A culture of perfection What about 'the least, the lost and the last'? From the birth of Louise Brown in 1978 following In Vitro Fertilization to the mapping of the human genome, we are faced with unprecedented questions about the future of the human race. The marriage of genetic and reproductive sciences changes our notions of what it means to be human, the nature of family and the value of technology. The rapidly advancing research and urgency of the questions demand public discussion. When should genetic screening be offered and for what reasons? Should we screen at birth to diagnose and treat illness? At 16 to 20 weeks to allow treatment or termination of the fetus? In cases of IVF, before embryo transfer to select embryos without disease? Or prior to attempting pregnancy to assess the parents for diseases they may carry? Or to select a child's gender? Two issues pertinent to the relationship between genetics and reproduction are: First, how do genetic and reproductive sciences change the nature of what it means to be part of the human family? Reproduction involves ethically charged issues such as sexual relations and the definition of life — and when life begins. What do we do with fetuses who, according to medical or cultural standards, are imperfect or defective? Christianity has always had an ethical and theological concern for the "least, the lost and the last." Yet we don't wish that a child will endure a life of horrific suffering caused by genetic abnormalities. Such dilemmas challenge the notion of what it means to be a parent, of the value of human life. Neither science nor theology alone can answer these questions. We need to search together. Second, who benefits from these medical advances and technologies? Currently, reproductive technologies such as IVF are available only for those who can afford them. Martin Luther reminds Christians that we must always consider the neighbor. In The Freedom of the Christian, Luther says: "See, according to this rule the good things we have from God should flow one from another and be common to all, so that everyone should 'put on' his neighbor and so conduct himself toward him as if he himself were in the other's place." And so we must ask, "Who is our neighbor?" The church hasn't always been helpful in equipping people to struggle with such complicated issues around life and death. Many of us want clean, clear answers. But the decisions we make are often ambiguous, messy and uncertain. So how does the church help those dealing with such questions? The church can turn to the scientific community for help in understanding exactly what is happening. Congregations can become communities that listen, support and aid those living inside the messiness and pain of these dilemmas. Lutheran theology reminds us that our relationship before God isn't determined by making the right decision. We are freed to face and live in ambiguity, knowing that God's grace supports and nurtures us through whatever life brings. Open dialogue between the public, medical professionals and theologians allows our society to exercise compassion and maintain vigilance in protecting the "least, the lost and the last." We must base our legislative decisions on improving the welfare of all those involved, especially the most vulnerable. We must remain open to the idea that being a family is more important than the route used to become a family. The process by which we come to such ethical decisions is as important as the result. We may not reach an outcome considered desirable by all, but together we might create a gracious, compassionate space for those facing questions of life and death.
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