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Toward a Theology of Infertility and the Role of Donum Vitae

  • Kathryn Lilla Cox (a1)

A theology of infertility is needed to help couples and the broader ecclesial community understand the theological implications of infertility. Infertility raises questions about human freedom, finitude, embodiment, childlessness, and parenthood. In this article, dominant cultural assumptions surrounding each of these areas when considering reproductive technologies are sketched. Official Roman Catholic teaching on reproductive technologies (Donum Vitae), while rejecting most forms of such technologies, does provide a viable response to the presupposition that reproductive technologies resolve infertility. Given the dominant cultural assumptions and insights from Roman Catholic teaching, this article advocates for several ecclesial changes when considering infertility. Finally, theological resources for developing a theology of infertility are offered. Specifically, insights from Karl Rahner's theology of concupiscence are examined with an eye toward how they provide a framework for rethinking the cultural assumptions about freedom and finitude when considering reproductive technologies.

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1 Throughout the article, “assisted reproductive technologies” and “reproductive technologies” will be used interchangeably.

2 The issues include the procurement of sperm, the status of the embryo, the goods of marriage, universal norms/absolute norms, the nature of the person in relation to faith, our understanding of parenthood, the role of the will of God in creation, the distinction between morality and public policy, the understanding of natural law, and economic questions, among others. The series Readings in Moral Theology, ed. Curran, Charles and McCormick, Richard (New York: Paulist, 1979–) examines many of these themes. See also Ryan, Maura, The Ethics and Economics of Assisted Reproduction: The Cost of Longing (Washington, DC: Georgetown University Press, 2001); Kilner, John F., Cunningham, Paige C., and Hager, W. David, eds., The Reproduction Revolution (Grand Rapids, MI: Eerdmans, 2000).

3 Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae), March 19, 1987 (Boston: Pauline Books and Media, 1987); also available at (the English translations vary slightly; I have used the Pauline Books version); Congregation for the Doctrine of the Faith, Instruction on Certain Bioethical Questions (Dignitas Personae), December 18, 2008, While released in December 2008, Dignitatis Personae was approved on June 20, 2008 by Pope Benedict XVI and signed by William Cardinal Leveda, prefect for the CDF, on September 2, 2008.

4 The success rate varies for any number of reasons, including age, where younger women have more success becoming pregnant with reproductive technologies than older women. On the Centers for Disease Control and Prevention web site, see “Infertility FAQ's,” The statistics cited in the FAQ's come from data in two reports from the CDC, 2010 ART Fertility Clinic Success Rates Report ( and 2010 ART National Summary Report (

5 I would argue that these same presuppositions underlie, in part, the critique of celibacy as a valid and worthwhile vocation, as well as human discomfort with singleness beyond a certain age. However, the similarities and differences between celibacy, single life, and married childlessness cannot be explored in this article.

6 In this article, I rely on a definition of marriage as between one man and one woman. I remain cognizant of the debates in contemporary society regarding expanding the definition of marriage to include same-sex couples. Additionally, since this article focuses on infertility, I will frequently use the term “infertile couple,” even though those who suffer from infertility are defined by more than their infertility.

7 For additional questions that need further study, see Kelly, Kevin T., Life and Love: Towards a Christian Dialogue on Bioethical Questions (London: Collins Liturgical Publications, 1987), 147–52.

8 Frantz, Nadine Pence and Stimming, Mary T., eds., Hope Deferred (Cleveland: The Pilgrim Press, 2005), 6.

9 Ryan, Maura A., “Particular Sorrows, Common Challenges: Specialized Infertility Treatment and the Common Good,” Annual of the Society of Christian Ethics (1994): 187206; see 192 n. 11.

10 An exception to this celebration was the critical coverage of the birth of octuplets to Nadya Suleman in 2009. Given the positive coverage of other multiple births, one wonders if part of the criticism was due to her single status, raising the question of whether the coverage would have been more positive if she had been married. The influence of Oprah Winfrey's talk show in framing and thinking about various cultural, political, and ethical issues, such as the ethics of assisted reproductive technologies are beyond what can be considered in this article. For an examination of Oprah's media influence, see Cotten, Trystan T. and Springer, Kimberly, Stories of Oprah: The Oprahfication of American Culture (Jackson, MS: University Press of Mississippi, 2010): Lofton, Kathryn, Oprah: The Gospel of an Icon (Berkeley: University of California Press, 2011).

11 John M. Staudenmaier, SJ, “Electric Lights Cast Long Shadows: Seeking the Greater Good in a World of Competing Clarities,” April 14, 2005, Boardman Lectureship in Christian Ethics, ed. Adam Graves,; Staudenmaier, , “To Fall in Love with the World: Individualism and Self-Transcendence in American Life,” Studies in the Spirituality of Jesuits 26.3 (May 1994), 128.

