Multiply and Replenish
Mormon Essays on Sex and Family
Ethical Issues in Reproductive Medicine
A Mormon Perspective
Lester E. Bush
[p.183]This essay—originally delivered at the University of Utah’s Fifth Annual Birth Defects, Mental Retardation, and Medical Genetics Symposium in 1983—bears on four emerging medical ethical issues: the termination of pregnancies with fetal abnormalities which will not cause serious impairment until well after birth, genetic engineering, in utero surgery, and in vitro fertilization. It does not represent the Mormon perspective but the point of view of a Mormon. The Mormon point of view does not exist on the subjects under discussion. Certainly many hold strong views, and some argue their views reflect those of the LDS church.1 But if one wrote, as I did, to ask the First Presidency—which is solely entrusted with the authority to establish official church policy—if it has “a position, or a doctrine … relating to the subject” of any of the four medical processes this essay addresses, one would be informed that there is not “an official position with respect to the issues raised by the scenarios.” Surprised that this should be so regarding abortion, I wrote again and was referred without elaboration to the “current official policy of the Church with respect to [abortion]” and advised that “the scenarios … should be viewed in light of this policy.”2
With this in mind, let us review the Mormon view of medicine in general, then examine the Mormon record on birth control (the most [p.184]closely related issue on which much doctrinal history exists), abortion, and other related subjects. To the extent that generalizations emerge from this review, I will hazard a guess as to what they might portend for the future.
Although not prominent on the agenda of early Mormonism, medical ethical questions were an early and persistent concern in the church. The first and most conspicuous of these involved what was then termed the heroic medical practice of orthodox physicians. Joseph Smith and his colleagues regularly condemned what they viewed as dan gerous heroics in the treatment of disease.
Given the state of the medical art at that time, this view was pragmatic; but the justification went well beyond what otherwise might have been labelled common sense. As biblical literalists, Mormon leaders felt doctrinally bound to the advice of New Testament apostle James who counseled the sick to “call for the elders of the church; and let them pray over him, anointing him with oil in the name of the Lord” (5:14). Should an additional step be necessary, according to a revelation announced in 1831, sick believers who “[had] not faith to be healed [by priesthood administration] … shall be nourished with tenderness, with herbs and mild food” (D&C 42:43)—guidelines again in harmony with biblical precedents.
Authoritative counsel reinforced these implicitly anti-heroic guidelines in unequivocal terms. During the Mormon trek west, for example, Brigham Young, acting as president of the church after Joseph Smith’s death, advised members of the Mormon Battalion: “If you are sick, live by faith, and let the surgeon’s medicine alone if you want to live, using only such herbs and mild food as are at your disposal.”3
At least at the theoretical level, this anti-heroic ethic extended to severe cases such as that of Elizabeth Morgan, a fifty-five-year-old convert living in London in 1842. She had a “spasmodic affection” which one day developed into an inflammation of the bowel. Despite a rapid deterioration in her condition, treatment was limited to anointing “with oil in the name of the Lord, … sage tea with Cayenne pepper, [and] leeches.” All efforts failed and the “beloved sister” died.
The lessons drawn from these developments were revealing. The coroner feeling the “remedy … worse than the disease,” and shocked that no “medical gentleman” or “surgeon” was called in, “had his [p.185]doubts whether [the case was] not one of manslaughter.” A jury was convened to investigate but “after some deliberation returned a verdict of ‘natural death,’ with a hope `that the present inquiry would act as a caution to [the Mormons] how they acted in such cases for the future.'” Mormons reprinted a London Despatch article on the story in their own official journal and added a hyperbolic editorial observing that “what gives deep interest to the fact [of Sister Morgan’s death] and adds solemnity to the scene is that she died a natural death!!!!!” rather than be allowed “the privilege of being killed through the administration of the learned medical faculty.”4
With the passage of time, orthodox medicine became more “scientific,” herbalism fell into disrepute, and LDS opposition to regular medical doctors began to erode. Late in life, Brigham Young sent young Mormons back east to be educated in leading orthodox medical schools and hospitals. Under the influence of this growing cadre of well-educated physicians and a few regular physician emigres, “scientific medicine” came to dominate the Utah medical scene. By the turn of the century, the LDS church had fully embraced modern medicine. The increasingly “state-of-the-art” practice espoused at this time was judged not so much by a doctrinal yardstick as by—in the words of Apostle James Talmage—the “intelligent exercise of common sense.”5 In the words of a Deseret News editorial accompanying the opening of a well-equipped church-sponsored hospital in 1902, “Remedies are provided by the Great Physician or by nature as some prefer to view them and we should not close our eyes to their virtues or ignore the skill and learning of the trained doctor.”6
While herbalism was discarded during the general accommodation, orthodox therapy and priesthood blessings came to be seen as adjuncts to each other, especially when a serious illness was involved. Again, the words of Apostle Talmage, “We must do all we can, and then ask the Lord to do the rest, such as we cannot do. Hence we hold the medical and surgical profession in high regard. … When we have done all we can then the Divine Power will be directly applicable and operative.” This symbiotic relationship has continued to the present. On 19 February 1977, in the face of a resurgence of nineteenth-century anti-medical “fundamentalist” theology, the LDS Church News repeated editorially that “our belief in the divine power [p.186]of healing should in no way preclude seeking competent medical assistance.”
Looking back on this, many would say that God had commended to the early Saints the most effective and safest treatments of the day. While the case for herbalism, even in 1830, is debatable, for our purposes the important point is that general medical judgments were demonstrably pragmatic, even though they were couched in a doctrinal vernacular. This is the same standard against which the church today seems to evaluate even the most heroic medical measures. It is no longer, as it once was, a priori, a matter of doctrine. Rather—to paraphrase Talmage—it is a question of common sense and technical feasibility.
While a sympathetic relationship now exists between medicine and Mormonism, there are a few points of discordance. Most typically, they are issues involving human reproduction.7
The early-twentieth-century birth-control controversy provides an instructive parallel to the current national ferment over abortion. It was during a time of radical reform, when artificial contraception was illegal, that the first formal statements by the Mormon hierarchy were made on the subject. Joseph F. Smith, the first LDS church president to address in any detail what was then termed “prevention,” had heard as early as 1900 that “steps were being taken” among Latter-day Saints “to prevent … spirits being tabernacled.” He spoke regularly on the subject for nearly two decades.8
One of Smith’s earlier statements was in response to a physician’s inquiry in 1908 as to whether it was ever right “intentionally to prevent, by any means whatever, the spirits … from obtaining earthly tabernacles?” Smith’s answer was that “in a general way, and as a rule, the answer to this question is an emphatic negative. I do not hesitate to say that prevention is wrong.” In addition to promoting selfishness and a “host of social evils,” it would also “disregard or annul the great commandment of God to man, multiply and replenish the earth.'”9
While the tone and substance of the statement derived from a nineteenth-century perspective, he also added a caveat reminiscent of the new pragmatism with which Mormons viewed medicine in general: “I am now speaking of the normally healthy man and woman. But that there are weak and sickly people who in wisdom, discretion and common sense should be counted as exceptions, only strength-[p.187]ens the general rule.” His thinking was less liberal than this might suggest: Smith concluded that in such exceptional cases the only legitimate preventive was “absolute abstinence.”
