On April 1, 2025, Trump’s Health and Human Services froze just over $65 million worth of Title X grants to family planning clinics, citing concerns with “possible violations” of federal civil rights law. HHS said it would investigate clinics for “widespread practices across hiring, operations, and patient treatment that unavoidably employ race in a negative manner” as well as “taxpayer subsidization of open borders”—for example, conducting programs in a way that “overtly encourages illegal aliens to receive care.” 

The funding in question had been for sixteen grantees in seven states—California, Hawaii, Maine, Mississippi, Missouri, Montana, and Utah—including nine Planned Parenthood state affiliates, and affecting roughly eight hundred abortion sites across the United States. (The total number of abortion clinics in the United States is unknown, but most estimates suggest roughly eight hundred are currently in operation.) Other states that receive grants under Title X, such as Texas, received partial funding during the freeze. 

Within weeks, the American Civil Liberties Union and National Family Planning and Reproductive Health Association, which represents most Title X grantees, sued the administration for “unlawful” withholding of the grants. In the ensuing months, affected abortion clinics provided materials to HHS in response to the concern that they violated federal rules for diversity, equity, and inclusion programs. That lawsuit was dropped last Monday, after the Trump administration began releasing frozen funds on December 19, citing a completed review of the grants in question.

Pro-abortion activists have said that the lack of Title X funding caused many clinics to shutter, though the total number of brick-and-mortar abortion shops had already begun dropping before the Dobbs v. Jackson Women’s Health Supreme Court decision, following the prevalence of mail-order mifepristone. At least two shops in Utah did close during the freeze, one on the northern border near Idaho, where abortion is banned, and the other on the southern border near Arizona. Apparently, the demand for Planned Parenthood’s services was not significant enough to sustain a clinic, absent heavily subsidized and free options for low-income clients. 

Veteran pro-life strategist Tom McClusky, director of government affairs at CatholicVote, called the move to return the grant money strategically necessary, since the Trump administration was “virtually certain to lose the lawsuit, forcing them to repay the full amount plus interest and cover attorneys’ fees,” he told the Daily Signal.

One reason for this is that HHS withheld the money before amending 42 U.S. Code Part 300, a rule that governs family planning grants. As currently written, the rule allows HHS to grant and contract with public or nonprofit private entities to establish voluntary family planning services, including “natural family planning methods, infertility services, and services for adolescents,” with additional memoranda from Biden in 2023 to explicitly protect abortion access and promote mifepristone availability in the wake of the Dobbs decision. 

At its inception in 1970, Title X of the Public Health Service Act was championed by President Richard Nixon and incoming President George H. W. Bush, as it sought to improve access to family planning services to low-income women. It was an easy sell because, in its original form, the Title X program expressly prohibited grant recipients from using the funding to provide abortions, as aborting an unborn child was not considered a legitimate form of “family planning” at the time. Yet since then, Title X has been subject to a match of political volleyball, with Democratic presidents ordering HHS to use the funds for abortion clinics, while Republican presidents from Ronald Reagan onward have instated the Protect Life Rule, which prohibits the funding from being used in the same facilities where abortions take place. 

The Protect Life Rule, neutered by President Joe Biden, has yet to be reinstated by Trump during his second term. Yet, as the pro-life research organization Charlotte Lozier Institute has pointed out, the rule is ultimately a mere stopgap for more sturdy congressional action: “A bill that explicitly amends Title X to prohibit abortion referrals in Title X projects and requires strict separation between the projects and abortion businesses would avert threats to this federal program by future administrations.” In other words, Republican congressmen can defund Planned Parenthood themselves, and more permanently than Trump ever could. One has to wonder what they’re waiting for, with a Republican majority in both houses and a Republican in the Executive Office. 

Despite their political strength, Republicans are still sheepish on national abortion legislation, perhaps habitually so. This is somewhat understandable: Multiple state-level pro-life ballot initiatives have failed (though few have been exceptionally strategic), and the fearmongering from the left about a national abortion ban has yet to let up since 2022. Truly, there is nothing a Republican loves less than proving a Democrat right, even for the sake of an objectively good policy. 

Yet, Trump was re-elected after his judges overturned Roe. This says something, however ambiguous, about the moral compass of the American people. Abortion turned out to be a lot less of a rallying cry for either side in the 2024 election than expected, which means now could be exactly the moment to gently roll the ball forward. There is much room between banning abortion and saying the government may not, in fact, subsidize organizations that profit from killing low-income, minority children. 

