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Pastoral Care

2/6/2015

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It was my pleasure to attend a symposium on infertility ethics at Concordia Seminary, St. Louis on November 8. The actual presentations are available at www.lcms.org/life. My notes/summaries of a presentation follows.

Esget, Christopher. “Pastoral Care for Those Experiencing Infertility and Miscarriages” Lecture, Infertility Ethics Symposium from LCMS Life Ministry and the Concordia Seminary Life team, St. Louis, November 8, 2014.

Pastor Esget introduced his presentation by observing that he is a pastor. As he cares for people he walks with them through all sorts of victories and trials. Some of the events in lives are part of a journey through mistakes. Some are the result of sin, whether ours or the sinful condition of the world in general. Some involve pain, and it is deep pain. He identifies many like Hannah, the mother of Samuel, from the Bible. In 1 Samuel 1 she is clearly experiencing the pain of childlessness, which is different from the pain of childbearing. It is a sign of the loss of life, not of the addition of life. It is full of bitterness, weeping, and anguish.

Esget lists what he calls the crosses of the barren.
 isolation/exclusion
 disappointment to self and spouse, to parents
 “When will you start a family?” Indicates that a married couple (or, for that matter, a single person) is not a real family.
 judged as selfish
 excluded - not really adults

Think - If you are pregnant we put you on the prayer list. What about people who are trying or hoping for pregnancy?

Esget went on to ask about our cultural catechesis. What does our world teach us about having children?
 Having children is a choice - you have autonomy
 children or no children a choice of lifestyle
 we have control - best to wait until . . . our will dominates
 Russell Moore discusses “the god of a self-directed future”

Spiritual challenges in seeking a child
 To pursue a career you may need to delay childbearing
 After a delay it is more likely to have difficulty
 This may lead to guilt, recrimination, resentment
 In the fertility war intimacy becomes an urgent and often costly encounter.
 What if we had tried one more time?

“The pursuit of a child of one’s own has become a form of idolatry.” We may end up in situations where we think we have failed personally if we have not given birth. At that point, encounters with children tell us again that we have failed, because they are other people’s children.

Esget discusses this situation, calling it the trial of barrenness. He prefers the term “barrenness” to “infertility.” This is because often the psychological impact of having no children is akin to lacking something without which we cannot survive. We feel like we are in a barren wilderness.

 We begin to pray and bargain with God.
 We ask why God doesn’t answer.
 We feel anger, resentment and numbness.
 We question whether God is punishing us.
 Esget quotes Luther, Isaac and Rebecca “supposed that they were cursed and under God’s wrath.”


What about when a couple conceives?
 Pregnancy leads to euphoria.
 What about a miscarriage? The euphoria suddenly turns to silent grief.
 As a pastor what do you tell her when she asks? Often it is the husband who asks. There isn’t a satisfactory answer. The couple is suffering. God brings healing and sustenance in our times of pain and suffering. But it isn’t a satisfactory answer. The situation is still full of pain.
 Everybody ELSE moves on.

Esget talks about a parenting club, the people who know all about watching their children developing. But there is a more secret club than the parenting club. It’s the one where people know and understand our sorrow and grief. This is a difficult club to find because most people never discuss being part of it.

How do we care for people? By “making their cross your cross and taking them to Jesus who has cared for you both.”

Fertility difficulties are a severe challenge. In our grief we need to turn to Jesus. He is the only one in whom we can hope. We are really unable to conceive on our own.

Esget moved on to ask two questions.

  1. Is my baby in hell? A cold theological rationale is not comforting. We commend the child into God’s hands realizing that God is love. In Psalm 50:15 God tells us to call on him in the day of trouble. We know this is trouble and we call on him, trusting that his grace will be sufficient.

  2. Did I kill my baby? Esget says to consider the situation of an ectopic pregnancy. The child cannot survive and the mother is not likely to survive. Even though the mother may not have sinned, the pastor absolves her. If she has a guilty conscience, do not minimize it, forgive it. Be present.

Esget then moved to some practical matters related to pastoral care.
 Expose and absolve the sins resulting from barrenness, sins such as guilt, greed, anger, etc.
 Acknowledge you don’t have words to take away the pain.
 Remember that spiritual care takes time.
 Pray regularly and publicly for those who are having difficulty with pregnancies and those who have lost children.
 Be sensitive to those excluded from having children.

In the end, remember that the Christian’s identity is not in having children or not having children, but in Jesus. We speak of the atonement, not merely forensically, but as Jesus very personally enters into all our human sorrows (Isaiah 533:4).




