The Individual in the Context of Assisted Reproduction: A Theological Approach

1. Introduction

Although the basic methods of medically assisted reproduction (1) have been in use for decades, public interest remains undiminished, whilst bioethical debate is on the rise and the body of specialist literature is extensive. The reasons for this long-standing and systematic concern regarding assisted reproduction are likely to be found both in the ever-increasing number of people resorting to these methods and in continuous scientific progress, which enables the improvement of existing methods as well as the application of new ones. According to a recent study by the World Health Organisation, it is estimated that, by 2022, approximately one in six people worldwide, or 17.5 per cent of the population, will face the problem of infertility 2, a fact which highlights the importance of assisted reproductive technology. Scientific research is moving in this direction, developing methods that were once considered unachievable.

However, the most important reason, in our view, why medically assisted reproduction attracts such great interest is that it seems to constantly overturn certain contested knowledge and long-held beliefs about the most fundamental personal relationships. Whilst the mother was, beyond any doubt, the one who gave birth to the child, through the method of surrogacy (παρένθετη μητρότητα) the3, the fact that she is also the child’s biological mother ceases to be self-evident and obvious. Furthermore, although after the menopause (ἐμμηνόπαυση) it was impossible for a woman to become a mother, this physical limitation was overcome through the method of in vitro fertilisation (ἐξωσωματική γονιμοποίηση) 4. Similarly, whilst it was previously impossible for a widow to have a child by her deceased husband, this has now become possible through sperm freezing. And whilst, from time immemorial, a human being has, biologically speaking, had a mother and a father, through in vitro fertilisation or reproductive cloning this certainty appears to be shaken.

This undermining of the certainties that humankind has held over time regarding how a person comes into being, as well as regarding the most fundamental human relationships—such as that between a child and their mother and father—perhaps more justly compels us to re-examine our understanding of the human person in the light of medical progress in the field of assisted reproduction. Does the concept of the person change when humans intervene in the way they come into being? Do the options available to a woman to have a child without a partner – using sperm from an unknown donor to become a mother once she has passed the age of fertility, or to choose a genetically healthy child of the desired sex through in vitro fertilisation and pre-implantation diagnosis, compromise the dignity of the person or, on the contrary, extend their personal reproductive freedom? 5

The possibilities offered by modern assisted reproductive technologies are not, of course, only to those mentioned above, nor can they be assessed ethically 6 in a generalised and comprehensive manner, because each has its own particular characteristics in terms of human motivations, the means employed and the intended purpose. This ethical assessment is particularly important, as it shapes medical practice, the legal framework governing it, and also the personal views of each individual concerned. However, in the context of this paper, we shall not address7 [that assessment], but shall endeavour to investigate the significance of the person in the context of medically assisted reproduction and to evaluate [that significance] from the perspective of Orthodox theology. More specifically, we shall examine two diametrically opposed approaches: according to the first approach, medical intervention runs counter to the personal nature of the transmission of human life and the dignity of the person, whilst, according to the second approach, [such intervention] broadens the scope of reproductive freedom enjoyed by human beings as persons. Before presenting and evaluating [these two approaches], however, we consider it appropriate to briefly refer to the theological understanding of the person.

2. The theological conception of the person

The term ‘person’ (πρόσωπον) denotes the social nature of human beings and the special value of their lives. As indicated by the etymological origin of the term ‘πρόσωπον’ [πρός (= towards) + ὤψ – ὠπός (= face, sight), derived from the verb ὁράω-ῶ (= to see) 8], human beings do not exist merely as monads, but come into being through a personal relationship and live in communion with their fellow human beings. However, at the same time, by attributing the quality of personhood to human beings, it is affirmed that their life does not merely have a simple value, which can be replaced by some equivalent, but possesses dignity, since every human being is unique and irreplaceable. This dignity, which is expressed, amongst other things, through the recognition of rights, requires that human beings should not be regarded as a means, but as an end in themselves. In accordance with Immanuel Kant’s well-known maxim, it is fitting for a person to behave in such a way as to treat humanity, both in one’s own person and in that of others, as an end in itself and never merely as a means 9.