12 McCormick, Richard A., Corrective Vision: Explorations in Moral Theology (Kansas City, MO: Sheed & Ward, 1994), 165–66.

13 Arendt, Hannah, The Human Condition (Chicago: University of Chicago, 1958), 139–58. In this work, Arendt analyzes human alienation from each other and the world. One aspect of her analysis focuses on human attempts to control and dominate “nature.” Her critique of homo faber, our relationship to work and labor, and utilitarianism can also be applied to notions of human freedom. Thus we can arrive at a negative definition of freedom. Freedom does not permit unlimited choices, nor does it permit treating others through the lens of their usefulness or as an object or means to an end.

14 See Cahill, Lisa Sowle, Sex, Gender, and Christian Ethics (1996; reprint, Cambridge: Cambridge University Press, 1996), chap. 7.

15 Harwood, Karey, The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies (Chapel Hill, NC: University of North Carolina Press, 2007).

16 Ryan, The Ethics and Economics of Assisted Reproduction. Access to reproductive technologies is alleviated for some when they use a surrogate in India. This type of “medical tourism” is growing, highlighting the belief that we should have freedom of choice and access to all options for pursuing our dreams and fulfilling our desires. See Nilanjana S. Roy, “Protecting the Rights of Surrogate Mothers in India,” New York Times, October, 4, 2011.

17 Harwood, The Infertility Treadmill, 39. RESOLVE is a national nonprofit organization founded in 1974. It offers support groups and takes various advocacy roles governing reproductive technologies. For more information see the RESOLVE web site at

18 McCormick, Corrective Vision, 166. McCormick argues that “value variables” are intertwined with and nourish each other. Therefore, “value variables” often need to be examined together.

19 Miroslav Volf, introdution to Frantz and Stimming, Hope Deferred, vii. The book Hope Deferred is a collection of essays by theologians who have suffered some form of reproductive loss, including infertility. Insights into the tussles with finitude are found throughout the essays.

20 Ryan, “Particular Sorrows,” 196. For more patient perspectives, along with some analysis of the emotional and psychological effects of infertility and the use of reproductive technologies, see Patient Perspectives,” in Assisted Reproductive Technologies: Analysis and Recommendations for Public Policy (New York: The New York State Task Force on Life and the Law, 1998), 117–34.

21 For a description of the dimensions of this suffering, see Ryan, “Particular Sorrows,” 195–200; Nadine Pence Frantz, “Why,” in Frantz and Stimming, Hope Deferred, 15–30, at 15–16; Mary T. Stimming, “Sorrow,” in Hope Deferred, 33–45, at 34.

22 Lorber, Judith, “Choice, Gift, or Patriarchal Bargain? Women's Consent to In Vitro Fertilization in Male Infertility,” in Feminist Perspectives in Medical Ethics, ed. Holmes, Helen Bequaert and Purdy, Laura M. (Bloomington: Indiana University Press, 1992), 169–80.

23 The Pope Paul VI Institute in Omaha, Nebraska, is addressing these issues.

24 See Alpern, Kenneth D., ed., The Ethics of Reproductive Technology (Oxford: Oxford University Press, 1992).

25 Ryan, “Particular Sorrows,” 198–99.

26 Stimming, “Sorrow,” 33–45.

27 See Linda A. Mercadante, “Faith,” in Frantz and Stimming, Hope Deferred, 87–99; Nadine Pence Frantz and Mary T. Stimming, introduction to Hope Deferred, 3–8. Frantz and Stimming draw on several authors in their discussion, including Lisle, Laurie, Without Child: Challenging the Stigma of Childlessness (New York: Ballantine Books, 1996), and May, Elaine Tyler, Barren in the Promised Land: Childless Americans and the Pursuit of Happiness (Cambridge, MA: Harvard University Press, 1997).

28 Oduyoye, Mercy Amba, “A Coming Home to Myself: The Childless Woman in the West African Space,” in Liberating Eschatology, ed. Farley, Margaret A. and Jones, Serene (Louisville, KY: Westminster John Knox Press, 1999), 105–20, at 108.

29 Ibid., 119.

30 Cahill, Sex, Gender, and Christian Ethics, 121–216.

31 Reproductive technologies often keep the focus on the couple and the desires of the potential parents. In other words, the technology, when successfully used, provides children for childless couples. This is different from adoption, which, while fulfilling the desire for a child, also finds parents for a parent-less child. See Demmer, Klaus, “Ethical Aspects of Reproductive Medicine,” in Andrology: Male Reproductive Health and Dsyfunction, ed. Nieschlag, Eberhard, Behre, Hermann M., and Nieschlag, Susan (New York: Springer, 2010), 601–12.