While Smith held to the same basic view throughout his presidency, which ended with his death in 1918, his last extensive counsel on the subject introduced another exception to his general condemnation: “I think that [curtailing the birth of children] is a crime whenever it occurs,” he advised the women’s Relief Society in 1917, “where husband and wife are in possession of health and vigor and are free from impurities that would be entailed upon their posterity.” Without elaborating such disorders, Smith continued: “I believe that where people undertake to curtail or prevent the birth of their children that they are going to reap disappointment by and by. I have no hesitancy in saying that I believe this is one of the greatest crimes in the world today.”10
Smith’s successor, Heber J. Grant, presided over the church during Utah’s depression years, which began in the early 1920s, a decade earlier than for the nation. During these years, the birth rate among Mormons dropped to levels not again reached until the advent of “modern” contraceptives in the 1960s. However, senior church authorities said relatively little in response to this unprecedented family limitation; even then, advice was generally given only in personal correspondence.
J. Reuben Clark, a member of the First Presidency, wrote privately in 1933 that the LDS church did not have an official position on birth control.11 Several years later, in 1939, a similar letter from Grant set forth his views. He first invoked the counsel of his predecessor, then added, “Married couples who, by inheritance and proper living, have themselves been blessed with mental and physical vigor are recreant in their duty if they refuse to meet the natural and rightful responsibility of parenthood. Of course, in every ideal home the health of the mother, as well as the intelligence and health of the children should receive careful consideration.”12
In 1942, the influential apostle John A. Widtsoe advised a personal correspondent that “as far as I know the Church has not expressed itself as to birth control.”13 Later that year he published an important essay in the Improvement Era entitled “Should Birth Control Be Practiced?” It was a remarkably even-handed treatment of the [p.188]subject, clearly reflecting another phase in the evolution of the leadership’s view. Instead of rejecting economic arguments out of hand, he found them “seldom convincing.” Equally interesting, he rejected total abstinence as the sole recourse open to those with legitimate grounds for controlling fertility. His advice was that “a careful recognition of the fertile and sterile periods of woman would prove effective in the great majority of cases.”14
Four years later, Apostle David O. McKay15 in private correspondence carried this position a step farther in advising that “when the health of the mother demands it, the proper spacing of children may be determined by seeking medical counsel, by compliance with the processes of nature, or by continence.” While some leaders were—and still are—willing to label birth control “gross wickedness”16, McKay’s more tolerant view was the dominant perspective after he became president in 1951. The high-water mark in this direction can be found in the writings of his counselor Hugh B. Brown who wrote in 1960 that “the Latter-day Saints believe in large families wherever it is possible to provide for the necessities of life, for the health and education of their children, and when the physical and mental health of the mother permits.”17
Ultimately, probably at Brown’s prompting, the First Presidency issued a formal statement on 1 April 1969–the first and only formal statement specifically dealing with birth control. In this McKay, Brown, and N. Eldon Tanner wrote:
“The First Presidency is being asked from time to time as to what the attitude of the Church is regarding birth control. …
“We seriously regret that there should exist a sentiment or feeling among any members of the Church to curtail the birth of their children. We have been commanded to multiply and replenish the earth that we may have joy and rejoicing in our posterity.
“Where husband and wife enjoy health and vigor and are free from impurities that would be entailed upon their posterity, it is contrary to the teachings of the Church artificially to curtail or prevent the birth of children. We believe those who practice birth control will reap disappointment by and by.
“However, we feel that men must be considerate of their wives who bear the greater responsibility not only of bearing children, but of caring for them through childhood. To this end the mother’s health and strength should be conserved and the husband’s consideration for his [p.189]wife is his first duty, and self-control a dominant factor in all their relationships.
“It is our further feeling that married couples should seek inspiration and wisdom from the Lord that they may exercise discretion in solving their marital problems, and that they may be permitted to rear their children in accordance with the teachings of the gospel.”18
This masterpiece of diplomacy effectively combined the essence, and often the exact wording, of guidance issued throughout the twentieth century into one ultimately ambiguous statement which transferred responsibility from the church to the individual. Their success is indicated by the fact that Mormons across the entire spectrum of possible attitudes cited it in defense of their beliefs. Beyond reiterating the strong pro-family tradition which has sustained nearly all commentary on the subject, the statement placed individual decisions above ecclesiastical review.
In a larger sense, perhaps, church leadership also ratified the collective judgment of rank-and-file Mormons. For years surveys of active Mormons found that a large majority either used or planned to use contraceptives; and by the late 1960s, when the First Presidency statement was issued, Mormon birth rates were at historic lows, ranging between 26 and 28 births per thousand.
The point to be made is not that the church capitulated on the issue of birth control, but rather that a change in societal perspective was accompanied, eventually, by a similar change in religious belief. In fact, the LDS church did not really capitulate on its more fundamental concern—that procreation and family life lie at the heart of human existence. While this is now interpreted in the context of a broadly defined medical concern for the well-being of the total family, there still has been no formal sanction of arbitrary spacing of births because of educational or economic goals.
The positive injunction given to Adam and Eve to multiply and replenish the earth was really the foundation of all Mormon commentary on birth control. And Mormons at large have responded to this ideal. While unmistakably influenced by changing socioeconomic circumstances, Mormon families still collectively average 1.5 additional children per family than their non-Mormon contemporaries—a distinction held throughout the twentieth century.
Those who followed McKay to the presidency of the church have [p.190]been both more outspoken and more conservative in their commentary on birth control. However, they have chosen not to revise the formal guidance already issued on the subject. While the new emphasis may have created a brief rise in the birth rate of Mormons in Utah in the late 1970s, it seems not to have influenced the overall use of contraceptives in the church (which by the end of childbearing seems ultimately to approach 90 percent). A recent study based on a small sample from the 1975 National Fertility Studies found that 96 percent of reporting Mormons had used birth control.19 Though this is somewhat higher than previous reports, surveys since 1935 have found the majority of Mormon respondents either endorsing or using birth control.20 Indeed, the most recent guidance on the subject of birth control in official church forums is essentially indistinguishable in tone and substance from that which appeared in the 1960s. One of the most extensive commentaries appeared in the Ensign‘s “I Have a Question” column in August 1979. In a thoughtful response to the question, “Is there not any kind of ‘gospel family-planning,’ for lack of a better way to say it?”, Mormon obstetrician Homer Ellsworth first noted “our spiritual obligation, to bear children and to have a family,” then lamented family limitation for “selfish” reasons. But, on the other hand,” he continued (in part), “we need not be afraid of studying the question from important angles—the physical and mental health of the mother and father, the parents’ capacity to provide basic necessities, and so on. If for certain personal reasons a couple prayerfully decides that having another child immediately is unwise, the method of spacing children—discounting possible medical or physical effects–makes little difference. Abstinence, of course, is also a form of contraception, and like any other method it has side effects, some of which are harmful to the marriage relationship.”21
Although there was no formal statement of church policy on abortion until recently, the views of early church leaders on the subject were clear: abortion was synonymous with murder. Polemically, at least, no distinction was made between “foeticide,” the abortion of an embryo, and “infant murder.” John Taylor, for example, spoke with some regularity of “pre-natal murders,” or “murders … committed while the children are pre-natal”; of infants killed “either before or after they are born”; and of murdering children “either before or after they come into the world.” Similar language [p.191]can be found in the related sermons of nearly all late nineteenth-century Mormon leaders.22
Given this perspective, it is not surprising that those involved in such “hellish” practices were condemned. George Q. Cannon of the First Presidency in 1884 was perhaps the most graphic: “They will be damned with deepest damnation; because it is the damnation of shedding innocent blood, for which there is no forgiveness. … They are outside the pale of salvation. They are in a position that nothing can be done for them. They cut themselves off by such acts from all hopes of salvation.” John Taylor had given the same message in 1881: “They are murderers and murderesses of their infants … and you that want them, take them, and you that do will go along with them, and go to perdition with them, and I tell you that in the name of the Lord.”23
Despite this seemingly categorical stance, the condemnation of abortion was not absolute. A few years earlier, in 1876, amid the national anti-abortion crusade which fueled much of the Mormon commentary, Utah passed an anti-abortion statute. The criminal penalties were not as severe as one might have expected: one to five years for mothers, two to ten for doctors. More importantly, there also was an explicit exemption in cases where abortion was necessary “to preserve [the] life [of the mother].”24
In practice, abortion seems to have been uncommon. After the intense national agitation ended, the subject largely disappeared from church commentary for nearly a century. When it reemerged, the social and medical context was radically different from that faced by John Taylor and associates.