Human sociability and dignity are argued for, from a theological perspective, primarily on the basis of the teaching concerning the creation of humankind ‘in the image and likeness (κατ’ εἰκόνα καὶ καθ’ ὁμοίωσιν) of God’10. The term ‘in the image’ of God does not describe human beings in and of themselves, but as persons who come into being in relation to God and in reference to Him 11. Beyond this, however, in addition to the personal connection and kinship with God, Who is the giver of life, man also has a personal connection with his parents, who are co-creators. Indeed, man’s earliest experiences, during pregnancy, are of a social nature, since before acquiring an awareness of the ‘self’, he possesses an awareness of the ‘we’12. By regarding man as a creature ‘in the image’ of God, he is elevated to the status of a being who must be honoured and respected absolutely. St Basil the Great characterises man as ‘great’ and asks: ‘For what thing on earth was made in the image of the One who created it?’13 The Holy Fathers of the Church attribute the phrase ‘in the image’ to various human attributes, such as free will, reason, creativity and dominion over creation. St John of Damascus associates ‘in the image’ particularly with man’s freedom to chart the course of his own life 14, whilst St John Chrysostom associates it chiefly with the stewardship of creation, a stewardship entrusted to man 15. Through each of these attributes, humankind reflects God; consequently, the value of human existence lies in humankind’s creation by God and in its relationship with Him, as the image in relation to the prototype 16. This teaching on the creation of humankind forms the basis for the Christian approach to bioethics. Since a person’s personhood derives from God’s creative calling of humankind into existence and from communion with God, as an image in relation to the original, humankind is, consequently, a person from the very beginning of its existence. He does not become a person at a particular moment in his continuous development, but is a person right from the start; he exists as a person.

Man’s choice to disobey God’s commandment and to sin resulted in the darkening of his ‘in the image’ state—that is, the disruption of his relationship with God, with his neighbour and with creation—as well as the loss of his ‘in the likeness’ state, in other words, of his capacity to be like God and to be deified. However, God does not abandon sinful man; rather, through the mystery of the Incarnation of the Son—which is inconceivable to the human mind—human nature is renewed, man’s communion with God is restored, and the sting of death is overcome. Man no longer derives his dignity solely from his origin ‘in the image’ of God, but also from the fact that the Son became a perfect Man, making man a son of God. Every person, regardless of any distinguishing features of sex, race, age, education, abilities or social status—even those considered ‘the least’—is, in the words of Christ, His brother 17 and has God as their Father 18. Finally, the value of human life is also linked to its eschatological perspective. The potential for likeness to God, which is temporarily lost through the Fall, is restored through the crucifixion and resurrection of Christ. Consequently, human beings have inestimable value not only for what they are, but also for what they are called to become, namely, god-like by grace.

3. The view that assisted reproduction is a technique that violates human dignity

Perhaps the most negative stance towards assisted reproduction is held by the Roman Catholic Church, since it morally rejects even the less invasive methods carried out intrauterinely (ἐνδοσωματικά / in vivo), such as homologous artificial insemination (ὁμόλογη τεχνητὴ σπερματέγχυση 19)20. What is particularly interesting in relation to the subject at hand is that the arguments put forward focus on the concept of the person. Even when it comes to a homologous method—that is, one applied to married couples—assisted reproduction is not ethically acceptable because (a) it is contrary to the nature of the transmission of human life and (b) it affects the dignity of the person.

In accordance with the first argument, God entrusts the transmission of human life to an act of love which, by its very nature, is conscious and personal. He blesses the union of man and woman ‘into one flesh’ through the sacrament of marriage and incorporates into the spouses’ communion of love and shared spiritual life the prospect of creating a family. The artificial separation of the conjugal union from the potential for having children clearly contradicts God’s will, whether the aim is to prevent the birth of children, as is the case with 21 contraception, or to conceive a child, as is the case with various methods of assisted reproduction. The separation of childbirth from the loving union of the spouses undermines the personal nature of the transmission of human life and is therefore rejected. As is characteristically emphasised in the Catechism of the Roman Catholic Church, ‘techniques involving only the married couple are perhaps less reprehensible, although they remain ethically unacceptable. They separate the sexual act from procreation. The act that brings a child into being is no longer one through which two people give themselves to one another, but an act that entrusts the life and identity of the embryo to the power of doctors and biologists and places technology above the roots and future of the human person’22”.

