ethical issues, they're treated as medical problems, medical recommendations. And so Christians may go along with those recommendations without realising, for example, that not every embryo will have their life protected in the way the clinic usually runs. But if we want to live in a way that's pleasing to God, we need to consider right and wrong from a biblical perspective and evaluate modern healthcare through a Christian lens. And this can be difficult, as many of the things our society seeks in healthcare, such as a child of 1's own, are actually good thing, which we also want for ourselves. It's not wrong to want your own child. That's the way God made us. We may seem cruel to oppose some modern practises, we might be accused of not caring about those who suffer, but none nonetheless. I believe it's an essential task for Christians if we're seeking to live with wisdom in a way that places God, and seeking the common good so that everyone can flourish. Emotional Challenges and Faith in the Infertility Journey But. But I also think churches need to take some responsibility for our expectation that we will have children. While nowhere in the Bible does God promise that we'll all have our own children, we know that God can choose to open a barren womb. But ultimately, whether or not we have children is completely in God's hands. But we still talk about children in marriage services in the Christian Church as if there are foregone conclusion and this can make the pain of infertility harder to be as our expectations are dashed in a church full of children's programmes. Speaker 1 Because I guess is that is one of the huge challenges in this area, isn't it, that we couples can have an intense desire for children and that's, it's, that's what dreamed of having. And we, we can talk rationally about God being in control and trusting him. But this is a situation where that's a really emotionally tested, isn't it? Speaker 2 Absolutely. It's very a very difficult situation to be in. Speaker 1 And as you say, we've got a, a technological and, and in many ways economic process that's sort of overlapping with natural desires and natural blessings, natural of marriage. That's why they're so. Speaker 2 Hard to analyse I think. Speaker 1 Yeah, well, let's step through a scenario and see if we can step into the shoes of a Christian couple who are keen to have a baby and doing all the right things to have to conceive a baby in doing them for several months but but nothing is happening. Let's have a think about some of the questions they need to ask and some of the the issues they might face. They're getting anxious. They're starting to get anxious. What might we say to them at this point? It's just been a few months, they haven't fallen pregnant as expected. What might we say to them now? Speaker 2 Well, infertility is a disease of the male or female reproductive system, but it can't be diagnosed until 12 months have passed where the couple has been having regular, unprotected sexual intercourse. That's two or every two or three days. And 85% of people will conceive within 12 months, but 93% will have children within two years. So sometimes what we think is infertility is in fact impatience, and we have to remember that God uses his timing, not ours, when He answers prayer. But there's a lot you can do when you're waiting. Your ability to conceive is impacted by the health of both the husband and the wife. Women are born with all the eggs they're ever going to have, but a man will have a new batch of sperm every three months. So there's a wonderful opportunity to improve their quality in this time of waiting. Actually, some doctors say you should spend at least three months cleaning up your ACT before you even attempt to get pregnant. And we know that several lifestyle factors can contribute to infertility. So it's it's worth controlling what you can. So it's eating a well balanced diet, getting a check up to see if there's any supplements you should be taking, exercising, trying to maintain a normal weight, stop smoking. Women should stop drinking alcohol altogether when they're trying to conceive, and men should reduce their intake, reduce coffee to two cups a day maximum. You know, there's lots you can focus on during this period of of waiting and I think we need to use that time well. But obviously there's also going to be challenges to 1's faith, and there might be. Speaker 1 Waiting is hard, isn't it? Speaker 2 Yes, sometimes I can remember when I was very worried when I was waiting to get pregnant. And while fertility is described in the Bible as a blessing for the obedient, there's lots of passages in the Old Testament along those lines. Infertility is often represented as a curse of God. That's certainly presented that way in Leviticus. And some couples might need reassurance that while all the sickness, suffering, and trouble in our world is a consequence of the fall, problems such as infertility are not connected with our personal sins. On a neat one to one basis, the examples of man born blind in John 9 I think make it clear that we can't expect that direct link is always there. Speaker 1 Do you find that that is easy for Christian couples to feel concerned that God is perhaps cursing them at that point? Speaker 2 I think that the emotional desire to have a child is so strong that you can't help wondering if it's your fault in some way that you haven't cursed it quickly. I remember that feeling myself. It was just overwhelming and I just don't know how I would have felt if if I hadn't