In any case, the dismissal of the Title X lawsuit clears the way for a more successful fight against Planned Parenthood funding, which rumors on Pennsylvania Avenue suggest could be coming soon. At the very least, reinstating the Protect Life Rule would seem an easy win for pro-life voters on the eve of the March for Life in Washington, D.C.

The post Is Trump Playing the Long Game on Abortion? appeared first on First Things.

Yes, the administration has been ostentatious about performing aspects of religiosity. But its top policy priorities have tended not to display any real commitment to the concerns raised by people of faith. Old-guard concerns about the institution of marriage, single parenthood, drug use, gambling, vice, and, yes, abortion have all tended to be back-burnered.

Put aside prudential concerns raised by some about the White House’s application of just war theory, the expansion of marijuana availability, or its chaotic foreign aid cuts. On the issue of life alone, the second Trump administration has defended Biden-era regulations around the abortion pill, expanded federal support for fertility technology that destroys embryos, and approved a generic version of the abortion pill. Now, just this week, the president directed Congressional Republicans to be more “flexible” in allowing taxpayer funding to partially subsidize insurance coverage of abortion. 

To be sure, the pro-life segment of the coalition has not been left empty-handed: The traditional reinstatement of the Mexico City policy, the pardons issued to imprisoned pro-life activists, and Congress’ temporary defunding of Planned Parenthood should all be counted as positives. But overall, the policy wins have mostly stacked up on the “cultural”—or, if you prefer, “secular”—side of the ledger, compared to conservatism’s more socially traditionalist or religious wing. 

Politics will always require some measure of strategic alliances. The ultimate goal for pro-lifers remains convincing more Americans that we have the best interests of pregnant women and the children they carry at heart and can be trusted to enact laws that take seriously both of their claims on justice. That work won’t be accomplished according to the timetable of a midterm election cycle. As EPPC president (and my boss) Ryan Anderson wrote for First Things in the heat of the 2024 election, “we are all incrementalists now.” 

The problem, as Ross Douthat replied in his New York Times newsletter, is that “nobody can yet fully agree on what incrementalism means.” Talk to pro-life leaders about the right priority for the next three years and you’ll get a half-dozen ideas: We should investigate abortion pill residue in the groundwater; push to make birth free; double down on preventing Planned Parenthood from ever receiving any federal dollars; fund a national abortion pill reversal hotline; focus on making state laws ever-more restrictive.

These ideas, and more, have at least some merit. But if everything is a priority, nothing is. And without the galvanizing goal of overturning Roe, or pushing for a signature federal piece of legislation, the pro-life movement runs the risk of having too many targets at which to shoot, and too little coherence to do so effectively. 

So what, then, should be the focus of federal energies during the remaining years of President Trump’s second term in office? I propose pro-life organizations and actors train their fire on two goals.

Above all else, pro-lifers should be uncompromising in continually upping the pressure on the Trump administration around the abortion pill. The Biden administration’s decision during the pandemic to allow women to receive a prescription without meeting with a doctor in-person dramatically expanded access to abortion pills. Not only has that led to an uptick in abortions post-Dobbs, it has also produced horrifying cases of men mail-ordering abortion drugs and covertly administering them to wives or girlfriends. At a bare minimum, a nominally pro-life White House should restore the in-person requirement. Anything other than a reversal of the Biden administration’s mifepristone regulations should be seen as rank political cowardice and a betrayal of the movement that helped get the president elected. 

The next goal will require a little bit more of a stretch—but it’s far from outside the realm of political reality. Pro-life groups should put their energies behind a concerted push to get cash assistance into the hands of new parents shortly after childbirth, commonly known as a “baby bonus.” 

In its ideal form, a “baby bonus” would arrive right around the same time as the child’s Social Security Card, either via direct deposit or as a physical check. A $2,000 or $4,000 upfront payment to new parents would not be intended as a way of lifting America’s birth rates or improving maternal and infant health outcomes—though those may be happy side effects. It would, however, be intended to recognize the costs associated with having kids, in terms of both new expenses and income foregone, and a visible signal that America proudly stands with new parents who choose to bring their child to term. 

Ideally, such a provision would recognize the importance of having two married parents in the household, and give both mom and dad more flexibility to take time off of work around the birth of a child. This could easily be done by ensuring a “baby bonus” provides a baseline of support for single parents (who are most at risk of choosing abortion) while doubling the amount for married parents. Crucially, it would need to be salient and accessible—not tucked in to the next tax filing season, or a savings plan that won’t provide assistance for decades hence. There are plenty of other policy goals that could fit into a pro-life policy schema, but none are as compelling as up-front cash assistance for new parents. 