…human beings are not merely reproductive specimens of their biological species, but persons who express both what is common to human nature and something new and unique, which cannot be repeated or reproduced. Human beings are created by God through a personal relationship of love between their parents.

According to the second argument, medical intervention in reproduction undermines the dignity of the person. Whilst the child is a gift from God and a living testimony to the union and personal love of the spouses, through medical intervention the child becomes the object of scientific methods of reproduction. As Pope Emeritus Benedict XVI emphasises in an article he wrote whilst he was a cardinal and Prefect of the Congregation for the Doctrine of the Faith, a human being is not merely a reproductive specimen of their biological species, but a person who expresses both the commonality of human nature and something new and unique, which cannot be repeated or reproduced. Human beings are created by God through a personal relationship of love between their parents. He concludes that respect for the dignity of the person dictates that a human being must be the fruit of their parents’ love, and not the result of an artificial or ‘23’ intervention. From the above, it becomes clear, in our view, that the violation of human dignity is deemed to be greater when interventional methods, such as in vitro fertilisation, surrogacy or reproductive cloning, are further explored.

4. Viewing assisted reproduction as a technique designed to expand an individual’s reproductive freedom

The second approach we are examining stands in stark contrast to the first, as it tends towards the acceptance of any possibility offered by contemporary medicine, on the grounds that it expands an individual’s freedom of reproduction. There is no doubt that human beings have a right to reproduction, a right which, of course, is constitutionally enshrined, as it is linked to personal freedom. The right to reproduction requires respect for each person’s choice to decide for themselves whether, when and how many children they will have 24. However, the question that arises does not relate so much to natural reproduction as to the multitude of possibilities offered by modern medical science today, and is posed as follows: do modern techniques, such as post-mortem fertilisation, the use of donated genetic material, genetic enhancement of the child, sex selection, surrogacy, reproductive cloning, etc., also fall within the scope of an individual’s right to reproduction?

In this context, we refer to the views of experts who answer this question in the affirmative. Although one might note some partial differences, a central position in their argument is held by the individual’s freedom of reproduction. According to this freedom, reproduction is a particularly significant human activity, as it shapes, to a large extent, a person’s personal identity as well as their own life. Consequently, respect for reproductive freedom does not consist merely in protection from external interference and unlawful restrictions, but also encompasses making the most of the possibilities offered by medicine, so that individuals may shape their reproductive choices, in accordance with their personal principles and wishes 25. Since, naturally, a person’s right to reproduction is linked to their freedom, this right forms part of the fundamental rights of the individual and is placed on a par with freedom of expression and religious conscience. From this perspective, reproductive freedom is not merely argued for as a better option, but is directly linked to human dignity. Thus, depriving a person of available reproductive choices is considered to be an affront to their dignity 26. Consequently, whilst, according to the previous approach, assisted reproduction is rejected on ethical grounds because it affects a person’s dignity, in the present case, the person’s dignity is not only not a ground for rejection but, on the contrary, requires the acceptance of the reproductive techniques that are offered as possibilities for a better expression of the person’s reproductive freedom.

To the legitimate question of whether invoking reproductive freedom is sufficient to justify the acceptance of all reproductive methods and techniques, John Harris answers in the affirmative, citing as the sole exception any potential threat to society or any infringement of the rights of others. In such a case, however, the harm suffered by society or one’s fellow human beings must be real and present, not hypothetical or future. The opposing view or the disapproval of the majority of society towards certain methods of reproduction does not, in his opinion, constitute sufficient grounds for prohibiting a person from using a method available to th27e. Torbjörn Tännsjö shares this view, but wonders about the possibility that the harm relates to the child yet to be born. In this context, he examines the case of prospective parents who, with a statistically significant probability, could give birth to a child with a serious hereditary disease and who wish to undergo in vitro fertilisation but reject pre-implantation diagnosis. The Swedish professor of philosophy fully accepts that, in this case, the ban seems logical and appealing; however, he does not suggest restricting reproductive freedom, as he believes it is preferable to allow individuals to make mistakes in their reproductive choices rather than have the state determine what is right and what is wrong, because this could lead to eugenic28 policies. He therefore emphasises the need to respect an individual’s choices and justifies the use of assisted reproductive technologies even in the absence of health or fertility issues 29.