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Reproductive Counseling Practices

1/8/2015

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It was my pleasure to attend a symposium on infertility ethics at Concordia Seminary, St. Louis on November 8. The actual presentations are available at www.lcms.org/life. My notes/summaries of the presentations follow.

Voss, Kevin E. “An Ethics Survey of Reproductive Counseling Practices in the Lutheran Church.” Lecture, Infertility Ethics Symposium from LCMS Life Ministry and the Concordia Seminary Life Team, St. Louis, November 8, 2014.

Voss’ presentation was not exactly easy to follow. He presented a discussion of a survey on reproductive counseling. The goal of the study was to identify opinions about IVF and prenatal genetic testing among a population of Roman Catholic, Lutheran, and Jewish congregations.

“Little research has been conducted on the importance or quality of reproductive counseling.” Voss’ thesis was that there is a need for reproductive counseling. Leaders know the theology but may not know enough of the science to give wise counsel. He found that four studies had already been done. Not much had been done with clergy involvement in IVF and PGT counseling. He constructed questions about demographics, knowledge, beliefs, assessment standards, and alignment with  the leaders’ religious bodies.

Infertility affects about 9%of couples. About 12% of women of childbearing age have used fertility services. There is a 2-3% chance of significant birth defects. Genetic issues contribute significantly to infant mortality. PGT is used to identify a disease. Voss suggests people question whether it is always appropriate to use the testing and whether it is appropriate to end a pregnancy.

Voss observes the profession of genetic counselors, who are trained to be nondirective, clarifying situations. At times this may interfere with or conflict with religious beliefs. Counselors are supposed to encourage couples to heed their religious values. Voss emphasizes that clergy involvement may be very helpful. The congregational leader is available, accessible, and is prepared to connect people to their faith community and traditions.

According to a 1993 study, most rabbis are uncomfortable with genetic issues. Voss generalizes this to other religious leaders as well. If that is the case, it is important for clergy to learn to interact with these issues, both with health care professionals and with congregations.

In time, genetic screening may become more routine. The screens, however, create an urgent need. A condition is found which is to be addressed quickly. Therefore, clergy needs to be ready to respond quickly. Voss observes that genetic counselors are normally carrying a very large caseload and are not always able to devote the time and energy needed to care for some concerns.

Voss returned to the survey he conducted. The survey was conducted among the Roman Catholic, the Lutheran Church Missouri Synod, and Conservative Judaism.

What were the stated positions about IVF?
 Roman Catholic - the embryo is an entity deserving dignity, IVF is therefore not appropriate.
 Lutheran - IVF may be used, but strongly discouraging donor sperm or egg and no abortion.
 Conservative Judaism - IVF is fine, abortion is allowed in case of problems.


What were the stated positions about PGT?
 Roman Catholic - diagnosis is all right but not appropriate to threaten life
 Lutheran - diagnosis is all right but not appropriate to threaten life
 Conservative Judaism - diagnosis is all right, fine to terminate pregnancy in case of defect

Voss moved on to discuss the construction of his survey and a statistical analysis. Since details are available in the text of the presentation I will not attempt to reproduce my notes at this point.

Voss’ recommendations?

  1. Pre-seminary should include training in the science of these matters.
  2. Seminary bioethics courses should be required.
  3. Seminars about counseling should be required.
  4. Church bodies should develop a special emphasis on bioethics.
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Be Fruitful and Multiply

1/1/2015

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It was my pleasure to attend a symposium on infertility ethics at Concordia Seminary, St. Louis on November 8. The actual presentations are available at www.lcms.org/life. My notes/summaries of the presentations follow.

Cwirla, William. “Be Fruitful and Multiply: Fertility Ethics Viewed in the Light of Creation and Redemption.” Lecture, Infertility Ethics Symposium from LCMS Life Ministry and the Concordia Seminary Life team, St. Louis, November 8, 2014.

Cwirla introduced his topic by observing that infertility is a delicate topic. There may be a tendency on the part of the Christian ministry to dismiss it altogether and leave it to clinicians. He does not think this is a wise route to take. Because we are embodied creatures we live out our spiritual lives within the body. Our ethics and behavior are intricately linked to our view of spirituality. “Ethicists remind us that our actions matter.” Therefore it is appropriate that the Christian minister deal with the topic. Cwirla then discussed the fact that he has both a pastoral and personal interest in the topic, observing that he and his wife are childless after many years of marriage. This childlessness, however, is not their identity. He would prefer to see it within the doctrine of vocation, as a station of life which they have and in which they can live to the glory of God.