Standing staunchly against pro-abortion moves, whether from the other political side or within one’s own party, will require tenacity and courage. But concentrating the financial power, political engagement, and prophetic witness of the pro-life movement on two discrete goals could give the movement some much-needed definition during the waning years of a lame duck administration. 

Pro-lifers must be prudent. But prudence should not excuse cowardice. Plenty of governors have signed pro-life legislation in red and red-purple states and paid no political price. The lesson is not that pro-life moves are popular across the board, but that acting on pro-life convictions need not be an albatross if a governing coalition is also delivering wins on economy, inflation, and the border. If a political party is failing on pocketbook issues, however, no amount of social issues fecklessness will save them.

Perhaps a future Republican president will be more willing to expend political capital on the pro-life cause. For now, many within the GOP, including the current president, would prefer the issue fade quietly from view. If the pro-life movement can agree on an intra-squad compact around two goals—one offensive, one more defensive—it has a better chance of ensuring its victory in Dobbs was merely the end of a chapter, and not the beginning of the end of its story.

The post Two Pro-Life Goals for 2026 appeared first on First Things.

Anyone who raises a question about the legitimacy of IVF and surrogacy is vulnerable to accusations of being meanspirited or even of denying the humanity of the children born through these methods. My answer to such criticism has always been that I do not deny the humanity of such children but, ironically, the procedure itself encourages society to think of children as commodities. In the eyes of the law, they necessarily become analogous to pieces of property, to things, as the law must intervene in the many complicated situations that arise as a result of divorcing reproduction from its traditional context. When the surrogate child has Down syndrome, for example, who has parental responsibility? Those who donated egg and sperm, or the woman bearing the child in her womb? If the people paying for the process want the child aborted, do they have the right to demand the surrogate does as they desire? And as we move in the (near?) future toward the commercial creation of children from other body cells, the questions will only become more complicated. 

I have never denied the humanity of a child born through IVF or surrogacy. Indeed, it is not the critics of the processes but the processes themselves that are shifting the cultural imagination toward seeing children not first and foremost as persons but rather as things, as pieces of property to be defined and disposed of by the law of the land, not the law of nature.  

But is reproductive technology the source of the problem or rather something made plausible by longstanding shifts in other areas of our culture? A friend who read my manuscript in advance has raised an interesting point: Did the advent in the West of no-fault divorce effectively set this whole process of objectification in motion? In retrospect, it seems obvious how its redefinition of marriage as a sentimental, utilitarian contract paved the way for gay marriage. But what of its effect on how society treats children? No-fault divorce has made into a routine part of our cultural imagination something that previously applied only in extreme cases—the consideration of children as pieces of property whose relationship to parents is necessarily a matter for the courts to decide.

The point is a pungent one and a reminder that marriage is part of the ecology of what it means to be human. Alterations in its definition or function cannot be confined to the domestic sphere but necessarily have a transformative effect on the broader anthropological question. The practical definition of marriage in any given society is connected to how that society understands what it means to be human. Make marriage a sentimental, contractual bond and you have to revise the relationship between the children that are its fruits, and thus parenthood. In short, you have to revise the most basic of human relationships—and therefore the concept of humanity itself—at a foundational level. In a no-fault divorce world, all relationships become contractual, even that between parent and child. And given that the Christian (and Jewish) view is that human beings are made in the image of God, such basic revision of what it means to be human has religious significance. Revise the image of God and you revise the nature of God. 

The next decade looks set to bring a cascade of novel moral challenges into the lives of many people, not least in the area of reproduction. The Protestant churches will find the challenge of fertility treatment to be particularly acute. That is not to say that Catholicism faces no difficulties. The routine and unchecked practical rejection of the Catholic Church’s teaching in the area of reproduction by vast numbers of her adherents is an ecclesiastical scandal, while the annulments of marriages that have produced children look, to this Protestant at least, just a little too culturally convenient when compared to Christ’s own rather more stringent teaching on the matter. 

But those huge problems are for Catholics to address. My Protestant world has problems of its own. It has largely lost its sense of human teleology as a whole and it has bought into a pragmatic, utilitarian view of reproduction. How many pastors even know where to begin when it comes to IVF and surrogacy, let alone what conclusions to draw? Further, and to return to my friend’s comment, its casual acceptance of no-fault divorce many years ago not only altered the ecology of marriage but also of anthropology itself. The churches’ longstanding desecration of man is bearing fruit, not least in the way it accepted divorce laws that pressed us all toward seeing children as things. And that makes clear thinking about reproductive technologies such as IVF impossible, short of a willingness to take unpopular, distressing, and counter-intuitive positions.