been able to have a child. It's it's a very difficult situation to be in. Speaker 1 Yeah, yeah. Understanding the Ethical Challenges of IVF for Christians Well, let's say this couple continues trying for a baby. We're two years down the track now and and, and there's still no pregnancy. And so they go and see their doctor, he refers them to an infertility, to a fertility specialist. And by the time you've spoken to them, they've already seen the specialist and they've already assigned the paperwork to start on IVF. What are some important questions that you think they need to talk through with each other and and with their Christian community and with their doctors at this stage? Speaker 2 Well I really think the first question they should ask is how can we postpone the IVF? IBF is an an ethical minefield for Christians and a lot of the problems can only be avoided if you know about them in advance. So Christians need to stop and educate themselves about what IBF involves before that, well ideally before the 1st appointment. I think the the main concern with IBF is the destruction of human embryos because all human beings are made in the image of God and needed to be treated with great care and dignity, even from the very beginning at the time of fertilisation. But there are many other issues that need to be understood in order to make ethical decisions because couples are so emotionally vulnerable when by the time they've presented at an IVF clinic, they're they're very vulnerable and they're likely to agree to anything that's suggested if it means it increases their chance of having a baby. So we need to be forewarned so that we're prepared to to evaluate the things that are offered to us on an ethical basis when we're actually there in the clinic. But we also need to mention that when you're facing a diagnosis of infertility, it's OK not to pursue any further treatment. A couple may be happy to accept that childbearing is not God's current plan for them and look to his guidance for the future. And I must say, when I've said this in conferences, there's always a line of people to talk, talk to me afterwards thanking me for saying they're not obliged to access IVF. They're quite relieved that they have permission to say that they don't want to go down that pathway. Speaker 1 That's interesting. They, they, they, they have permission to not go that way. What makes them feel they must go that way? It's. Speaker 2 Usually grandparents, people who want grandchildren. Speaker 1 Yeah, OK. Speaker 2 And, and also, I think that advice from doctors is often interpreted as being prescriptive. This is what I have to do rather than saying, well, this is something you could do. But in in my limited personal discussions, I'd say the most common thing is the parents wanting to be grandparents, the parents of the couple wanting grandchildren. Speaker 1 Yes, interesting. OK. Speaker 2 Grandchildren are wonderful. I understand. I understand that perspective as well. But IVF is so difficult and expensive and costly in many ways emotionally, that I I find people, there's a group of people who just breathe out a sigh of relief when someone says you don't have to do this. Exploring Alternatives to IVF and Church Support for Childless Couples And I guess I mean, in my observation, it is often assumed when you talk to the doctor that this is the path to go down. What other options are open to this couple at this point? I remember talking to a friend who came from Central Asia and she was horrified at our readiness to jump into ART when adoption or fostering could be an option. Is that a realistic option for a lot of couples? Speaker 2 Well, let let me step back a bit. A couple who's not planning to use IVF still may like to know why it is they can't conceive. And that can be helpful even if no further treatment is pursued because sometimes it can be easily corrected. I think sort of when you think about the issue of diagnosis, it's important to think of infertility as a marital problem rather than an individual problem for the sake of marital unity. But we we need to remember that AIT doesn't cure infertility. It bypasses the problem of infertility. So what has been happening say particularly over the last 10 years is in view of the many physical and ethical challenges involved in ART, there's been rekindled interest in treating the underlying causes of of the infertility. So it might be fertility charting, lifestyle changes and medical treatments that restore your natural fertility. So that is are treating the underlying problem instead of bypassing it. And this can lead to better maternal and newborn outcomes than ART. And it may cost less, but it is a longer road to take. And this is called restorative reproductive medicine. And AGP could refer you to the appropriate specialists. But in Australia there's a huge shortage of foster parents. It is hard to adopt A newborn because most of the children who previously would have been adopted at birth are now aborted. But there's a huge need for foster parents in Australia and and I do feel very strongly that we can, I think the consumer culture is thinking I need to have my own child. But how wonderful for a child with no family to be taken in by Christian parents. I just think that is such a wonderful, generous gift to give any child, and I would like to see it taken more seriously in the Christian Church. Speaker 1 It's, it's kind of a, it's, it's like a mini play of the gospel really, isn't it? Our Father adopting us into his family. Speaker 2 Adoption