32 Rae, Scott B. and Core, John H., “Reproductive Technologies and the Theology of the Family,” Ethics and Medicine 10.1 (Spring 1994): 1121.

33 See, e.g., Post, Stephen G., “Adoption Theologically Considered,” Journal of Religious Ethics 25.1 (March 1, 1997): 149–68; for responses to Post's essay, see Elizabeth McKeown, “Adopting Sources: A Response to Stephen Post,” ibid., 169–75; and William Werpehowski, “The Vocation of Parenthood: A Response to Stephen Post,” ibid., 177–82.

34 For several responses to and analyses of Donum Vitae, see Spagnola, Antonio G., Pietro, Maria L. Di, and Sgreccia, Elio, “Reproductive Technologies in the Light of Vatican Instruction,” Ethics and Medicine 5.1 (1989): 911; Shannon, Thomas A. and Cahill, Lisa Sowle, Religion and Artificial Reproduction: An Inquiry into the Vatican “Instruction on Respect for Human Life in Its Origin and on the Dignity of Human Reproduction” (New York: Crossroad, 1988); Bernardin, Joseph Cardinal, “Dignity of Procreation: Science and the Creation of Life,” Origins 17.2 (May 28, 1987): 21, 23–26.

35 See, e.g., Hilgers, Thomas W. and Sr. Wallace, Marilyn, eds., The Gift of Life: The Proceedings of a National Conference on the Vatican Instruction on Reproductive Ethics and Technology (Omaha: Pope Paul VI Institute Press, 1990) (contributors include Joseph Boyle, Rev. R. Cessario, Lorna Cvetkovich, Germain Grisez, Rev. R. Lawler, William May, Rev. J. Sheets, Janet Smith, and William Wagner); Pellegrino, Edmund D., Harvey, John Collins, and Langan, John P., eds., Gift of Life: Catholic Scholars Respond to the Vatican Instruction (Washington, DC: Georgetown University Press, 1990) (contributors include J. Harvey, M. Damewood, J. Huber, J. Langan, B. Schüller, J. Haas, Msgr. Sgreccia, and Lisa Sowle Cahill); Johnstone, Brian V., “The Instruction Donum Vitae and Its Reception,” Studia Moralia 26 (1988): 209–29.

36 Kelly, Life and Love, chap. 2, esp. pp. 106–10, at 106–7. In the postscript, Kelly indicated that he knew that the CDF would be issuing a document.

37 Donum Vitae, II, B, 4, citing Humanae Vitae, art. 12.

38 Donum Vitae, II, B, 6–7; Dignitas Personae, arts. 12 and 13.

39 The first three are discussed in Dignitas Personae. While varicocele is not listed, given the criteria for permitting the first three, treating varicocele would be permitted. See Dignitas Personae, art. 13.

40 Cahill, Lisa Sowle, Family: A Christian Social Perspective (Minneapolis: Fortress Press, 2000), 4860.

41 Ryan, The Ethics and Economics of Assisted Reproduction, 155–56.

42 For work analyzing Roman Catholic theological anthropology regarding women, see Ruether, Rosemary Radford, Sexism and God-Talk: Toward a Feminist Theology (Boston: Beacon Press, 1983, 1993), esp. chap. 4. For constructive attempts toward a feminist retrieval of anthropology see Graff, Ann O'Hara, ed., In the Embrace of God: Feminist Approaches to Theological Anthropology (Maryknoll, NY: Orbis Books, 1995); Carr, Anne and Fiorenza, Elisabeth Schüssler, eds., Motherhood: Experience, Institution, Theology (Edinburgh: T&T Clark, 1989); Teevan, Donna, “Challenges to the Role of Theological Anthropology in Feminist Theologies,” Theological Studies 64.3 (September 2003): 582–97; Abraham, Susan and Procario-Foley, Elena G., eds., Frontiers in Catholic Feminist Theology: Shoulder to Shoulder (Minneapolis: Fortress Press, 2009), esp. pt. 1.

43 Pope John Paul II, “Letter of John Paul II to Women,” June 29, 1995,, art. 10 (emphasis in the original).

44 Pope John Paul II, Apostolic Letter, On the Dignity and Vocation of Women (Mulieris Dignitatem), August 15, 1988,, art. 17. For similar reasoning, see Pope John Paul II, Apostolic Exhortation, On the Role of the Christian Family in the Modern World (Familiaris Consortio), November 22, 1981,, esp. arts. 17–22 (emphasis in the original).

45 While I would like to say this conundrum does not exist, I have had too many conversations with Catholics who tell me that this is how they see their reality.