The post When No-Fault Divorce Turns Children into Commodities appeared first on First Things.

This last seals the boy’s fate. There will be no lifesaving operation. The crying baby with chubby legs and wide-open blue eyes, facing the flashbulbs of the press, is instead to be starved and dehydrated to death. It is an act of the “kindest mercy” for the child to be “put out of its misery,” the physician has told the parents. For the next decade, in newspaper columns, in public speeches, and even in a feature film that he will write and star in, the physician will present his patient as an exhibit in his argument that compassion and the scientific method compel American medicine to bring about rational ends to “lives of no value.” The editorial board of the New Republic, Helen Keller, and many leading physicians will agree with him.

The Bollinger baby—christened by his relatives Allen after his father, yet unnamed in the press and even in modern accounts of the tragedy—became the first publicized case of a newborn in America forced to die because of his disabilities. The year was 1915. The physician became a celebrity. Decades before Jack Kevorkian, decades before either abortion or assisted suicide was legalized anywhere in the United States, there was Harry Haiselden, the surgeon and showman at the head of the ­German-American Hospital in Chicago.

No jury would convict Haiselden. He insisted that he treated his “defective” infant patients as he did “because he love[d] them.” He loved them to death. Sometimes he actively accelerated their deaths: He removed the umbilical ligature of one patient, leaving him to bleed to death, and prescribed another potentially lethal doses of opiates. It was an ambivalent love. “Horrid semihumans drag themselves along all of our streets,” Haiselden warned at the end of his autobiography. “What are you going to do about it?”

It is tempting to dismiss Haiselden’s odious question, precisely because it is odious. That would be a mistake. Today Haiselden is achieving a posthumous conquest of the medical field. His victories are not just in Canada, where the Quebec College of Physicians and many clinical ethicists have urged Parliament to legalize the euthanasia of disabled newborns, or in the Netherlands, which under the infamous Groningen Protocol has been euthanizing “neonates” with terminal illnesses for two decades.

It is in less likely places that Haiselden’s victory is taking shape, pitting parents against the physicians of their disabled children—parents like Krystal VanderBrugghen, who alleges that her child with Down syndrome received inadequate, discriminatory, even life-threatening medical care, in “the best children’s hospital in the world.” Stories like hers have been a century in the making.

The best children’s hospital in the world for 2026, according to Newsweek and Statista, is the Hospital for Sick Children (SickKids) in Toronto. I walked into SickKids in the summer of 2025 to see Krystal, a “mama bear” according to one of her friends, and Mo, who asked me not to use his ­real name because one of his children is receiving treatment at the hospital, and he fears retaliation. Krystal befriended Mo’s wife in the coffee lounge over the summer, and soon Mo was friends with Krystal, too.

We decided it would be best to speak in the wing of the pediatric unit, whispering whenever a nurse walked past. Mo and Krystal both credit religious faith—Mo is Muslim, while Krystal and her husband Jeremy are Canadian Reformed Christians—with fortifying them to bring children with Down syndrome into this world. Mo said his wife felt guilt-tripped by their healthcare team, who asked her immediately what quality of life she, Mo, and their three other children would have if she gave birth to a child with Down syndrome. “At the end of the day,” Mo told me, “I am not God. I cannot decide who lives, who doesn’t live.” Now, with his child with Down syndrome already five years old, the experience of raising him is “probably . . . the best thing in my life.” Krystal experienced the same pressure and reward. She was advised three times by clinicians that she could “terminate at any point and start again.” She didn’t want to start again. She wanted her child to be born.

On December 4, 2023, eighteen months before I met Krystal and Mo, Veya was born at McMaster University Medical Centre in Hamilton, Ontario. Like many children with Down syndrome, she had a cardiac defect, which in her case meant that she was in active heart failure for the first four months of her life. She needed cardiac surgery, which required her to be transferred to SickKids Hospital in Toronto. It is an hour-plus commute for Krystal on “a good day,” especially since the AC in her car stopped working. It was worth it; the surgery worked. “It’s funny,” said Krystal. “They try so hard to end this life, but the second she’s born, they do everything they absolutely, possibly, humanly can do to preserve her life and get her here to get her heart repaired. But once we started getting involved with GI [the gastro­intestinal team] and she started having more problems, that’s when it was like they drew the line.”

A month after her heart was repaired, Veya developed an undiagnosed liver disease, causing her bile to be thick. She underwent liver surgery. This time, the surgery didn’t work. Veya desperately needed a liver transplant, and although the rest of her individualized specialty care team approved her for a liver transplant, the trans­fer team ­denied her this lifesaving treatment. ­Krystal still doesn’t know the reason. Veya needed to stay in the ICU.