5. A critical examination from the perspective of Orthodox theology

One observation that readily emerges from a comparison of these two diametrically opposed approaches is that both focus their arguments on the dignity of the person. According to the first approach, medically assisted reproduction methods undermine human dignity, which is why these methods are rejected. Conversely, according to the second approach, a person’s reproductive choices are broadened, which is why these methods are accepted. This difference in assessment stems from the fact that the dignity of the person under consideration relates to different subjects: the Roman Catholic Church’s assessment focuses primarily on the unborn child, whilst the corresponding assessment by many specialists focuses on the person wishing to have a child. This difference is rooted in the differing views of the unborn child and, specifically, whether or not to attribute the status of a person to it, as well as the rights that derive from this [status]. This subject represents one of the most fundamental themes in bioethics, as it concerns not only the ethical consideration of assisted reproduction methods, but also all applications that have the unborn child as their object 30. For this reason, in this paper, we do not go into detail regarding this issue, but limit ourselves to a critical examination of the two views we have presented.

The Roman Catholic Church’s approach rightly emphasises, in our personal view, the importance of the sacrament of marriage and the personal nature of the transmission of life, but it does not sufficiently explain why medical intervention, which assists the reproductive process where a biological dysfunction is identified, necessarily offends the dignity of the unborn child. A departure from the erotic act does not always sever the link between the spouses’ communion of love and procreation, and the child does not cease to be a fruit of this love 31. As emphasised in a text published by the Ecumenical Patriarchate under the title ‘For the Life of the World’. The Social Ethos of the Orthodox Church, ‘the Church has no objection to the use of certain modern and constantly evolving reproductive technologies by couples who sincerely wish to have children, but are unable to do so without external assistance. At the same time, however, the Church cannot approve methods that lead to the destruction of ‘countless’ fertilised eggs. The essential criterion for assessing whether each available reproductive technology is lawful must be the inalienable dignity and incomparable value of every human life. As medical science continues to advance in this field, Orthodox Christians, both laity and clergy, will need to bear this point in mind whenever a new method emerges, with the aim of helping couples to conceive and have children, whilst also examining whether this method respects and honours the sacredness of the relationship between the two spouses32 Therefore, from an Orthodox perspective, assisted reproduction is not considered, by definition, to offend human dignity, provided that the method involves married couples, is of a therapeutic nature, does not offend the sanctity of the sacrament of marriage, and does not lead to the destruction of embryos 33.

From an Orthodox perspective, assisted reproduction is not considered, by definition, to offend human dignity, provided that the method involves married couples, is of a therapeutic nature, does not offend the sanctity of the sacrament of marriage and does not lead to the destruction of embryos.

The view that assisted reproduction is a technique intended to broaden an individual’s reproductive freedom and, for this reason, to morally justify the use of any available method, is, in our opinion, highly problematic. First and foremost, although a person’s reproductive freedom is, in fact, expanded—because they have more options 34—at the same time, and paradoxically, it is also restricted, as it is accompanied by certain conditions relating to the method chosen. Instead of simply wishing to have a child, a person wishes to have a child within a specific timeframe, free from illness, of a particular sex or with certain characteristics 35. However, when a child is desired only insofar as they fulfil their parents’ wishes and expectations, they are treated as a means rather than an end. Indeed, for an act to be ethically acceptable, good intentions alone are not sufficient; its means and consequences must also be analysed together. In other words, although it is natural and legitimate for prospective parents to wish for a healthy child, not every method leading to the fulfilment of this wish is always ethically justifiable.

This difference in assessment stems from the fact that the dignity of the person under consideration relates to different subjects: the Roman Catholic Church’s assessment focuses, first and foremost, on the unborn child, whilst the corresponding assessment by many specialists focuses on the person wishing to have a child.