When considering the issue of infertility we begin with the creation mandate, “Be fruitful and multiply.” In the opening chapters of Genesis God shows himself to be productive and makes productivity a blessing.

Included in the mandates of God are the laws of nature in which offspring is the norm.

Apology of the Augsburg Confession 23 discusses celibacy and observes that reproduction does belong to human nature and is not to be denied.

Human procreation seems unique in the way desires and responses come about. Cwirla prefers the term “procreation” rather than “reproduction” - emotional bonds lead to creation of a family.

Cwirla prefers the biblical concept “know” rather than the term “mate.”  All of this is part of the human nature as created in God’s image.

Marriage can well be seen as a barrier protecting the one flesh relationship described of married couples in Scripture.

Cwirla discussed Old Testament history as a record of the promised seed, Christ, who would come to redeem the world. In this narrative marriage and procreation serve to move people through creation toward redemption. The Old Testament is full of the blessings of having children. “The barren womb represents the monergism of God who works alone.” God fills what is empty, showing his irresistible work of blessing. Finally, he uses not a barren womb but a virgin one, fulfilling the promise to bring a Messiah.

What of responses to childlessness? Cwirla discussed surrogacy, which was known and used in the Old Testament, observing that Ishmael, Dan, Naphtali, gad and Asher were all children of surrogacy. Though this was a method used to bring several tribes of God’s chosen people, Israel, into existence, the overall Old Testament picture is not precisely approving of the idea. In all the instances recorded there are accompanying episodes of strife and struggle.

The New Testament tends to have a focus less on the biological family than on the family of God. This is not a family which is naturally born but which is born of water and the Spirit. The body of Christians comes to be seen as the true mother, brothers, and sisters. Rather than being blessed by being born into the people of Israel, people are blessed because they hear the Word of God and keep it. Jesus affirms marriage, family, and children. Yet he has a greater interest in the life of redemption. In the resurrection people neither marry nor are given in marriage. Celibacy is good, as is marriage and family. We know nothing of the apostles’ families except that Peter’s mother-in-law is mentioned, and that only once. Ultimately, Christianity does not deny the body, refuse marriage, or downplay raising children. There are good factors to those states, as there are good factors to the state of singleness and lack of children.

Turning his attention more specifically to infertility, Cwirla observed that it is not life-threatening, that it is not a sign of sin, but that it is a vocation, a status in life. This is something that Cwirla would include in the idea from Psalm 139 that we are “fearfully and wonderfully made.”

Counter to this idea, our modern scientific world tends to replace the above with forced biological reproduction on demand. Cwirla sees this as an effort which can tend to separate the ideas of marital intimacy and offspring. The potential path which reproduction on demand can take includes IVF, developments in cloning, and, ultimately, the idea of baby factories as seen in Huxley’s Brave New World. “Fertility is something almost taken for granted today. It’s like a light switch we can turn on and off, or so we think.” However, Cwirla observes that the fact that reproductive technology works does not mean it is approved by God.

Once a couple seeks assistance in childbearing, Cwirla identifies them as entering onto what he would consider “The Infertility Superhighway.”

A couple seeks medical help, thus having conception rather than intimacy as the goal.

Artificial reproductive technology is introduced, bringing procreation separate from intimacy.

The in vitro fertilization process removes procreation from the body entirely.

Cwirla observes that each “failure” tends to propel couples to the next step. Moving down the superhighway only a short distance can bring in donor eggs or sperm, surrogacy, or other solutions which often, due to confidentiality issues, not only bring in the complication of another individual’s participation, but also sometimes a lack of clarity in medical history, which can lead to medical challenges at a later time.

In addition to these challenges, Cwirla considers that there are multiple ethical issues involved in seeking assistance. The issues often run deeper than the couple expects. There are challenges to the one flesh relationship. There may be emotive challenges and a sense of erosion of the family. On occasion reproductive assistance may leave children feeling as though they are property rather than family. Some of the attempts may go beyond trusting God to a situation where the prospective parents are “playing God.” These are concerns which Cwirla would urge couples to consider as they are considering assistance, thus avoiding a challenge arising by surprise.

Cwirla closed his presentation with seven pastoral observations.