The twentieth century brought an unprecedented public acceptance of active intervention in the reproductive processes. Infant mortality had declined precipitously, so there no longer was a need to have extra children as “insurance” to guarantee a “full” family surviving into adulthood. Society became increasingly mobile and urbanized. Those with large families encountered emotional and economic challenges from which their parents and grandparents seemingly were spared. And family limitation through birth control, despite a controversial entry into the national arena, became increasingly acceptable—even in the Mormon community.
To a growing number of participants in this social revolution, [p.192]particularly since 1960, a logical next step was to make therapeutic abortions available in cases other than those threatening the mother’s life. Some Mormons have seen this as yet another symptom of sweeping moral decay. Others find convincing the statistical evidence that, although illegal “abortionists” operated with high mortality, therapeutic abortions in legal medical settings result in substantially less maternal morbidity and mortality than does childbirth itself.
Both medical and popular sentiment on abortion had moved substantially away from the categorical abhorrence of earlier decades. Accordingly many states had revised their abortion laws. In 1969, Utah Senate Bill 121 was introduced to revise Utah’s century-old statute, proposing to allow abortions where the mother’s mental or physical health was at stake, where pregnancy resulted from rape or incest, or if the child was likely to have “grave or permanent physical disability or mental retardation.” As a member of LDS Hospital’s house staff in 1968-69, I recall numerous conversations among the hospital’s physicians. Many felt that the church would not oppose the proposed legislation–an indication of how far sentiment within the LDS community had shifted. As startling as this view may seem in retrospect, there are several reasons why it might have been true.
First, there was the practical consideration that a somewhat liberalized policy was already tacitly in effect in most major hospitals in Salt Lake City, including the LDS Hospital itself. Only Holy Cross Hospital reported no therapeutic abortions between 1954 and 1964. Although far from routine, abortions were being performed occasionally, including 9 percent for fetal deformities and 18 percent for psychiatric reasons. Perhaps as many as 73 percent of abortions labelled “medical” were, in fact, performed for other reasons.25
Second, in the 1960s there was a relatively tolerant attitude toward birth control on the part of the current church leadership. The use of contraceptives was largely viewed in actual practice as principally a medical judgment.
Third, there were theoretical reasons why abortion laws might have been ecclesiastically acceptable. The LDS church had never taken an official stand on abortion. Given nineteenth-century rhetoric, this may seem a technicality, but it is not. Notwithstanding its authoritarian image, Mormonism in fact has few authoritative doctrines. Its canon, the standard works, rarely bears unequivocally on [p.193]twentieth-century issues. Principles continue to be extracted and applied, but there is always a strong subjective or “inspired” interpretive element in these applications.26 Moreover, unless these interpretations are publicly issued by the First Presidency—which is rarely the case—they do not attain the status of formal doctrines of the church. Even those so issued are subject to later revision, though an effort is made to avoid explicit rejection of a previously published view. The record on birth control illustrates both these points. What often passes for “doctrine” in Mormon society is in reality a widely held consensus, perhaps espoused in sermon or print by Mormon general authorities, but ultimately without formal sanction by the First Presidency. In theory, such a consensus is not binding on church members. In practice, it is not unlikely to change.
Despite the level of nineteenth-century church rhetoric, mid-twentieth century Mormon leaders did not view abortion in entirely the same doctrinal light as their predecessors. While nothing definitive had been stated publicly, as early as 1934 Apostle David O. McKay privately expressed his opinion that the church had not made an “authoritative answer” to the question of whether abortion should be “termed murder or not.”27 Later, as church president, McKay and the First Presidency affirmed that “as the matter stands, no definitive statement has been made by the Lord one way or another regarding the crime of abortion. So far as is known, he has not listed it alongside the crime of the unpardonable sin and shedding innocent blood. That he has not done so would suggest that it is not in that class of crime.”28 In 1958 J. Reuben Clark, though generally opposed to abortion, was willing to advise a pregnant woman who had contracted German measles that on the question of terminating the pregnancy “she should seek the advice of her physicians … and also seek the Lord in prayer.”29
That abortion should not be viewed as murder resulted in optimism that there might be no official objection to some modest liberalization in state laws. The church also had no formal stand on another theologically relevant subject: the relationship between a noncorporeal spirit and the physical body of flesh and blood with which it is associated. Assumptions about this relationship are central to some frequently heard condemnations of abortion.
Mortal existence, as we know it, was represented by Joseph Smith [p.194]as the union of a spirit with its earthly body to form what was termed a “soul.” At death, the spirit and body again separated, to be permanently reunited at the time of resurrection. Ultimately this resurrected soul accounts before God for his or her conduct on earth.
The essence of this theology is not unique to Mormonism. Among other common themes, it shares the popular notion—of some medical interest—that the spirit animates the body and that death coincides with the departure of the spirit. As biblical literalists, early Mormons have assumed, as did many of their contemporaries, that the spirit was prenatally present, using as proof-text the familiar passage in Luke 1:44 in which Elizabeth’s child “leaped in [her] womb for joy” at the news of Mary’s pregnancy. The problem with this as a firm Mormon scriptural guide was a Book of Mormon episode in which the adult Jesus appeared—presumably in spirit form—the day prior to his birth.
With these paradoxical precedents, it is understandable that leading Mormons held a variety of views over the years about timing of ensoulment–and that none of these views attained the status of formal doctrine. Brigham Young assumed the spirit arrived at the time of quickening.30 This view, the conventional Protestant wisdom of the day, was easier to maintain before modern science demonstrated that fetal motion was present almost from the outset of pregnancy, long before it could be detected by the mother. President McKay felt that the spirit joined the body at the time of birth. “Life manifest in the body before that time would seem to be dependent upon the mother.”31 To the best of my knowledge, no leading Mormon ever asserted the third obvious alternative—that the spirit arrived at the time of conception.
Although McKay’s position would seem intrinsically more flexible than Young’s, this was not necessarily so. Young also believed, as quoted by successor Wilford Woodruff, that “when some people have little children born at 6 & 7 months from pregnancy & they live a few hours then die … I think that such a spirit will have a Chance of occupiying [sic] another Tabernacle and develop itself.”32 While it is not clear where he would draw the line, he periodically ridiculed the notion that babies who die are “resurrected” into new, mortal infant bodies.33 Ultimately the First Presidency wrote—though it did not formally publish—that “there is no direct revelation upon the [p.195]subject [of when the spirit takes possession of the body] … it has always been a moot question. That there is life in the child before birth is undoubted fact, but whether that life is the result of the affinity of the child in embryo with the life of its mother, or because the spirit has entered it remains an unsolved mystery.”34 So far as I am aware, nothing further has been said on the subject.