has a bad name in Australia, I think, well in the Western world, and a lot of that is because of things like the stolen generation and and practises in the 50s and 60s that were terrible. But adoption is a very biblical model that we shouldn't be worried about. Speaker 1 I wonder, too, whether we need to be a little better at valuing and embracing couples who are childless, who are unable to have children, just in the position that they're in, other than always sort of, you know, wanting to thinking that they should be having children. Speaker 2 It's a tricky situation because some couples just are so distressed they don't want to talk about it. At the same time, they can feel very excluded and quite frankly, I think the only way you can know the best way to help someone is just to ask them. I remember we had one woman come to a ladies Bible study at church when my children were small and she stopped coming after a short period. That's one of those ladies Bible studies with kids everywhere. Who taken off to creation, brought back afterwards. And she said to me, look, you know, we've been struggling with infertility and it's just too painful for me to see all those young children. I just can't cope. And I you know, I said quite understand, you know, I completely understand that. But then there was another couple in our Bible study group in the night time and they had no children and we were having a one year old birthday party and so. I wasn't sure if I should invite them. On the one hand, if they were in, you know, after talking to this other lady, I thought, oh, you know, should I invite them or what should I do? So I just said, look, we'd love you to come, but we understand if it's hard. And they said we'd love to come. It is hard, but it's harder to be excluded, which was another good lesson for me to think, well, the only way I can tell if people want to be included or not, it's just by asking. Yeah. We can't assume. We can't assume. Everyone has their own reaction. Speaker 1 Yeah, yeah. But but that that is such a common pattern in churches, isn't it? We, we, we rightly celebrate families and children, but it's very easy for those who are in that age group but but not in that situation to feel on the periphery and as though they don't quite belong anywhere. Speaker 2 Yes, and we need to be sensitive to that on Mother's Day and Father's Day, I think, to include in our prayer those who wish they were parents as well as those who are. Speaker 1 That's right. The Christian View of Embryo Dignity and Human Personhood OK, well, let's go back to our couple. They have done some thinking and some talking and they they have decided that they would like to proceed down the IVF route, at least for the moment. Are there particular questions, particular aspects of the IVF process that they need to particularly understand and have open discussions with their specialist about there? Speaker 2 Are depending on the particular technologies they are offered, different questions will arise and I've gone through all the different things that can be offered in my first book. Fearfully and wonderfully made. There's too many to go through in detail, but probably the most important issue to discuss is the fact that you think every human embryo needs to be treated with dignity and given a chance at life. If we believe that a human embryo is made in the image of God and one of our children, albeit at a very early stage of development, we need to protect them. We are responsible for them having been created. We need to protect them. This is not the mainstream approach to human embryos. What's usually done is that as many embryos as possible are made and then they're screened so that the best ones are transferred. But but that's not the way Christians should view their embryos. If there's life in the embryo, it's got a chance of developing. So they all need to be transferred to a worm at some stage to have a chance to develop. And if you want to go into IVF as a Christian, you need to be prepared to fight for your embryos because that is not that you are going to be a nuisance. That is not the way the clinics want to proceed. Speaker 1 It's not efficient. Speaker 2 It's not efficient. It doesn't give them the best success rates in their their view and they want to have good success rates because that helps them commercially and they are after all big business. So I think the most common problem I have I'm contacted about by couples who've been in IVF is I have lots of leftover embryos and what am I going to do with them? You can avoid that problem at the outset by only creating the number of embryos you want to have as children. So if you don't want more than four children, don't create more than 4 embryos and you're not going to have that problem of leftovers. And so this is really the most important thing to talk about in advance. While there are options for dealing with leftover embryos after the fact, you shouldn't go into IVF thinking I'll deal with leftover embryos if I have them. You need to do everything you can to make sure there are no leftovers. Speaker 1 Because that is strikes me as an increasingly common situation that a couple have even 2030 embryos frozen and yeah, what what what to do with those embryos. Speaker 2 There are thought to be hundreds of thousands of frozen embryos around the world at any one time. It's it's a tragedy, yeah. Speaker 1 And so the first thing to do is to be aware of and, and the, the, if the, the, the preciousness of each of those embryos and that each of