For example, in vitro fertilisation, which is the best-known and most widely used method of assisted reproduction, usually results in the creation of many embryos, of which the desired number is transferred into the woman’s body for fertilisation, whilst the remaining embryos, which are regarded as surplus, are either frozen for future use or used for experimental purposes. The term ‘surplus embryos’ is indicative of the devaluation of the human person, since it places them in the category of matter, as if they were a kind of utilitarian object that may be left over or deemed surplus to requirements. From our point of view, it is paradoxical and contradictory that, whilst invoking a person’s reproductive freedom, a method of reproduction should be regarded as legitimate when, through it, human beings are devalued and underestimated.

We shall round off our critical examination of this approach with one further observation: a person’s freedom of reproduction cannot be viewed merely as an individual matter, because having a child also concerns another person, and that child, naturally for many years after birth, needs parental love, care and protection. Consequently, procreation entails, beyond the individual’s right, a responsibility towards the child who comes into being. And the responsibility borne by the prospective parent certainly also influences their freedom of procreation, as they are duty-bound to give serious consideration to the best interests of their child 36. When a woman without a husband uses the sperm of an unknown donor to become a mother, she deprives her child of a parent. Furthermore, when she chooses surrogacy, several people assume the role of parent, thereby creating confusion in personal relationships within the family and possibly disrupting its unity 37. And since procreation pertains precisely to the most fundamental human relationships and to the child’s best interests, what takes precedence is not the expansion of options, but the exercise of personal responsibility.

Imagine

• 1

  I have retained certain specific terms in Greek to make them easier to identify in technical literature (translator’s note).

• 2

  The full study is available via the following link: https://www.who.int/publications/i/item/978920068315. For a brief summary of the key findings of this study, see https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility.

• 3

  Or surrogate (translator’s note).

• 4

  Also known as in vitro, which refers to the creation of the embryo in a test tube and its transfer to the future mother’s womb (translator’s note).

• 5

  The prospects for the development of contemporary genetics are unpredictable, given that they may even involve the genetic re-engineering of humankind or the elimination of the distinction between the two sexes; see Marianós Karasis, Sensations and Illusions of Progress. Studies and Essays, Thessaloniki, 2010, pp. 253–261.

• 6

  Or morality. In Greek, the same term, ‘ηθική’, is used for the Romanian terms ‘morală’ and ‘etică’. The difference between them, as regards Orthodox Christian theological language in Romanian, is that ‘morale’ also involves reference to the teachings of the Church, whereas ‘ethics’ refers more to the norms of civic conduct (translator’s note).

• 7

  With the author’s consent, I have added clarifications, nuances and the like in square brackets to aid a clearer understanding of the text (translator’s note).

• 8

  That is to say, ‘the view or face towards’. In the specialist literature, there are other etymological interpretations of the Greek term ‘πρόσωπον’. See, for example, the meaning ‘that which is / lies before (another’s) eyes’, in Remus Mihai Feraru, ‘Being and Substance, Hypostasis and Person: considerations regarding the development and crystallisation of Trinitarian terminology in the 2nd–4th centuries’, in Revista Teologică 97/3 (2015), p. 9, note 21 (translator’s note).

• 9

  Immanuel Kant, ‘Grundlegung zur Metaphysik der Sitten’, in Kants Werke, vol. 4 (Akademie Textausgabe), Berlin, 1968, p. 429.

• 10

  Genesis 1:26.

• 11

  Nikos Matsoukas, Dogmatic and Symbolic Theology, Vol. III, Thessaloniki, 1997, pp. 192–195; Georgios Mantzaridis, Christian Ethics, Vol. II, Thessaloniki, 2003, pp. 22–23.

• 12

  Ibid., op. cit., vol. I, Thessaloniki, 2002, p. 108.

• 13

  St Basil the Great, On Psalm 48 (Εἰς τόν ΜΗ´ Ψαλμόν), 8, in PG 29b, 449 B: ‘For what else on earth has been made in the image of its Creator?’

• 14

  Saint John of Damascus, The Exact Exposition of the OrthodoxFaith (Ἔκδοσις ἀκριβής τῆς ὀρθοδόξου πίστεως), 2, 12, in PG 94, 920.

