Prenatal testing:
Powerful tools raise serious concerns

		Making Sense  Out of Bioethics  Fr. Tad  Pacholczyk

Each year, more and more prenatal technologies become available to pregnant women that allow them to test whether their children will be affected by certain diseases.

Approximately 450 conditions can currently be diagnosed in utero by testing fetal cells, often through chorionic villus sampling (early in the pregnancy) or through amniocentesis (later in the pregnancy). Based on some pending technologies, this number may soon skyrocket to nearly 6,000 diseases.

Such powerful medical tools raise some serious concerns: are prenatal testing results rapidly becoming the equivalent of death sentences for children in the womb? Prenatal testing does have its valid uses and applications, but the temptation to misuse it is a serious one, so the decision to carry out such testing must be made very carefully, and within a limited set of circumstances.

'Conspiracy of eugenics'

Kaiser Permanente, a large managed health care organization, offered a disturbing statistic regarding prenatal testing in a 2004 New York Times article. When their members in northern California tested their unborn children for cystic fibrosis, some of them tested positive. Of those parents who received a positive test result, a full 95 percent terminated their pregnancies.

When couples learn they have a child affected by Down's Syndrome, the figure is comparable. One argument made in favor of testing for various genetic defects is that the couple can then mentally prepare themselves better for what lies ahead once their child is born. But these sobering statistics indicate that, at least for some diseases, few children can run the gauntlet successfully.

Thus, while prenatal screening may seem to give couples more power, it often actually takes choices away. Society's demand for physical perfection places enormous pressure on couples to "conform to the norm" by aborting less-than-perfect children. When medical professionals advocate prenatal testing, the profession subtly communicates a message that there may be certain lives that are not worth living.

This quiet "conspiracy of eugenics" is beginning to reach to all levels of society, affecting even Catholics and others of a strongly pro-life persuasion. As Dr. John Larsen of the Department of Obstetrics and Gynecology at George Washington University Medical Center put it in the same Times article: "People will come into my office in tears and say they've been against abortion their whole lives, but they'll make an exception for themselves [when their baby is affected]."

Moral guidelines

Against the backdrop of this widespread and growing societal pressure, how can we decide whether we should have prenatal testing done or not? Some basic moral guidelines can be of assistance:

First, if prenatal testing is done with the intention of having an abortion when a defect is discovered, such prenatal testing itself would constitute a gravely immoral kind of action. Even if no anomalies were found, but a mother and father carried out prenatal testing with the firm intention of aborting a defective child, they would be culpable for a seriously sinful decision, and, if they were Catholics, they would need to bring the matter to confession. The intention to commit a serious evil, even if not ultimately acted upon because of circumstances, constitutes grave sin.

Second, prenatal testing is permissible, indeed desirable, when done with the intention of providing early medical intervention to the child. For example, the life-threatening disease known as Krabbe's leukodystrophy can be successfully treated by a bone marrow transplant shortly after birth. If a diagnosis of the disease is made by prenatal testing, the family can initiate the search for a matched bone marrow sample even before the child is born. That way, valuable time can be saved, and the early intervention improves the likelihood of a good outcome.

Certain other diseases like spina bifida can be treated by doing microsurgery on the baby while still inside the womb. Prenatal testing which aims to provide diagnostic information to assist in the treatment of an in utero patient represents a morally praiseworthy use of this powerful technology.

Serene acceptance

Third, prenatal testing to help parents come to a more serene acceptance of a child with a permanent disability would also represent a morally legitimate use of this technology, provided the testing itself would pose minimal risk to the unborn child.

When a couple discovers they are pregnant, they should explicitly discuss the possibility that their child might have a disability. Such discussions, together with prenatal test results, can go a long way in helping them prepare for their child's birth.

There are various resources and Web sites devoted to offering hope, encouragement, and support to parents of children with special needs - especially those whose children are diagnosed with genetic conditions before birth.

A nonprofit organization called Prenatal Partners for Life (www.PrenatalPartnersforLife.org) was founded as a result of one mother's personal experience when she learned her child had a disability similar to Down's syndrome. She organized a network of compassionate, nurturing parents and medical professionals who offer emotional and practical support to parents who have learned that their child will have special needs. Such resources can be of great comfort and assistance to parents who receive an adverse diagnosis from prenatal testing.