In practice, Mormon ritual has always distinguished between miscarriages or stillborn deliveries and neonatal deaths. The former are not formally recorded in church records; the latter are. Vicarious ordinance work, deemed essential for all humankind in Mormon theology, is never performed in the case of a miscarriage or stillborn delivery. It is for a deceased infant. In essence then whatever the doctrinal uncertainties, church practice treats birth as the time when the spirit-body bond takes place. (It also should be noted that the church follows the variable legal definitions current in different jurisdictions as to what constitutes a live birth.)
Returning to 1969, the church did issue a short statement on the proposed abortion reform bill, about a week after it was introduced in the Utah legislature. In this, the First Presidency stated that after “careful consideration,” they were opposed “to any modification, expansion, or liberalization of laws on these vital subjects.”35 The bill was not enacted.
Some flexibility in this official opinion became evident just a few weeks later in a private letter from Joseph Anderson, secretary to the First Presidency, on their behalf. The letter stated: “Nevertheless there may be conditions where abortion is justified, but such conditions must be determined acting under the advice of competent, reliable physicians, preferably members of the Church, and in accordance with the laws pertaining thereto.”36 Two years later this private counsel was given much wider circulation when a new First Presidency published an identically worded statement in the official Priesthood Bulletin. The following June 1972 the presidency’s views were more fully elaborated in another bulletin. Their statement at that time remains the most comprehensive official Mormon response to the question of abortion. Because of its importance to the present discussion, I will quote it in full:
“The church opposes abortion and counsels its members not to submit to or perform an abortion except in the rare cases where, in [p.196]the opinion of competent medical counsel, the life or good health of the mother is seriously endangered or where the pregnancy was caused by rape and produces serious emotional trauma in the mother. Even then it should be done only after counseling with the local presiding authority and after receiving divine confirmation through prayer.
“As the matter stands today, no definite statement has been made by the Lord one way or another regarding the crime of abortion. So far as is known, he has not listed it alongside the crime of the unpardonable sin and shedding of innocent human blood. That he has not done so would suggest that it is not in that class of crime and therefore that it will be amenable to the laws of repentance and forgiveness.
“These observations must not be interpreted to mean that acts of abortion, except under circumstances explained in the preceding paragraph, are not of a serious nature. To tamper or interfere with any of the processes in the procreation of offspring is to violate one of the most sacred of God’s commandments—to multiply and replenish the earth. Abortion must be considered one of the most revolting and sinful practices in this day, when we are witnessing the frightening evidences of permissiveness leading to sexual immorality.
“Members of the Church guilty of being parties to the sin of abortion must be subjected to the disciplinary action of the councils of the Church as circumstances warrant. In dealing with this serious matter it would be well to keep in mind the word of the Lord stated in the 59th section of the Doctrine and Covenants, verse 6: ‘Thou shalt not steal; neither commit adultery, nor kill nor do anything like unto it.'”
This statement stops short of defining abortion as murder, finding it rather “like unto it”–possibly in the sense that some might consider a fetus not to be identical with human life in the normal usage, but like unto it. Although a “most revolting and sinful practice” when unwarranted, abortion is defined more liberally than, for example, in Utah laws of the time and, excepting only the cases of fetal abnormalities and incest-related pregnancy, was compatible with the unsuccessful legislative reform introduced three years earlier.
While a panel of federal judges held in 1971 that Utah’s abortion law was constitutional, the statute did not withstand the 1973 Su-[p.197]preme Court ruling which in essence struck down all state laws on the subject. In the wake of this development, the LDS church reissued its 1972 guideline; and over the past decades, it has periodically republished essentially identical official statements.
With the advent of the Spencer W. Kimball presidency in late 1973, abortion regained the prominence in sermon and print it had been given a century before in Mormon circles. Abortion was again a national issue, as well, and Kimball regularly cited it in a litany of grave sins besetting society. Although the characteristically hyperbolic Church News editorials which accompanied this renewed focus (for example, that of 17 May 1975) occasionally suggested that spirits assigned to aborted fetuses would lose their chance for an earthly experience, I believe this view was generally assumed to be without official basis.37 It was more the tone than the substance of church discourse that changed during these years.
One quasi-official departure from the 1972 statement was evident in 1976, when the church distributed to all Mormon congregations a graphic filmstrip reinforcing its opposition to abortion. In addition to the proscriptions already outlined in the official statement, the following new counsel was included as part of an accompanying discourse by Kimball entitled “A Visit With The Prophet” which was reprinted in the Church News, 27 March 1976, page 6: “Occasionally the question of pregnancy by rape will be asked. Medical evidence indicates that this is an extremely rare situation. But regardless of how the pregnancy was caused, abortion would greatly compound the wrong. An unborn baby must not be punished for the sins of his father. Letting the baby be born and placing him in an adoptive home would surely be a better solution for an unfortunate situation.”
[p.198]Despite the extensive distribution of the filmstrip and explicit guidance of the accompanying talk, the LDS church did not officially depart from its former stand—a paradox which illustrates some of the problems in assessing an authoritative or authoritarian religion with few formal doctrines. That there had been no binding departure from previous guidance was clear within just a few weeks when the First Presidency reaffirmed its previous policy on abortion in an “official statement.” Circumstances which allowed for abortion included “pregnancy … caused by forcible rape and producing serious emotional trauma in the victim.”38
Despite ongoing debate, this is where things generally stand at present.39 Interestingly enough, the First Presidency never has condemned the termination of pregnancies involving seriously defective fetuses. Rather, they chose the indirect condemnation of not exempting such cases from a general indictment of abortion. In his remarks accompanying the 1976 filmstrip, Kimball did assert that “no one, save the Lord himself, has the right to decide if a baby should or should not be permitted to live.” One can presume therefore that he personally would counsel against intervening in such cases. Nonetheless, the First Presidency appears to have intentionally avoided singling out this difficult issue for unequivocal condemnation, despite periodic inquiries from concerned physicians on this specific subject or on the related use of amniocentesis.
My impression is that this quasi-silence on the part of the church coincides with a continuing evolution in perspective among both Mormon physicians and patients, an evolution of just the sort previously seen under similar circumstances on the question of birth control. While I do not foresee any wholesale endorsement for terminating abnormal pregnancies, there nonetheless already has been some change in attitude. At the anecdotal level, for example, I am aware of local church leaders who have availed themselves of amniocentesis for high-risk pregnancies within their own families. They argue that this option promotes larger families, for without it they would not risk further pregnancies. For Mormon physicians there is a growing ethical and legal obligation to at least discuss amniocentesis, as an option in high-risk pregnancies.
One LDS obstetrician, not in Utah, estimated that in the general area where his practice is located, about half of the LDS women pregnant after age forty requested amniocentesis. This figure seems generally consistent with a Centers for Disease Control study which found that about 10 percent of Utah women pregnant after age thirty-five sought amniocentesis—a figure about half the national average.40 It is compatible with figures given by Dr. Robert Fineman that nationally about 80 percent of pregnancies found to have genetic abnormalities were terminated, and in Utah about 66 percent. While proportionately few amniocenteses reveal abnormalities, it apparently is not rare for LDS women discovering significant fetal abnormalities to have these pregnancies terminated.