• 15

  St John Chrysostom, To Stagirius (Πρός Σταγείριον), 1, 2, in PG 47, 427–428; idem, On Statues (Εἰς Ἀνδριάντας), 7, 2, in PG 49, 93.

• 16

  Stavros Kalantzakis, Interpretation of Passages from the Old Testament, Thessaloniki, 1999, pp. 55–62; John Breck, The Sacred Gift of Life: Orthodox Christianity and Bioethics, New York, 2000, pp. 8–9 and 28–29.

• 17

  Matthew 25:40 and 45.

• 18

  Matthew 6:9.

• 19

  This type of artificial insemination is a technique aimed at achieving a human pregnancy by transferring, into the genital tract of a married woman, sperm previously collected from her husband (translator’s note).

• 20

  The Roman Catholic Church’s negative stance on assisted reproduction methods remains firm. The first time it officially took a stance on this issue was in 1987, when the Congregation for the Doctrine of the Faith was asked whether artificial fertilisation was ethically permissible. At that time, the Commission gave a brief and clear answer: It is not permitted; see H. Denziger, A. Schönmetzer, Enchiridion Symbolorum, Definitiorum et Deklarationum de rebus fidei et morum, Freiburg, 1999, paragraph 3323. Since then, many leaders of the Roman Catholic Church have taken a negative stance on assisted reproduction, emphasising that the transmission of human life is a personal act of loving union between spouses, an act which is subject to God’s holy commandments, which no one is permitted to disregard. The most systematic examination of assisted reproduction was carried out in 1987 by the Congregation for the Doctrine of the Faith, in the document ‘Instruction on Respect for Human Life from its Origin and on the Dignity of Procreation’, also known as Donum vitae, see http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html. These same positions are reiterated both in 1995, in the encyclical Evangelium vitae, which sets out the Church’s doctrine on bioethical issues, and in subsequent editions of the Catechism of the Roman Catholic Church. For the text of the encyclical Evangelium vitae, see http://w2.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html.

• 21

  Contraception is not accepted by the Roman Catholic Church, in accordance with the teachings of the papal encyclical Humanae vitae. For the text of the encyclical, see http://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae.html. For further details on its arguments, see Germain Grisez, Joseph Boyle, John Finnis, William May, The Teaching of Humanae Vitae: A Defence, San Francisco, 1988, as well as Kevin McMahon, ‘Theological Development of Catholic Teaching on Contraception and Family Planning’, in Russell E. Smith (ed.), Communicating the Catholic Vision of Life, Braintree, 1993, pp. 265–280.

• 22

  Catechism of the Catholic Church, http://www.vatican.va/archive/ENG0015/_INDEX.HTM, para. 2377.

• 23

  Cardinal Joseph Ratzinger, ‘Man between Reproduction and Creation. Theological Questions on the Origin of Human Life’, in Reinhard Löw (ed.), Bioethics: Philosophical and Theological Contributions to a Controversial Topic, Cologne, 1990, pp. 28–32. For an analytical presentation of the Roman Catholic Church’s positions on assisted reproduction, see Miltiadis Vantsos, The Sanctity of Life. A Presentation and Evaluation from the Perspective of Orthodox Ethics of the Roman Catholic Church’s Positions on Bioethics, Thessaloniki, 2010, pp. 235–275, particularly pp. 237–250.

• 24

  Thanasis Papachristos, ‘The Right to Have Children and Its Limitations’, in St. Tsinorema, L. Kitsos (eds.), Topics in Bioethics. Life, Society and Nature Faced with the Challenges of the Life Sciences, Heraklion, 2013, pp. 275–276.

• 25

  Catherine Mills, ‘Reproductive Autonomy as Self-Making: Procreative Liberty and the Practice of Ethical Subjectivity’, in Journal of Medicine and Philosophy, 38 (2013), pp. 639–656; Dan Brock, ‘Cloning Human Beings: An Assessment of the Ethical Issues Pro and Co’, in B. Steinbock, J. Arras, A. J. London (eds.), Ethical Issues in Modern Medicine, Boston, 2003, pp. 633–634.

