biomedical ethics: August 2005 Archives

what do you think?


Conjugal Love and Procreation:


God's Design

From the bishop of Patterson NJ.
Way to go, Bishop Serratelli!

or, those who do not study history often end up trapped in it.

There is a discussion over on another blog about whether or not altruism is essentially evil. It started as a philosophical question comparing Ayn Rand to Robert Heinlein, and as those things tend to, it devolved a bit. It started me to thinking about how often what seems, on the face of it, to be A Good Idea, often turns out to be the beginning of a particularly virulent form of social insanity. And that got me to thinking about Dr. John Rock.

Dr. Rock was at one time a devout Catholic and a daily communicant. He was a skilled (and by all accounts) compassionate Ob/Gyn, devoted to his patients, wanting to help those who were unable to conceive to be able to have the children they so wanted. He was also troubled by women whose health was seriously affected by pregnancy. When he started his practice, there were no antibiotics, and only a rudimentary understanding of the natural process of conception, pregnancy, and childbirth. Twilight sleep (heavy doses of morphine for pain, scopolamine to erase memory, and ether or chloroform for the actual birth) was quite common for childbirth. Large episiotomy and routine forceps delivery was quite common. Women were kept in bed for days after giving birth, and blood clots were a common complication of childbirth. With no antibiotics, and with only primitive surgical techniques, cesareans were often a death sentence, and many women were damaged, sometimes permanently, from the management of their 'lying-in'. It would be decades before it became clear that many of the interventions meant to prevent damage from childbirth actually contributed to the problems.

Despite his vociferous profession and practice of Catholicism, in 1931, Dr. Rock called for repeal of the Massachussets law banning the sale of contraceptive devices (in those days, condoms and diaphragms). Casti Connubii had already been promulgated in response to the Anglican's endorsement of contraception in marriage "for serious reasons". I am not sure that he was aware of either of these developments from Europe, but it is clear that Dr. Rock endorsed at least in principle the idea of birth control. I don't understand why his pastor and/or his bishop didn't correct him at this point. Could it have been because the Cardinal archbishop was the one who officiated at his wedding? Or could it have been because the law would also forbid teaching the basics of determining the fertile and infertile period?

In 1936 Dr. Rock started a clinic teaching the Ogino-Knaus rhythm method, using the calendar and the thermometer. However, he was frustrated by the enormous variability of the menstrual cycle, and eventually wrote it off (quite publicly, in the New England Journal of Medicine). He felt that the degree of abstinence required was unrealistic. His eventual bent in research was to find a method of manipulating the menstrual cycle to artificially extend the natural infertile period. He did find it useful, though, in counseling infertile and marginally fertile couples in how to time relations to maximize their chances of conception.

The basic research into female reproductive hormones that eventually led to the birth control pill was initially intended to help the infertile woman. Dr. Rock was also convinced that medication that simply created infertility (by replicating the hormonal milieu of the infertile times of the menstrual cycle) should be considered 'natural' and endorsed by the Church. Dr. Rock was one of many researchers in the 1930s who elucidated the varying roles of the hormones estrogen, progesterone, FSH and LH. He developed the basic technique of endometrial biopsy and was the first to use it to date the menstrual cycle and identify the hormonal milieu of ovulation.

The understanding of the dance of the hormones has also helped give NFP a scientific basis way beyond that of Ogino and Knaus. I find it tragic that Dr. Rock became so convinced of his own rightness that he abandoned trying to understand and started trying to control. In reading his biography I learned that he may well have been one of the more influential persons who redefined pregnancy as beginning not at conception but at the positive pregnancy test.

Starting in 1938, he deliberately scheduled ("medically necessary") hysterectomies for women in the post-ovulatory phases of their cycles (as determined by their rhythm/temperature charts), telling the women to go ahead and have relations then. During the course of the suregery, the team would search for the eggs, fertilized or un. Dr. Rock and his research partner did not "consider the conceptuses they hoped to find to be abortuses".

Over the 14 years that the study was conducted, the team found 34 fertilized eggs, representing the first 17 days of life. Amazingly, the general public never heard of this research even after it was published. These specimins of human life at its earliest stages are still the only such collection in existence.

Reading his biography I learned how intertwined the concepts of assisted reproduction and contraception truly are. Rock carried out experiments in artificial insemination and pioneered cryopreservation of human sperm - reported in the journal Fertility and Sterility in 1946. Even earlier (1944), he reported successful in vitro fertilization - performed by his highly skilled lab assistant from eggs collected during hysterectomy and sperm donated by medical students. These early stage embryos, along with the 34 embryos collected, are still in the Carnegie Collection in Maryland.

The hormonal manipulation that led to the birth control pill also grew out of attempts to correct infertility. Dr. Rock had a theory that 'resting the ovaries' might restore their function. He administered high doses of progesterone - similar to the levels one would find after ovulation or during pregnancy - for months on end. This completely suppressed ovulation and the menstrual cycle, and many of his patients did go on to conceive once their bodies restarted ovulation after treatment was ended. (I'm guessing that this was therapeutic for endometriosis - without the menstrual cycle, the endometrial implants would shrink).

From this, the birth control pill was eventually developed. In vitro fertilization with embryo transfer (IVF-ET) grew out of his basic research. And from the mass production of embryos for infertility, we now have the social pressure to put these 'unwanted' embryos to 'good use' as research tools.

The intents were of the best - to help women to avoid conception if pregnancy would be damaging to health or well-being and also to help those who wanted to conceive be able to do so. And yet - and yet. Losing sight of the means and focusing on the ends has led to both more and less of what was sought. The ultimate separation of sexuality and procreation has been a major factor in changing the overall culture. I have no doubt that there are families who have used contraception and/or assisted reproductive technologies who have not found these to be anything but helpful (in their own perception)to themselves as individuals. But the overall effect on our culture has been to make marriage and monogamy seem to be unecessary or luxury items, not a basic foundation for family. Sex need not lead to children, and children don't necessarily require a sexual relationship between a man and a woman, and the whole cultural basis of family is affected.

The earthquake was many decades ago, and we are still getting aftershocks.

No, she's not making this up.


St Vincent de Paul, ora pro nobis


Scandal in France concerning mishandling of the remains of aborted and stillborn infants.

I don't think that we can assume this to have been a Catholic hospital (despite the name). At least I hope not.

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About this Archive

This page is a archive of entries in the biomedical ethics category from August 2005.

biomedical ethics: June 2005 is the previous archive.

biomedical ethics: September 2005 is the next archive.

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