them needs to be implanted and, and given a chance to grow and to not create too many of them. That's right. Speaker 2 Yeah. Speaker 1 I mean even if if you create 4 though, it's it's not uncommon to have natural children after number one or two come along. Is that right? Speaker 2 What people think is infertility can often be impatience and people do conceive after starting IVF cycles. That's I don't know if it's a result of the IVF or it would have happened anyway. Speaker 1 Now say 4 embryos are created, one or two might be implanted at a time. Is that correct? Speaker 2 Generally in Australia they recommend just one for most women. It increases risk to the mother and the child. If there's every time you have more than one child in the womb, it increases risks in the pregnancy. Speaker 1 And those remaining embryos are frozen. Can you tell me just briefly a little bit, a little bit about that process? Is that a risky process? Speaker 2 Well, it's it's complicated because not all human embryos that are conceived naturally and sort of implant in the womb wills will develop and and survive. So in in natural process, not every embryo created will end up as a live birth. And it's true that embryos that are frozen in a lot of clinics in Australia, they're probably frozen around 5-6 day age. Not all of them will defrost successfully, not all of them will implant, not all of them will develop normally. So an embryo, there's no calculation of this many embryos will lead to this many live births either naturally or through IVF. That's actually the reason why clinics like to make as many embryos as possible to increase the risks of the chances of a live birth. Because the more embryos you have, the greater the chance that one of them will will come to a live birth. But that's why the excess number of embryos tends to be created by the clinic because because we just can't tell. Sometimes they might, you know, you might create 10 embryos and you transfer 4 and you have 4 babies and you've got 6 leftovers and all of them are good embryos. So there's no calculation available to know what's going to happen. So they may develop, they may not, whether you're conceiving naturally or through IVF. And we know that lots of women have miscarriages and it's thought that they're probably due to genetic problems. It's an area where a lot of research is being done. But it's in God's hands. We we don't have control over this this process. Speaker 1 Although I guess one of the complications here is that because it's a a technological process rather than just a purely natural one, we do have more responsibility for our actions. Would you would you agree with that? Speaker 2 Well, yes, I, I think we have to be very conscious of our actions. If we are responsible for the creation of human embryos, we are responsible for what happens to them. And I think we should take that very seriously in medical dictionaries. This is a very sorry, I'm trying to simplify very complex topic in medical dictionaries. There were changes made in the 70s and 80s which basically defined conception as the time where the embryo implants in the womb. So while we think of conception as fertilisation, where the egg and the sperm create the first cell, the embryo, as the beginning of human life. And that's the view of embryologists, the experts in human development. In a lot of medical contexts, they say conception is implantation, which is about a week later when the embryo attaches to the wall of the mother's womb. So a lot of the technicians in the IVF lab will not think the embryo is a human person who needs protection. They think before it's attached to the wall of a uterus, it's just a bit of tissue. It doesn't matter what happens to it. So it's not as if the IVF clinic thinks these are human, tiny little human beings. And I don't care what happens. They don't think they're tiny human beings, so they're not being calloused. So that's why it's so important to make your worldview known to your specialist. Speaker 1 See that Why is it that? Where does that assumption that they're not yet human persons worthy of the same protection as a a born baby or as an adult? Where does that, where does that idea come from that there's a there's a certain period of time where the, where the the embryo is is not a human person, then they become a human person. And how is that point chosen? Speaker 2 Well, it's completely arbitrary, of course, but these, for most of human history, it would have been inconceivable to think that a human being was not a human person. That's the way we've always, always thought about human beings until quite recently. And then in the in the middle of last century, actually, a Christian minister called Joseph Fletcher published a book saying that what makes human beings special is our ability to reason. That's what separates us from animals. And he suggested that a human person is not just someone who has the potential to reason, You need to be actually able to reason at the moment to be a human person. And he quite specifically suggested that not only human embryos and human foetuses, but young children are not human persons, are not worthy of protection of lot of have their lives protected on grounds of not being a human person, and that it's only human persons who have a right to life, not human beings. His idea caught on. He was trying to argue for the legalisation of abortion because of course abortion would matter less if you weren't dealing with a human person who deserve to have their life protected. Now this