Prenatal technologies are indeed powerful tools that must be used with great discernment and circumspection. When used appropriately, these technologies can be a real source of assistance to growing families. Those families that manifest an openness and receptivity to every child God sends them, regardless of their imperfections and ailments, provide a compelling and vitally important witness in our troubled times. Children with special needs certainly bring difficulties and challenges, but they also bring great graces, opening our eyes to deep and important truths about life and the meaning of unconditional love.

Fr. Tadeusz Pacholczyk earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the Diocese of Fall River, Mass., and serves as the director of education at the National Catholic Bioethics Center in Philadelphia, Pa.

What the local church does for marriage

By Beverly Hartberg
ASSOCIATE DIRECTOR, FAMILY MINISTRY, DIOCESE OF MADISON

	This article is part of a series of articles exploring various aspects of marriage. The series is intended to provide information for Catholic citizens as they vote November 7 on a state Marriage Referendum. The referendum would amend the state constitution to provide that only a marriage between one man and one woman shall be valid or recognized in Wisconsin.

What does the local Church in Madison do for marriage? The Diocese of Madison, through the Office of Family Ministry, provides support, enrichment, and healing for couples at various stages of the married life cycle.

For couples contemplating marriage

Following the Wisconsin Pastoral Guidelines for Marriage Preparation, the Diocese of Madison offers Marriage Preparation as a one-day or two-evening program of immediate preparation for engaged couples in the period prior to their wedding.

Facilitated by a team comprised of a priest, deacon, or pastoral minister and two married couples, each Marriage Preparation session addresses self-awareness (family of origin, personal insight, and individual knowledge of oneself), communication (with guidance to share at a feelings level of dialogue), intimacy (relational, sexual, and emotional intimacy), formation of conscience in regard to Natural Family Planning, and sacrament (living out their faith, spirituality, and vocation as a married couple).

The diocesan office provides FOCCUS training to parishes for clergy and mentor couples who will facilitate the assessment process with engaged couples. FOCCUS is offered, in half of the diocesan parishes, to couples who are planning to marry.

Natural Family Planning instruction in several methods is coordinated and provided by the diocese. Both engaged and married couples learn to understand, appreciate, and respect their own fertility, share decisions and discipline, and mutual responsibility in response to being open to new life.

For married couples

Madison Marriage Encounter and Worldwide Marriage Encounter offer five to six weekend retreat experiences throughout the year for married couples to enrich their marriage, discover new ways of relating with one another, and deepen both their relationship and the level of communication between them.

ReFOCCUS, an enrichment process for married couples that can be facilitated in a parish or small group setting, allows married couples to explore their compatibility, communication, parenting, conflict resolution, faith and religion, and careers.

A one-day marriage enrichment seminar, which is offered annually and is open to engaged and married couples of all faiths and denominations, is coordinated by Madison Marriage Ministries, of which the Office of Family Ministry is a member.

For married couples in troubled or crisis marriages, perhaps even considering separation or divorce, Retrouvaille is a weekend retreat program, held two or three times a year, which helps couples find the tools and communication skills to begin working through their difficult issues. Each weekend is followed by monthly sessions to continue the work the couple has begun on the weekend.

Each year Bishop Robert C. Morlino honors married couples who have reached the half-century milestone by celebrating their 50th wedding anniversary with a Mass and a reception.

(For more information on the programs in this article, see the special Catholic Marriage section in this week's Catholic Herald [print edition only].)

Beverly Hartberg is associate director of family ministry in the Office of Justice and Pastoral Outreach of the Diocese of Madison.

Arrival of rains: Brings changes

		Notes from  The Gambia  Tom Brodd

The rainy season has finally arrived in full force within the last week, which means that the farmers are now busy planting their fields. Gambia has two seasons: the wet and the dry.

The dry season lasts from October to June. During the dry season everything that was green turns brown as the hot tropical sun bakes everything. One looks forward to the rains for the change back to green in the landscape.

The rains tend to be of the heavy downpour variety accompanied with heavy winds and thunder and lighting. Erosion is a major problem as there is little or no ground cover to hold the soil.

Return of the frogs

In the city another effect of the rains is the return of the frogs. During the dry season the frogs go into hibernation.