[p.199]Despite church guidelines encouraging disciplinary action against those involved in abortions, I have yet to learn of church courts held when known fetal abnormalities were involved. On the contrary, I understand that inquiries about such cases as anencephaly have received unofficial, tacit endorsement. Outside of Utah, one suspects such agonizing personal problems are not infrequently dealt with, or more accurately not dealt with, entirely by local leaders who counsel the family involved, but indicate that the final moral judgment must reside within the family.
A counter-theme which runs through much of the material on birth control relates to the question of genetic “impurities.” As early as 1917, Joseph F. Smith sanctioned marital abstinence when the husband or wife was not “free from impurities which would be entailed upon their posterity.” This same caveat can be readily traced throughout the twentieth century, right up to the First Presidency statement of 1969 which quotes Smith verbatim on this point.
This concern can be identified in early church history. Apostle Parley P. Pratt, for example, wrote in Key to the Science of Theology—a study second only to the standard works in defining church doctrine for nineteenth-century Mormons—that “a wise legislation, or the law of God … would not suffer the idiot, the confirmed, irreclaimable drunkard, the man of hereditary disease, or of vicious habits, to possess or retain a wife.”41 Although Utah’s territorial legislature did not enact such legislation, the state of Utah eventually did so in 1925. A statute passed that year, in the wake of a national enthusiasm over eugenics, provided for the sterilization of institutionalized individuals (including infants) who were “habitually sexually criminal, … insane, mentally deficient, epileptic, or … afflicted with degenerate sexual tendencies,” if “by the laws of heredity [they were] the probable potential parent of socially inadequate offspring likewise afflicted.”42
While such “a taint in the blood”—to use John Widtsoe’s phraseology—if “known to be capable of transmission, should be hemmed in and not allowed further propagation,” the historical Mormon solution to this issue always has been to encourage healthy people to have more children. It was this sort of positive eugenic which justified Mormon polygamy. Or as Brigham Young said in 1856 in terms not infrequently heard even today, “I have told you many times that there [p.200]are multitudes of pure and holy spirits waiting to take tabernacles, now what is our duty?—to prepare tabernacles for them; to take a course that will not tend to drive those spirits into the families of the wicked, where they will be trained in wickedness, debauchery, and every species of crime. It is the duty of every righteous man and woman to prepare tabernacles for all the spirits they can.”43
There is thus a eugenics heritage in Mormonism which may be relevant to the scenarios to be addressed. First, there is a clear precedent for taking otherwise unacceptable measures to avoid encumbering awaiting spirits with predictable defective “tabernacles.” Second, there is a strong tradition which seeks to provide the best possible chance for “good” people to become parents.44
Aside from the narrowly-defined exemptions for eugenic reasons, until recently Mormon Utah rejected all grounds for sterilization. Even the tolerant David O. McKay administration opposed an effort to liberalize a state law which as late as 1969 was interpreted as allowing only eugenic sterilizations. This presidency statement also opposed a bill which would have authorized voluntary sterilizations “where medically necessary to preserve the life or prevent a serious impairment of the mental or physical health of the patient or spouse.”45 However, while this legislative initiative failed, judicial review later determined that no prohibition against such sterilizations existed in Utah law. Unlike the case of abortion, this did not bring about a formal statement of guidance from the church.
In 1976 the Church Commissioner of Health prepared a short statement on sterilization, obviously patterned after the guidance on birth control–and taken almost verbatim from privately issued First Presidency guidance, which stated, “The Lord’s commandment imposed upon all Latter-day Saints is to multiply and replenish the earth. Nevertheless there may be medical conditions related to the health of the mother where sterilization could be justified. But such conditions, rare as they may be, must be determined by competent medical judgment and in accordance with laws pertaining thereto.”46 Although one Mormon authority warned two years later that those submitting to vasectomy might be ineligible for participation in temple ordinances, this guidance was never formally implemented. Nor have temple-recommend interviews ever officially included questions relating to sterilization (or birth control). Among other reasons, [p.201]sterilization, like birth control, can be seen as medically justifiable in most cases. The increasing frequency with which procedures such as hysterectomy are performed for non-pregnancy-related complications (e.g., uterine prolapse, fibroids, etc.) has contributed coincidentally toward making the question of birth control moot for many women in their later childbearing years.47
One might suppose that Mormons would look favorably on almost any technique which would lead to successful pregnancies in otherwise infertile marriages. And this may be true, as long as the semen is the husband’s. Of relevance is the biblical and nineteenth-century Mormon precedent for “raising up seed” to a dead husband whereby a woman sealed to the deceased man would marry another man for time but not eternity. Still, when the question of artificial insemination was first officially addressed by the LDS church in 1974, it was made clear that “the Church does not approve of artificial insemination with semen other than that of the husband” because donor semen “may produce problems related to family harmony.” At the prompting of the Church Commissioner of Health, this condemnation was softened by the addition of an acknowledgment that “the Church recognizes that this is a personal matter which must ultimately be left to the determination of the husband and wife with the responsibility for the decision resting solely upon them.”48
In view of the record on birth control, it is not surprising to learn that there has been some additional development in the church position on this subject. Two years later “the Church does not approve” was recast into the more positive counsel that “the Church approves of artificial insemination only in cases where the semen of the husband is used.” Then in 1977 the First Presidency softened the wording even further in counseling that “the Church discourages artificial insemination with other than the semen of the husband.” This formal statement clearly implied, moreover, that births through artificial insemination were to be viewed in the same ecclesiastical light regardless of the semen’s origin.49
After this historical tour, it is clear that attempts to project a specific Mormon perspective on emerging ethical issues must be tentative. Still, some useful generalizations emerge from the record to date.
First, contrary to its media image, the LDS church—and specifi-[p.202]cally the First Presidency—often chooses not to express itself on issues with obvious ethical or theological overtones. This is especially true when the issues are complex or when important scientific questions remain unanswered. A corollary to this is that there are relatively few fixed doctrines. For example, in a 7 September 1968 statement on citizen obligations and contemporary social and political conditions, the First Presidency wrote: “The growing worldwide responsibilities of the Church make it inadvisable for the Church to seek to respond to all the various and complex issues involved in the mounting problems of the many cities and communities in which members live. But this complexity does not absolve members as individuals from filling their responsibility as citizens in their own community.”50 The large number of statements issued in recent years affirming that the church has no position on organic evolution is a parallel case. David O. McKay on 3 February 1959 wrote cogently, “While scientific people themselves differ in their interpretations and views of the theory, any conflicts which may seem to exist between the theory and revealed religion can well be dealt with by suspending judgment as long as may be necessary to arrive at facts and at a complete understanding of the truth.”51
Second, when the First Presidency does comment on complex issues, the initial guidance is usually given privately, in response to questions from those most directly involved.