  1. Our identity as a Christian is not shaped by our vocation but by Christ.

  2. Use of technology is not in itself a sign of unbelief.

  3. Human life must not be sacrificed or compromised.

  4. The one flesh mystery must be protected at risk of losing identity as male/female in relationships.

  5. We should be sensitive to those without children. It is a valid vocation.

  6. Life is complicated and full of ambiguities. Ask how what we do loves and serves our neighbor.

  7. marriage and family is a gift of God. It is not the centerpiece, which is Christ alone.

A questioner asked pastor Cwirla how we would give pastoral counsel to those burdened by infertility. He responded that the heartfelt desire is good. In our walk we remind one another that our identity is at its heart that of a child of God rather than something defined by a vocation, including the vocation of parenthood or childlessness. Some doors in our lives are closed and we don’t always know why. In that realization we deal with the issues of grief and loss rather than the issue of infertility. We do not take fertility for granted. When our identity is in Christ we can find contentment whether we have children or not.
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    Proper 25C
    Proper 26C
    Proper 27C
    Proper 28C
    Prophets
    Proverbs
    Psalm
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    Quinquagesima
    Quintilian
    Rabbinic Character
    Real Presence
    Receptivity
    Reed 1995
    Reformation
    Reformation Day
    Reinhartz 2018
    Resurrection
    Revelation
    Rhetoric
    Rhoads 2010
    Richardson & Gooch 1984
    Riggs 1995
    Ritual Meal
    Romans
    Rordorf 1996
    Rosenberg 1986
    Rosenberg 1987
    Rosenfeld-levene-2012
    Rueger-2016
    Russo 1994
    Ruth
    Sacrament
    Sacrifice
    Saenger 1999
    Sailhamer1992
    Sailhamer-1992
    Sale 1996
    Samuel
    Scaer2004
    Scaer-2004
    Schaff 1886
    Schaff 1888
    Schaff 1889
    Schaff 2014
    Schaff-2014
    Schollgen
    Schwarz 2005
    Scriptural Usage
    Seeliger 1996
    Septuagesima
    Sermon
    Sexagesima
    Simon And Jude
    Smith-2009
    Smith 2018
    Sommerville-2006
    Songofsongs
    St. Andrew
    Stark 1997
    St. Barnabas
    St. Bartholomew
    St. John
    St. John The Baptist
    St Luke
    St Mark
    St Matthew
    St. Matthias
    St Michael And All Angels
    St. Paul
    St. Peter And Paul
    St Philip And St James
    Strawbridge 2017
    St. Stephen
    St. Thomas
    St. Titus
    Sunday Of The Passion
    Tatian
    Taylor 1888
    TDNT
    Teaching
    Telfer 1939
    Tertullian
    Textual Comparison
    Textual Integrity
    Theophilos 2018
    Theophilus Of Antioch
    Thielman-2010
    Thursday In Holy Week
    Timothy
    Titus
    Transfiguration
    Transfiguration-a
    Transfigurationb
    Transfiguration-c
    Trinity 1
    Trinity 10
    Trinity 11
    Trinity 12
    Trinity 13
    Trinity 14
    Trinity 15
    Trinity 16
    Trinity 17
    Trinity 18
    Trinity 19
    Trinity 2
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    Trinity 21
    Trinity 22
    Trinity 23
    Trinity 3
    Trinity 4
    Trinity 5
    Trinity 6
    Trinity 7
    Trinity 8
    Trinity 9
    Trinity-a
    Trinity-b
    Trinity-c
    Trinity Sunday
    Tsang 2009
    Tuckett
    Tuesday In Holy Week
    Tuilier 1995
    Twelftree 1984
    Two Ways
    Ty 19
    Van Der Merwe 2017
    Van Der Merwe 2019
    Van Der Watt 2008
    Van De Sandt 2002
    Van De Sandt 2007
    Van-de-sandt-2010
    Van-de-sandt-2011
    Van De Sandt & Flusser 2002
    Van Deventer 2021
    Varner 2005
    Veith1993
    Veith-1993
    Veith-sutton-2017
    Vikis-Freibergs 1997
    Visitation
    Voobus 1968
    Voobus 1969
    Warfield 1886
    Wasson & Toelken 1998
    Wednesday In Holy Week
    Wenham 1984
    Wenham 1992
    Weston-2009
    Wilson2011
    Wilson-2011
    Wilson20113470b5cf10
    Wolmarans 2005
    Wright 1984
    Young 2011
    Ysebaert-2002
    Zechariah
    Zephaniah

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