was very popular with philosophers and they grabbed on to that idea of of it's only a human person who deserves protection in the womb, not just human beings. And many different points are chosen. So it might be implantation it you know, there are various points quickening where the mother can feel the baby. For some it's viability that is, you know, the youngest age at which a child can survive outside the womb. For some of them, it's the time of birth. For some philosophers have suggested that you're not a human person till you're aware that you're an independent person, which is about 18 months of age. But quite a number of academic articles would say that when a child's born, parents should have a month to decide whether they want to keep the baby or not, and it should be legal to kill the child if the parents decide they don't want it. Speaker 1 That has implications for the end of life as well, doesn't it? Speaker 2 You know, and euthanasia of disabled newborns is, is legal in the Netherlands, for example. So it's a very dangerous philosophy to roll out, but that that certainly has been the idea that has been used in many countries to justify abortion. And then there were other decisions that were made about when the time at which human embryos are, the time up to which human embryos can be grown for destructive research. That's 14 days around most of the world. But these are just arbitrary because once you've actually got the embryo with it, the sperm and the the egg are united to create a new Organism. Everything you need for the mature adults is in that single cell and it directs its own development from that time. Any other points along that road of development is sort of the next step and the next step and the next step, but there is no change of the nature of that Organism throughout that pathway. So anytime after fertilisation as a time point at which human personhood begins is completely arbitrary and has been developed because of political expediency. It's definitely not a Christian notion. Speaker 1 But there's something profoundly beautiful about the Christian idea that our personhood doesn't rest on our abilities or our ability to express ourselves or make choices, but it's intrinsic to who we are because we're made in the image of God. But I I guess that brings with it though, a responsibility for us to love and care. Speaker 2 Well, that's right. I think if you look at ideas of personhood generally, it's about qualities, things that the embryo can do, whereas the Christian notion of personhood is based on who we are and we're not. We have intrinsic dignity, but not because of anything we can do is because of the God whose image we reflect. And I think that it's such a comforting thought, but it does make make give us that responsibility to care for those who are unable to care for themselves. And I would think someone told me that to be in your mother's womb is one of the most dangerous places you can be in our society. And, and I just think that is so sad. Unpacking Contraception Myths, Cultural Impact, and Ethical Mechanisms It's tragic as man just for the the remainder of our time together. If I can just move on to a a closely related but in in some ways an opposite issue and that is contraception. Can we think about another young, young Christian couple who are doing marriage preparation and the topic of contraception comes up and, and the the woman has already started on the pill and they're certainly thinking about having kids, but quite a few years down the track after they've they're established in their jobs. That's a very common scenario, isn't it? I think I remember being in a scenario very like that myself. Is it worth articulating some of the assumptions that Couple might be making with regards to contraception there? Speaker 2 Definitely the first thought that comes to mind is that there's a prevailing myth in our society that childbearing can wait. And I think the number of celebrities becoming first time mothers after the age of 35 years has perpetuated A myth that the biological clock can be ignored and childbearing can be safely delayed with today's technology. I know egg freezing is becoming very popular. When we read about these celebrities, what's often not mentioned is that many have used eggs donated by younger women, which can be difficult and expensive to acquire, and possibly a surrogate mother was involved. The number of older women who have tried and failed to conceive in their late 30s and 40s is usually not in the news at all. And while women generally know that their fertility reduces over time, many of them don't know when. 1 survey found that nearly 9 out of 10 young women were confident that they could get pregnant in their 40s. But in fact, a woman's fertility begins to decline at the age of 27. So with regards to fertility, there's only one message in the medical media and that's that women are urged not to delay having children. And sometimes it's our materialistic ideas of, you know, we need to have the house, we need to have the dishwasher, we need to have everything ready before we start a family. But I think that's a very unhelpful way to think about building a family. Speaker 1 And I guess another assumption might be that contraception always works, whereas the reality is, isn't it? If you're having sex, then contraception may well not work. Speaker 2 There is no method that's 100% effective. Speaker 1 Yes. And I have been reading some discussions recently just if we take a step back and think sort of more broadly, more