Third, formal public statements by the First Presidency on medical ethical issues—those which effectively establish church policy—generally do not appear until relatively late in the public discussion. At this point, it is not unusual for individual members and local leaders to have reached independent judgments on the questions involved. While inevitably leading to some confusion, this general process is not necessarily viewed as bad. More disruptive are the rare occasions when the first-issued public guidance contradicts that previously given in private. An example is the issue of sex-change surgery, the most recent medical ethical issue to be dealt with. Within recent years, such surgery was privately ruled not to disqualify one from participation in temple marriage and other ordinances. Subsequent public guidance not only reversed this, but imposed on offenders (patient or physician) severe ecclesiastical sanctions. In October 1980 ecclesiastical leaders received a replacement for Chapter 8, “The [p.203]Church Judicial System” for the General Handbook of Instructions (1976) which stated: In cases of … transsexual operations, either received or performed, [excommunication is mandatory and] … no readmission to the Church is possible.” Prospective converts who had such surgery were to be baptized only “on condition that an appropriate notation be made on the membership record so as to preclude [them] from either receiving the priesthood or temple recommends.” Though having or performing an abortion was also potential grounds for excommunication, local leaders were allowed discretion in bringing offenders to trial. Nor were there any prescribed restrictions on readmission.
A fourth generalization to emerge is that the passage of time almost always sees an evolution in church guidance on specific medical ethical issues. The public phase of this evolution invariably has been in the direction of greater conformity to the general medical/social consensus on the subject. We have seen this on the issues of birth control, sterilization, artificial insemination, abortion, and medicine in general. Note that this generalization applies to the public record only. As the instance of sex change surgery indicates, there may be a decided hardening of the official view during the pre-public phase.52
Fifth, to some extent this evolution is accompanied by the emergence of what in retrospect might be termed the core of ethical concern which motivated the guidance from the outset. This core is generally expressed in terms unambiguously tied to central tenets of the faith: the centrality of marriage and children; the overriding importance of maintaining family harmony and stability, and protecting the health and well-being of mother, children, and “tabernacles-to-be”; the preservation of free agency and personal accountability; and the total unacceptability of decisions based on “selfish” rationales.
Sixth, guidance which eventually is discarded in this evolutionary process in retrospect generally falls into one of two categories. The first is policy by fiat, with no effort at doctrinal rationale. Church guidance on sex change surgery specifies sanctions without offering any rationale whatever. To some extent, this situation also describes the case with sterilization and abortion.
In the second type of case, a particular view may have been [p.204]justified with socio-cultural (often emotion-laden) rationales readily identifiable with former societal values. This position is most explicit in the guidance on artificial insemination but is implicit in many other statements as well. At one point in late 1976, the guidance on artificial insemination noted that “the legitimacy of offspring of artificial insemination from semen other than that of the husband is open to question.”
Seventh, core beliefs themselves can be modified in accommodating new knowledge which is simply unreconcilable with the previous view. This development does not pose as much a challenge to church authority as might be supposed. It is in fact a tenet of the Mormon faith that this sort of refinement periodically will take place.
With these generalities as a backdrop and in the context of the history just covered, let us now turn to some developing ethical issues yet to be dealt with by the LDS church. The first scenario involves known genetic defects which will not be manifest until later in life. Although the First Presidency has not granted exemptions from their general condemnation of abortion, there is substantial historical precedent for modification in their stance. One can readily see several theological or theoretical reasons why this might eventually take place.
Mormon values would seem to favor interdicting demonstrably abnormal pregnancies. Some measures intended—as John Widtsoe put it—to “[hem] in and not allow further propagation” of “taints in the blood” would insure more healthy “tabernacles” for the pure spirits beginning their earthly experience. This is, after all, just the other side to counsel already given that expectant parents take no action which might cause infants to be born with defects. An example is the counsel of nineteenth-century church leaders that coitus be continued during pregnancy lest through abstinence “they might … entail on their offspring unholy desires and appetites.”53 Expectant mothers were also warned against wishing for such harmful things as tobacco, tea, coffee, and liquor.54 Moreover, if couples afraid to risk pregnancy because of a history of genetic disorders in the family or advanced age were enabled safely to attempt to bear healthy children, yet another Mormon ideal would be achieved.
Objections to abortion that outweigh such benefits must of necessity be substantial. Abortion has been officially labelled as a [p.205]grave sin which intrudes in the most violent way possible into the sacred processes of reproduction. In so doing, it brings about the death of a human embryo or fetus, an act once labelled murder and now interpreted as “like unto it.” Even the most cautious step toward liberalizing the grounds for abortion is viewed as potentially leading to the abandonment of ethical restrictions on its use. It is feared that the legacy of such a development could be an increasing and grossly self-serving irreverence for the sanctity of human life. In the Mormon mind, this would strike at the heart of the entire purpose of humankind’s mortal existence.
As insurmountable as these obstacles seem, it is arresting to recall that virtually identical arguments could have been made—indeed, were made many times—on the subject of birth control. It seems that neither the vigor with which such statements have been expressed nor the length of time over which they were espoused have proven infallible guides to their ultimate fate. To some extent, this situation is due to the difficulty of separating culturally mediated perspectives from those based on underlying theological absolutes, especially when emotional (or aesthetic) motives are strong. While the distinction between culture and eternal principle is difficult to make, technological advances have a curious way of clarifying things. When new, aesthetically less traumatic techniques are developed, emotional considerations disappear. For example, as unlikely as the idea may currently seem, the development of a monthly pill or intra-uterine implant which insured the viability of only defect-free conceptions (normal menstruation otherwise occurring) might well be acceptable to individuals who had “ethical” reservations to a d&c at ten weeks.
But doesn’t Mormonism have some truly fundamental, theological objection to abortion? Unquestionably the LDS church will always view a decision to terminate fetal life as a step with profound moral overtones. A selfish or callous decision of this sort will, I expect, always be considered a serious sin. But when it comes to a broader condemnation or even to a fixed definition of what should be considered an “abortion,” the doctrinal record suggests some flexibility. In addition to a tradition which has accommodated a surprising degree of ethical readjustment, Mormonism has never taken a stand categorically barring all abortion. Right from the outset, it has recognized legitimate reasons for terminating pregnancy. The ques-[p.206]tion never has been if there were such grounds, but always which grounds were legitimate. And the answers have varied with differing times and differing circumstances.
In particular, Mormons have important doctrinal latitude on the question of the nature of the embryonic or fetal life potentially jeopardized. Since this issue may alone distinguish selective abortion theologically from birth control, it is worth considering a little further.
The nineteenth-century equation of infant murder with abortion must have derived some intuitive support from the idea that infant deaths were about as common as grossly evident spontaneous abortions. Both seemed to kill perhaps 20 to 25 percent of fetuses or infants at risk. Recent research shows that 70 to 75 percent of conceptions actually fail to survive to term, and the dramatic decline in infant mortality to near 1 percent has changed this subjective equation markedly.55 In terms of relative risk nine months before or nine months after birth, there is no longer much epidemiological similarity between prenatal and infant life. In a sense, the prenatal period is no longer viewed as only the process whereby human life comes into being. It now also appears to be a process designed by nature to insure—albeit imperfectly—that only the most viable conceptions are carried to term. Thus pre-and postnatal survival rates are inherently of an entirely different order of magnitude.
New developments in medical sciences have undermined other aspects of our traditional understanding. An animating role for a maternal spirit can not readily be argued when an ova is fertilized in a petri dish, even less when the ova, semen, or early embryo remains frozen but viable well after the death of the original donors. It is similarly awkward to invoke an essential role for maternal spirit in a brain-dead “mother” sustained on life-support systems until the fetus can be delivered with some chance of surviving. Assumptions about an obligatory role for an “embryonal spirit” also are difficult when it is realized that twins may develop from what was for a number of days a single individual; or, conversely, that more than one embryonal animal may fuse into a single individual (chimera) of normal appearance. A mandatory role for any discrete spirit presence at all can be argued only with great difficulty in the case of living cell cultures, perhaps fetal in origin, alive and well in a petri dish. Most problematic [p.207]of all is to impute a mandatory spirit presence in the cloning process whereby entirely normal animals are “created” through the bio-physical manipulation of individual cells (cells which, in theory—to underscore the point—could have been obtained from cell cultures, and need not have originated in the reproductive system).