46 Donum Vitae, II, B, 4.

47 Pope John Paul II, Familiaris Consortio, arts. 15, 28, and 41.

48 Donum Vitae, II, A, 1 (emphasis in the original). This section cross-references Gaudium et Spes, art. 50.

49 Donum Vitae, II, B, 8.

50 In fact, John Paul II does offer an alternative understanding of procreation: procreation of a just society, dedicated to God. In his “Letter to Women” he makes reference to Genesis 1:28 (“Fill the earth and subdue it”), interpreting it as referring to both procreation and the transformation of the earth. He states, “In this task, which is essentially that of culture, man and woman alike share equal responsibility from the start. . . . To this ‘unity of two’ [husband and wife] God has entrusted not only the work of procreation and family life, but the creation of history itself” (art. 8 [emphasis in the original]). In other words, women and men have an equal role both in the public sphere and in their roles as parents. This understanding of vocation does not restrict women to the vocations of mothers and virgins. Rather, like men, women have vocations and contributions to make toward the common good in addition to parenthood.

51 Donum Vitae, II, B, 8.

52 Ryan, The Ethics and Economics of Assisted Reproduction, 151.

53 Ibid., 154.

54 The Sacramentary (New York: Catholic Book Publishing Co., 1985), 840–50.

55 The infertile are most aware of the blessing and gift language surrounding children. This awareness springs from the fact that they are not included in the group so blessed and gifted, and creates its own theological and spiritual distress for them as they wonder why God is withholding gifts and blessings from them.

56 Rahner, Karl, “The Theological Concept of Concupiscentia,” in Theological Investigations, vol. 1, God, Christ, Mary, and Grace, trans. Ernst, Cornelius (Baltimore: Helicon Press, 1961), 347–82.

57 Ibid., 362 ff.

58 Rahner, Karl, “The Passion and Asceticism,” in Theological Investigations, vol. 3, The Theology of the Spiritual Life, trans. Karl-H. and Kruger, Boniface (Baltimore: Helicon Press, 1967), 69.

59 Ibid.

60 Rahner maintains that the “finite person itself is at the same time always also a nature.” He further states that there is “no point in the concrete existence of man . . . which is not affected by the fate of the nature in the person.” This is because “the possibilities of personal existence always rest essentially on the possibilities of the nature.” In other words, nature forms the contours of the conditions within which freedom acts (Rahner, “The Passion and Asceticism,” 71).

61 Rahner, Karl, “Guilt—Responsibility—Punishment within the View of Catholic Theology,” in Theological Investigations, vol. 6, Concerning Vatican Council II, trans. Karl-H. and Kruger, Boniface (Baltimore: Helicon Press, 1969), 201–2. While Rahner ultimately talks about salvation and damnation in this particular passage, there is insight here for considering responses to infertility.

62 Rahner, “The Passion and Asceticism,” 58–85. In this article Rahner does not use “passion” to mean human emotions or intense emotion, as “passion” sometimes indicates in English usage. Rather, he uses it as a description of a state of existence, a matrix within which one lives, rather than a particular emotion or feeling. As such, I will follow the translator in capitalizing “Passion” to distinguish this existential state from a particular quality or type of emotion.

63 Rahner, “The Passion and Asceticism,” 69.

64 Dale Launderville's work exploring where the celibate fits into the structure and functioning of the ancient household has promise for understanding and articulating more explicitly how we understand the childless in contemporary culture. See his Celibacy in the Ancient World (Collegeville, MN: Liturgical Press, 2010).

65 This is a slight rewording of a question posed by Kelly in Life and Love, 152.

66 See, e.g., Miller-McLemore, Bonnie J., “Produce or Perish: A Feminist Critique of Generativity,” Union Seminary Quarterly Review 43.1–4 (1989): 201–22; Miller-McLemore, “Generativity, Self-Sacrifice, and the Ethics of Family Life,” in Equal-Regard Family and Its Friendly Critics, ed. Witte, John Jr., Green, M. Christian, and Wheeler, Amy (Grand Rapids, MI: Eerdmans, 2007), 1741; Gudorf, Christine, “Papal Ideals, Marital Realities: One View from the Ground,” in Sexual Diversity and Catholicism: Toward the Development of Moral Theology, ed. Jung, Patricia Beattie and Coray, Joseph Andrew (Collegeville, MN: Liturgical Press, 2001), 269–88; Gudorf, “Resymbolizing Life: Religion on Population and Environment,” Horizons 28.2 (2001): 183210, at 207–9.

67 Oduyoye, “A Coming Home to Myself,” 118.

68 I wish to thank my theology colleagues at the College of St. Benedict/St. John's University and the School of Theology-Seminary for discussing the topic of this article with me. My thanks also to the graduate students who wrote sample bulletin inserts and homilies as class assignments and who helped determine how these practices would be helpful in their parishes.  Finally, my thanks to the anonymous reviewers for Horizons for their insightful and helpful comments.

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