culturally, that one of the impacts of the introduction of contraception is that perhaps we're less open to kids, to having kids as as a good desirable blessing of marriage. I think that's true. Speaker 2 And if you watch television, I don't watch a lot of television, but when I do, there are a lot of programmes which are the cool young adults in with a child free existence. And if you look at polls of, you know, satisfaction and comfort of adults with and without children, life is easier without children. But that's not the point. I think having children might be as scary and challenging blessing, but it's a blessing nonetheless and I just wonder what's going to happen as life goes on for these child free couples if they will continue to find life, their materialistic existence as satisfying in 20 years time as they do at the moment. Speaker 1 And I guess I mean, I know from experience when I find my two daughters and the most magnificent blessing, I'm so thankful for them. But that's not to say that parenthood hasn't been terribly difficult and on almost every scale economically, time wise, energy wise, it is very costly. But I guess again, this is where the rubber hits the road for us in terms of trusting in God's loving Providence. Would you say that? Yeah. Speaker 2 I think the Bible doesn't expressly forbid contraception, and I have argued that in great detail in other places. I think it can have a legitimate place in Christian marriage so long as at some point the couple is open to children by not using contraceptives. And I think one of the purposes of of sex in marriage is to have children and build the family unit. Definitely, I think right back to Genesis. Speaker 1 When it comes to to the various forms of contraception, especially hormonal contraceptives, it seems difficult to be definitive about their exact mechanism of action. And a lot of Christians are concerned about contraceptive contraceptives that may work by essentially aborting the embryo. How difficult is it to be definitive about the exact mechanism of action of some, particularly hormonal contraceptives? Speaker 2 OK, well, I think for Christians, what we're saying is it's not just a question of whether contraceptives are morally permissible, but whether they're morally equal. And confusingly, not all contraceptives are what they appear. That is, not all of them just prevent conception, which is contraception is against conception. That's that's what you'd think they do. So once a decision has been made to use contraception, the mechanism of action of the so called contraceptive needs to be investigated. So what we're trying to do as Christians is to prevent the creation of an embryo, because once the embryo is being created, we're morally belarged to protect it as a human being made in the image of God. So the only way you can stop the creation of an embryo in this situation is to prevent fertilisation of the egg by the sperm. And that seems straightforward. But once again, this idea that. We, we have to talk about what if we're preventing conception? What do we mean by conception? And that goes back to what I was saying earlier about the fact that the definition of conception was originally fertilisation, which is what the experts say it is, and it's what Christians would believe is the point at which a new person is conceived. But it was actually in relation to the development of the oral contraceptive pill that the decision was made to move the definition of conception. Because if conception that is and infers human life only occurs at implantation, which is a week after fertilisation, then you couldn't say that a contraceptive causes an abortion if it acts before implantation. Because you're saying, well, there's no human life so you can't have an abortion. So I hope I've made that clear. It is conceptually quite difficult, but basically in the marketing of the oral contraceptive pill, there was a concern that it may act after fertilisation but before implantation. It would prevent implantation. So to allow them to market it as a contraceptive, they change the definition of conception. Now whether that in fact is an action of the oral contraceptive pill is controversial. Personally I don't think it does, but it's it's controversial and the science it is complicated and I have written about it in fearfully and wonderfully made if people want to know more. But even if we don't know how contraceptives work, we know where a lot of contraceptives work. But you do need to do your research to find out how any particular contraceptives works. Sadly it's not a clear hormone or non hormonal. It's not that straightforward research. Sadly, because of that change in definition of conception, which most doctors aren't aware of, your GP may not be able to help. You'll need to go to specialist Christian sources. As I said, I've I've written about it and fearfully, wonderfully made. Relinquishing Control, Trusting God, and Recommended Christian Resources There are some other Christian. Speaker 1 Books. And yes, we flagged fearfully and wonderfully made a couple of times. I think this is probably just not about it. You wrote that a little while ago. It's very comprehensive, isn't it? I found extremely helpful because it combines both medical research and biblical thinking. And in that book, the chapter on contraception, you do go through a number of different contraceptive agents and sort of look at how they work. Because that that is a it's a key, a key challenge for Christians, isn't it? We're talking to like GPS