When the rains come, all of the big potholes (since most of the roads in my area are dirt, they have many large depressions and potholes) are alive with frogs - their croaking and their tadpoles. This is a good thing as the flies and mosquitoes also return in copious quantities.

Since most of us are removed from farming and the importance of the rains, we do not appreciate how much the coming of the rains affects the rhythms of people lives. With the rains everyone has to get out to the fields to prepare the soil and plant the crops.

Hungry season

Even in cities most of the open areas are used as fields for growing staple food crops. People here grow their own food. If they miss the early planting rains or the rains are not sufficient, they will go hungry in the following year.

Since the soils here are rather poor, which leads to low yields, most people at planting time are down to two meals a day, as the food stocks from last years' harvests are running low. To make the food last, the most common practice is to cut back on the number of meals. To most people in this part of the world this time of the year is called the hungry season.

Since most farmers farm with hand tools (although some have donkeys for light plowing), that makes for slow arduous work in preparing land and planting. If you miss a day farming because of illness, or other reason, you will have a difficult time trying to make up that lost time.

Different crops

The main staple crops grown are millet, rice, peanut, and some corn along with various vegetables grown mostly in family gardens.

An interesting feature of farming here is that many crops are grown by either men or women but not both; so peanuts and millet are essentially grown by men and women are the primarily growers of rice and vegetables.

This is the time of year for school vacations so children can help their parents in the fields, just as it used to be in America.

Tom Brodd of Madison is living in The Gambia, West Africa, as one of 16 participants in the Catholic Relief Services (CRS) Volunteer Program, which provides U.S. Catholics with opportunities to share their skills and to live in solidarity with their brothers and sisters around the world.

Periodic abstinence: Difficulties and rewards

		A Culture of Life  Professor  Janet E. Smith

A sexual act open to the possibility of procreation ideally represents the kind of bond to which spouses have committed themselves.

Contraceptives, however, convey the message that while sexual intercourse is desired, there is no desire for a permanent bond with the other person. The possibility of an everlasting bond has been willfully removed from the very act designed to best express the desire for such a relationship. It reduces the sexual act to a lie.

Contraception, then, is an offense against one's body, against one's God, and against one's relationship with one's spouse.

Responsible bearing

But must spouses have as many children as is physically possible? This has never been the teaching of the Church. Spouses are expected to be responsible about their childbearing, to bring forth children that they can raise well.

But the means used to limit family size must be moral. Methods of Natural Family Planning (NFP) are very effective means and moral means for planning one's family; for helping spouses to get pregnant when they want to have a child and for helping them to avoid having a child when it would not be responsible to have a child. NFP allows couples to respect their bodies, obey their God, and fully respect their spouses.

Natural Family Planning is not the out-moded rhythm method, a method which was based on the calendar. Rather, NFP is a highly scientific way of determining when a woman is fertile based on observing various bodily signs. The couple who wants to avoid a pregnancy abstains from sexual intercourse during the fertile period. The statistics on the reliability of NFP rival the most effective forms of the Pill. And NFP is without the health risks and it is moral.

Difficulties and rewards

Many find it odd that periodic abstinence should be beneficial rather than harmful to a marriage. But abstinence can be another way of expressing love, as it is between those who are not married, or between those for whom engaging in sexual intercourse involves a significant risk.

Certainly most who begin to use NFP, especially those who were not chaste before marriage and who have used contraception, generally find the abstinence required to be a source of some strain and irritability. Abstinence, of course, like dieting or any form of self-restraint, brings its hardships; but like dieting and other forms of self-denial, it also brings its benefits. And after all, spouses abstain for all sorts of reasons - because one or the other is out of town or ill, for instance.

Important distinction

Couples using NFP find that it has positive results for their marital relationships and their relationship with God. When couples are abstaining during the fertile period, they are not thwarting the act of sexual intercourse since they are not engaging in sexual intercourse. When they are engaging in sexual intercourse during the infertile period, they are not withholding their fertility since they do not have it to give at that time. They learn to live in accord with the natural rhythms of their body. In a word, use of NFP may involve non-procreative acts, but never, as with contraception, anti-procreative acts.

Professor Janet E. Smith is the Fr. Michael J. McGivney Chair of Life Ethics at Sacred Heart Major Seminary in Detroit, Mich. These columns, syndicated by www.OneMoreSoul.com, are excerpts of a longer work by Smith.