Conceptually at least medical science is increasingly committed to the notion that early prenatal life may be entirely understood in bio-physical terms applicable to a cell culture. The record to date suggests that the LDS church may eventually take advantage of its open theology in this area and acknowledge the medical consensus: the church may no longer at some point assume that either a maternal or a fetal spirit is essential to prenatal viability. This would not be a concession to secularism, but rather a recognition that medical facts cannot easily be reconciled otherwise. Should this more naturalistic view become commonplace—a development which surely will be facilitated by the widespread use of in vitro fertilization techniques—the Mormon perspective on elected therapeutic abortions for known, serious defects could change.
If in fact the official Mormon view follows such a path, it most likely will not be initially manifest through detailed new guidance on abortion. More likely, there will be acquiescence to the judgment of “competent physicians,” whose judgment in turn will reflect this emerging perspective. While I cannot foresee a theological distinction ultimately being made between serious embryonal defects which will manifest at birth and grave defects which will not become evident until somewhat later, it is possible that during a transitional period such a distinction would be made. I would expect that only the most grotesquely abnormal defects—such as anencephaly or serious glycogen storage diseases—would initially be considered grounds for intercession. Even these may well be justified ostensibly by the imputed risk to the mother of continuing the pregnancy. While I expect no public change in the immediate future, a continuation of the general societal approval of such selected abortions56 and the inevitable development of earlier and less emotionally traumatic means for accomplishing this may well change things eventually.
The next scenario to be considered, involving genetic engineering, is the sort of thing which in the past has been labelled by the LDS church a purely medical question. To the extent that its use is limited [p.208]to the treatment of disease, I cannot conceive of a predictable rationale for Mormon objections to this amazing new tool. Certainly church leaders do not presently view deoxyribonucleic acid (DNA) as theologically any more sacrosanct than any other component of the human body. If a disease can be traced to some defect repairable through such engineering, this would certainly be hailed by leaders as yet another scientific miracle. That it might be subject to abuse at some future time would probably not distinguish it in their minds from drugs or other treatments also subject to abuse. To judge from the past, they would still defer to responsible medical expertise as to whether the potential benefits justified the perceived risks.
I would guess that much the same would prevail for in utero surgery. Aside from the hope it might offer as an alternative to abortion, it does not strike me as having major ethical overtones—at least in the Mormon context. One obviously must consider again James Talmage’s standard that such heroic intervention be moderated by the “intelligent application of common sense”; but if such procedures proved to be successful and relatively safe, church leaders would probably view them as just another extraordinary technological development. I doubt that any guidance would be issued, even privately, on the question of prioritizing who should be treated. So far as I am aware Mormon leaders have never considered this type of question within their official domain. If they were pressed, I would expect them to defer to the prayerful consideration of those more directly involved.
The final scenario, in the case of in vitro fertilization is a more interesting one to assess from a Mormon perspective. It both poses a dilemma and illustrates some of the points of convergence with church doctrine. It is at once a technique which enhances the chances of a couple’s having children of their own, yet simultaneously raises—in some minds—the specter of abortion.
So far as the official record is concerned, the church has not offered an opinion on the question of in vitro fertilization. If the public communications arm is asked, they sometimes reply that the church views the subject as a matter to be decided by the individuals concerned. Though both Mormon physicians and patients are apparently now availing themselves of this technology, neither counsel nor sanctions have been publicly forthcoming. While the recent record [p.209]on sex-change surgery shows this to be no sure indicator of even near-term events, the overall record on reproductive questions suggests that the LDS church will continue its present neutrality.57
The over-reaching Mormon concern that members “multiply and replenish the earth” could hardly be more applicable than to a technique specifically designed to make this possible. A rationale for the church’s support of in vitro fertilization therefore requires no imagination. Are the potential objections efficient to nullify this benefit?
Among the ethical arguments put forth against in vitro fertilization, one of the most common is that early embryos are aborted. One also hears that it is “unnatural” and that it poses unusual risks to the children so conceived. Of the various reservations I have seen expressed, only those relating to abortion seem to relate directly to contemporary theological concerns. Certainly the question of acceptable risk would be considered by the church as purely in the realm of medical and personal judgment. Nor does the church normally distinguish between “natural” and “unnatural” medical intervention. On these two counts, the Mormon tradition is by and large fully aligned with the medical mainstream.
What of the abortion question? It is evident that this is not a simple question. While it could be assumed that discarding an embryo or a fertilized egg was abortion, it has thus far not been seen in this light. Discarding a four-cell blastocyst (that is, a very early “embryo”) created by in vitro techniques is much closer emotionally to preventing the implantation of a fertilized egg through the use of an IUD than it is to surgically terminating a multi-week embryo or fetus. The church never has equated use of an IUD with abortion, and it seems likely to me that in vitro fertilization will be viewed in a comparable, if uneasy, limbo. With the passage of time, and increasing use of these techniques, a de facto if not ex cathedra judgment will be affirmed that this is not a proscribed form of abortion. In addition, this may well become a stepping stone to allowing interdiction of somewhat older embryos taking nutrients from the uterine wall rather than from a petri dish. It is just this type of progression which has marked the evolution of Mormon medical ethical thinking in the past.
In conclusion, my impression is that on science-related issues, [p.210]scientists shape theology as much as theologians do. This is not so much through confrontation or default on the part of theologians, but rather through new discoveries which directly or indirectly force modifications in the old ways of thinking. New facts have to be accommodated. Dated but inapparent sociocultural assumptions are exposed and eroded.
This phenomenon is surely evident in the Mormon record. That is a strength of the Mormon point of view rather than a weakness—because Mormons view scientific and religious truth ultimately as one and the same. The acquisition of knowledge, whether through secular or religious means, is held to be a divinely mediated accomplishment. There are, of course, some practical problems with this position; but in the final analysis, the Mormon point of view is healthy because it is designed to incorporate progress. I would suggest that in theory—and sometimes even in practice—”Mormonism” typically sees frontiers in medicine as opportunities for expanding its perspective rather than occasions for limiting personal choices.
LESTER E. BUSH, M.D., is author of Health and Medicine among the Latter-day Saints: Science, Sense, and Scripture, part of a multi-volume series on “Health/Medicine and the Faith Traditions,” sponsored by the Park Ridge Center, Chicago, Illinois. “Ethical Issues in Reproductive Medicine: A Mormon Perspective” first appeared in Dialogue: A Journal of Mormon Thought 18 (Summer 1985): 42-66.
1. The complex subject of what constitutes official “doctrine” in the Mormon church is beyond the scope of this essay. In general I use statements issued by either the president of the church or the First Presidency as my guide. A conspicuous article in an official church journal is also used occasionally to indicate at least the range of acceptable beliefs. Some useful criteria are given in J. Reuben Clark, Jr., “When Are the Writings and Sermons of Church Leaders Entitled to the Claim of Scripture?,” reprinted in Dialogue: A Journal of Mormon Thought 12 (Summer 1979).