and pharmaceutical companies who don't think about human personhood right from fertilisation in the same way as we do. So we do need to go to those, those specialist Christian sources. So, yeah. So you've written about that fairly pretty extensively in Fearfully and Wonderfully Made, yes. Speaker 2 And I think the other thing I'd say is one thing we pick up from our society is the need to be in control of every aspect of our lives. That we need to time the the children so they're all this certain period of years apart from each others. And we need to have the right bedrooms and the right colour curtains. And God welcomes us with such generosity. I think if Christian couples could just relax a bit and say we want to be open to children if God blesses us, and perhaps relinquish some of that desire for control, the issue of contraception may not be such a fraught 1. Speaker 1 Thanks Megan that it's been wonderful to talk to you. Thank you for your all your expertise and all your work in this area. Are there some other resources that you would like to suggest Christian couples who were thinking through issues of IVF and contraception might might look at as we've met, we've mentioned fearfully and wonderfully made also, yeah. Are there other resources that might be useful? Speaker 2 I have written a book one. One thing that I found in my research was that a lot of young people aren't aware of normal human development before birth. And I think it's important that we teach our young people that God's method of creating a human being is, well, it's, you know, we are fearfully and wonderfully made. It's, it's a wonderful process, but I think it would be easier for young people to understand human personhood from fertilisation if they realised how quickly and intricately we are made. Even at the embryo stage you can recognise a human being even after just eight weeks of development, so I think there's something. Speaker 1 To be talking about early, isn't it? We need to talk about it before. Speaker 2 Children become sexually active so that if there is an unplanned pregnancy, they don't think do I want to be a mother? They think I'm a mother or a father. What am I going to do now? And in order to promote that sort of conversations, I have written a book called A Life Already Started, which is is aimed at sort of late high school, but I know it's also used by Bible study groups at university. Just to think through the issues of unplanned pregnancy, human development, to think about raising it, you know, the issues of raising a child, adoption, thinking about abortion. Just to be educated about what these things truly mean before they have to make significant decisions for themselves. Because I know as a doctor that people on their deathbed sometimes talk to me about an abortion they had in their youth and the, you know, the persistent regret that's accompanied all through their lives. And you you want to save someone that hardship? Speaker 1 And I guess I mean, all of these issues are not just issues for women or for couples, they're issues for whole churches. We're all interdependent and we all need each other personally. Speaker 2 But if you look at the reasons why young women have abortions, one of the reasons is I come from a Christian family and my parents will kick me out if they know I'm pregnant. You know, the mother of Jesus was an unmarried mother. We, we need to be more welcoming of these brave young women who find themselves pregnant, unmarried and decide they're going to protect their unborn child. And we need a lot of of women, probably the majority don't have an abortion because they don't think they can support themselves through pregnancy and then a child after the birth. And the church should, I think, be much more active in this space to provide resources to help a young woman survive through a pregnancy because the new mother, you know, the single mother's pension doesn't kick in till after the birth. So if they have to stop working in late pregnancy, you know, and they've been kicked out of home, where are they going to live? And someone to teach them how to be a mum afterwards. Speaker 1 And a loving church community can make an enormous difference there. Kind of. I remember 1 of a lovely example of gospel love that I once saw was a young girl who in a church congregation who became pregnant and and the women gave her every bit as lovely a baby shower as they did for any other mum in the church. That's lovely. Then they were there, men and women helping in all sorts of As you say, there are many ways in which a young mum needs help. Speaker 2 This could support a pregnancy support centre. This there are always lots of cots and baby equipment sort of around a church and donating equipment to young women who have no one looking after them. But that's, that's a wonderful example. And I, I like to see more of that, yeah. Speaker 1 We could talk a great deal more along those lines, but we've run out of time for now. Thank you, Megan. And yeah, it's our prayer. It's just that that God will continue to bless you and bless many people through your ministry. And we'd love to see many, many more people interacting with your resources. So thanks for talking to us today, Megan. Speaker 2 And if people would like to receive our newsletter from Ethic Centre, which is an online hub of Christian ethics, they can look up ethic<spelling>centre</spelling>.com. Speaker 1 We'll put that website link on our website along with this podcast. Speaker 2 Thank you so much, Robin. Thanks, Megan.