• 26

  John Harris, ‘“Goodbye Dolly?” The ethics of human cloning’, in Journal of Medical Ethics 23 (1997), pp. 358–359. John Robertson, whilst sharing the same viewpoint, does not arrive at exactly the same conclusion. He rejects, on ethical grounds, techniques such as the genetic enhancement of the unborn child and reproductive cloning, as they deviate significantly from the fundamental interests of reproduction. And he concludes: ‘freedom of procreation would protect only those actions intended to enable a couple to have normal, healthy offspring whom they intend to raise’ (ibid., Children of Choice: Freedom and the New Reproductive Technologies, Princeton, 1994, p. 167).

• 27

  John Harris, Enhancing Evolution: The Ethical Case for Making Better People. Princeton, 2007, p. 74. Richard Dworkin expresses exactly the same view; see idem, Life’s Dominion: An Argument about Abortion and Euthanasia, London, 1993, p. 148.

• 28

  Torbjörn Tännsjö, ‘Our right to in vitro fertilisation – its scope and limits’, in Journal of Medical Ethics 34 (2008), pp. 805–806.

• 29

  Ibid., p. 804.

• 30

  Based on the theological understanding of the person, which I have summarised in that section, it is clear that, for Orthodox theology, human beings are persons from the very beginning. For a theological approach to this subject, see Miltiadis Vantsos, An Ethical Consideration of Abortion, Thessaloniki, 2009, pp. 49–108 and 171–229.

• 31

  Miltiadis Vantsos, The Sanctity of Life…, pp. 246–249.

• 32

  Ecumenical Patriarchate, ‘In Defence of Life in the World. The Social Ethos of the Orthodox Church’, paragraph 24, at https://www.goarch.org/el/social-ethos. The position of both the Patriarchate of Moscow and the Church of Greece on this matter is similar. In the text issued by the Moscow Patriarchate, entitled ‘ThePrinciples of the Social Doctrine of the Russian Orthodox Church’, it is stated that artificial insemination carried out within the context of marital relations is accepted, as it does not undermine the integrity of marriage and does not differ substantially from natural conception; see https://mospat.ru/gr/documents/social-concepts/xii/. For the corresponding position of the Church of Greece, see Επίσημα Κείμενα Βιοηθικής, Athens, 2007, art. 77, p. 82; compare with http://www.bioethics.org.gr/03_b.html#5.

• 33

  For the Orthodox view on assisted reproduction methods, see Metropolitan Nikolaos (Hatzinikolaou), ‘The Greek Orthodox position on the ethics of assisted reproduction’, in Reproductive BioMedicine Online 17, 3 (2008), pp. 25–33.

• 34

  Robert Sparrow adds to a person’s reproductive options the possibility of a man carrying a pregnancy, which may well one day become a reality. Based on the widely promoted argument for expanding an individual’s reproductive freedom, R. Sparrow concludes that this option cannot be rejected. However, he does not support it himself, but rather seeks to demonstrate, by reductio ad absurdum, that reproductive freedom must have concrete limits; see idem, ‘Is it “every man’s right to have babies if he wants them”? Male pregnancy and the limits of reproductive liberty’, in Kennedy Institute of Ethics Journal 18, 3 (2008), pp. 275–299.

• 35

  Eberhard Schockenhoff, ‘Freedom of Reproduction and Responsible Parenthood: On the Ethical Issues of Pre-implantation Genetic Diagnosis’, in Zeitschrift für Medizinische Ethik 49 (2003), p. 381.

• 36

  Eleni Kalokairinou, ‘Reproductive autonomy and ethical responsibility: Reflections on the techniques of medically assisted reproduction’, in M. Kanellopoulou-Boti, F. Panagopoulou-Koutnatzi (eds.), Bioethical Concerns, Athens, 2014, pp. 139–141.

• 37

  Onora O’Neill, Autonomy and Trust in Bioethics, Athens, 2011, p. 90; Vasileios Kalliamanis, ‘The Theological Perspective on the Right to Reproduction’, in Friendship and Society. A Festschrift in Honour of Professor Gregory Ziakas, Thessaloniki, 2008, pp. 254–255.