7. The most significant other problem to bring the church into conflict with the received medical view came in 1900. It involved the issue of “free [p.211]choice,” and grew out of a Utah Board of Health initiative to require all school-aged children to have smallpox vaccinations. Although the First Presidency accepted the merits and wisdom of vaccination, other prominent Mormons, notably Charles E. Penrose, the influential editor of the church’s Deseret News, felt the procedure was dangerous and unwarranted. (In a sense, this is a vestige of the old anti-heroic philosophy.) Penrose, who not long thereafter became a member of the Quorum of the Twelve, led a vigorous crusade against the initiative, and ultimately the Mormon-dominated state legislature banned (over the governor’s veto) a compulsory vaccination program. Despite their support of vaccination per se, the First Presidency chose not to exert its influence in support of an involuntary program. This same ingrained aversion to mandatory programs later created popular opposition to such public health programs as quarantines and fluoridation of water supplies.
8. Cf. Conference Reports of the Church of Jesus Christ of Latter-Day Saints, 70 A (Annual), (1 Apr. 1900): 39-40. Lester Bush, Jr., “Birth Control Among the Mormons: Introduction to an Insistent Question,” Dialogue: A Journal of Mormon Thought 10 (Autumn 1976): 12-44.
15. David O. McKay to unidentified correspondent, 27 May 1946, from the “files of LaMar Berrett, Professor of Religion, Brigham Young University,” in “Statements of the General Authorities on Birth Control,” Department of Religion, Brigham Young University, n.d., photocopy of typescript.
21. Homer Ellsworth, “I Have a Question,” Ensign 9 (Aug. 1979): 23-24. Since this essay was first published, a new edition of the authoritative General Handbook of Instructions (Salt Lake City: Church of Jesus Christ of Latter-day Saints, 1989), has been issued, including the most open-ended statement on “birth control” yet published by the church: “Husbands must be considerate of their wives, who have a great responsibility not only for bearing children but for caring for them through childhood. Husbands should help their wives conserve their health and strength. Married couples should seek inspiration from the Lord in meeting their marital challenges and rearing their children according to the teachings of the gospel” (11-4).
Five years earlier, Elder Gordon B. Hinckley’s 29 January 1984 address on “Cornerstones of a Happy Home,” which subsequently was published as a brochure and delivered by home teachers to every LDS family, had contained similar counsel. Hinckley had added, “[The Lord] did not designate the number [of children], nor has the Church. That is a sacred matter left to the couple and the Lord.” Paradoxically, as with the relatively liberal guidance of 1969, this statement follows the decline of the Mormon birthrate to the lowest level to date, 24.5 births per thousand for 1983.
26. An instructive contrast is the distinctly different approach taken to medical ethical issues by the Reorganized Church of Jesus Christ of Latter Day Saints, which, with access essentially to the same body of scripture, rarely makes categorical statements. Decisions on abortion, for example, are considered to be individual decisions. Such decisions may not be lightly made, but church leadership also “recognizes that there may be rare occasions which might make necessary, because of the conditions of the conception or the pregnancy, to terminate a particular pregnancy” (First Presidency [RLDS church], Handbook of Church Organization and Administrative Policies and Procedures [Independence, MO: Herald House, 1974]).
37. There is an inherent tension between the Mormon belief that we will be punished only for our own sins and the idea that we can deprive a person of an opportunity to grow through an earthly experience by killing or otherwise harming him or her. The problem posed by the death of young children was handled early by assuming that all who died before “the age of accountability” (eight years) were assured exaltation. That historically this could amount to perhaps 40 percent of all births makes the attempted analogy to abortion a little more intelligible. But our present medical understanding that as many as 85-90 percent of all conceptions fail to reach eight again undermines the whole proposition.
39. The 1983 General Handbook statement added pregnancy from incest to the published list of exceptional cases in which abortion might be justified. The other exceptions remained pregnancy resulting from rape, and circumstances where the “life or health of the woman is in jeopardy” (77-78). The 1989 General Handbook added a severely deformed fetus that will not survive beyond birth as another justification (11-4).
44. Beyond the physically redeeming merits of adherence to its Word of Wisdom and otherwise living righteously, nineteenth-century Mormons were taught that they were literally part of a “chosen lineage.” In a sense, this identification was just another aspect of the effort to create or restore the biblical ideal. It also promoted a sense of unity and served as an emotional shield during many trying years. Though now perhaps anachronistic, this notion of being elect still appears in popular Mormon lore. Indeed, at least symbolically it is an essential part of the Mormon tradition of patriarchal blessings. In its most fully developed form, this idea extended beyond this-worldly bonds of kinship to the belief that these bonds somehow existed in the pre-earthly spirit world. Certain spirits were said to be destined to be [p.214]born into specific Mormon families. While not a formal doctrine of the LDS church, this idea nonetheless in part shapes the way Mormons view, for example, such things as the number of children “destined” for their families.
47. The 1983 General Handbook combined Utah’s legal proviso with church counsel into what was the first statement on sterilization to be published by the church: “Sterilization may possibly be justified in a case where (1) medical conditions jeopardize the health of a mother, or (2) a person is born with defects or has suffered severe trauma that renders him mentally incompetent and not responsible for his actions. Such conditions, rare as they may be, must be determined by competent medical judgment and in accordance with the law” (77). This, of course, endorsed the exemption that the church opposed in 1969. The 1989 General Handbook retained the same advice (11-5).
52. A subtle shift also has begun in the case of sex change surgery as well. The 1983 General Handbook advised that “a change in a member’s sex ordinarily justifies excommunication,” (53) and exceptions under this proviso were known to have been made. Formerly the officially published guidance stated flatly, “Members who have undergone transsexual operations must be excommunicated,” with the added penalties detailed in the October 1980 version of Chapter 8 (2). By 1989 the General Handbook read, “Church leaders counsel against elective transsexual operations. A bishop should inform a member contemplating such an operation of this counsel and should advise the member that the operation may be cause for formal Church discipline. In questionable cases, a bishop should obtain the counsel of the First Presidency” (10-4). Public counsel on such surgery will surely continue to evolve. Some provision is no doubt made for children whose sex is “changed” as the only solution to ambiguous genitalia or some other purely medical miscue. As the church encounters (or fails to detect prior to conversion, etc.) well-adjusted adults who have undergone elective sex-change surgery, even further moderation will probably come about.
Another parallel is also apparent in recent counsel on oral sex in marriage. This crystallized from ambivalent or non-existent counsel to a First Presidency directive in January 1982 that married couples involved in such practices be denied access to temple ordinances, which in turn was rescinded in a follow-up directive in October 1982 that instructed local leaders to avoid [p.215]enquiring into “personal intimate matters involving marital relations between a man and his wife.”
56. LeRoy Walters (June 1982) reports that according to national surveys taken 1972-80 by the National Opinion Research Center at the University of Chicago, “a substantial majority of the adult population (range, 79 percent to 92 percent) finds abortion ethically acceptable in cases involving the so-called hard reasons for abortion (serious danger to the woman’s health, rape, serious fetal defect).” As noted above, the 1989 General Handbook did in fact make the first move in this direction, in approving abortion in cases of fetuses with such severe defects that they would not survive beyond birth.
57. Following the original publication of this essay, the 1989 General Handbook finally did address IVF, with guidance very similar to that given on artificial insemination: “In vitro fertilization using semen other than that of the husband or an egg other than the wife’s is strongly discouraged. However, this is a personal matter that ultimately must be left to the judgment of the husband and wife.”