Without a liver transplant, Veya’s immune system was vulnerable. I asked how Mo was ­recruited to help with Veya’s medical journey. “I invited him into my meetings,” Krystal said. Mo continues for her: “Yeah. I hear stories. Krystal tells me what’s happening. She’s gone through a lot, like, mentally. I’ve lived here almost a year. That’s hard. So God knows what she’s going through, right?” Mo’s child was being treated for leukemia in the hospital, and he had no complaints against SickKids. “It’s interesting because I’m seeing two sides, right?” said Mo. “I’m seeing my side and then I’m seeing her side. Two different teams, but from her side, ­Krystal’s team, and I’ve used this word a lot, I’ve been baffled on what’s happening.”

The quality of care for Veya dropped precipitously, Krystal and Mo believe. Shortly after Veya was denied her liver transplant, while she was unattended, she received a potentially lethal amount of potassium, ten times her usual dosage. Her heartbeat exceeded 350 beats per minute. The hospital told her that the overdose “passed through four pharmacists and two nurses,” Krystal said on a recent podcast. “We’re really sorry but it was around Christmas time,” was the only excuse she received from the hospital about the incident that nearly killed her daughter.

SickKids declined to answer my questions about the incident and about whether any steps were taken to prevent a similar incident in the future. In an emailed statement, a spokesperson commented: “We cannot comment on individual cases due to patient privacy. . . . Decisions about care for each child’s unique case are guided by clinical expertise, ethical standards, multidisciplinary collaboration, and partnership with families.”

At first, Krystal believed the potassium overdose had been an innocent mistake. Now she is not so sure. At several points, the physicians in the ICU have seemed to “[want] to free up a bed spot and rush her out because she’s been here for too long.” Three days into her care, a doctor said that if Veya needed a ventilator, she would not receive one, despite being on full code, because “it would do more harm than good.” (Due to a 2019 court decision in Ontario, physicians need not seek consent for a Do Not Resuscitate order, or even inform patients that one has been placed against them, if their care is deemed “medically futile.”) Krystal had to enlist the patient relations department in order to get her daughter’s DNR lifted.

She felt coerced into giving up. “SickKids is very ableist,” Krystal told me. Another ICU physician put his hand on her shoulder and said, “You know, Mom, it’s been such a long road for you guys. You can admit when enough is enough, and you can let someone die with dignity.” Was the overdose intentional? An effect of neglect? Or a simple accident? Whatever the case, it happened, Krystal and Mo believe, only because Veya is disabled. At one point, when she asked whether Veya was being denied a transplant because of her Down syndrome, a transplant physician answered, “Mom, I think you know the answer to that deep down in your heart.” She heard similar comments from the physicians. “[Another] ICU doctor said, ‘We look at Veya, all that she is and all that she was born with,’” Krystal said. “And I said, ‘What, a head, two arms, two legs?’ I’m like, ‘Yeah, she came with a cardiac defect. That’s fixed. That’s not causing the problem. Or are you isolating her extra chromosome here?’”

The accidents—if accidents they were—continued, always occurring when Veya was by herself. “Every time I step away, something happens,” Krystal said. Mo interrupts: “Twenty-minute lunch break.” Krystal continues: She went on a “twenty-minute lunch break, and they shut off a medication that they knew from a couple days ago she had withdrawal symptoms from.” Another incident occurred when Veya was struggling to breathe. It was a code blue, but the crash team, instead of rushing to help Veya, was slowly walking to her. Krystal had to raise the alarm herself.

Krystal and her husband Jeremy felt that Veya was unsafe at SickKids. The Delta Hospice Society and the Euthanasia Prevention Coalition organized a round-the-clock daily watch over Veya. But SickKids began to clamp down on the visits. It also banned Veya’s general pediatrics team from visiting unless they first asked for permission. When I spoke with Krystal, she was in the last steps of organizing an ambulance to move Veya to another hospital.

At the same time, Veya was meeting her development milestones. She liked geese and her bravery beads; she played with her brothers and sisters. “That’s the thing,” Krystal told me. “This ICU admission, she’s actually met three milestones, or two—I guess popping [your teeth] is not really a milestone. Maybe it is, but I’m like, you learn to smile. You learn how to coo. You just can’t make noise because she’s got the [respiratory] tube. But then, you popped your first tooth. I’m like, look at this! This isn’t a kid on death’s door. But they’ve been treating her like she’s on her way out and ­palliative.” When SickKids was handing Veya over to another hospital—at the time, Krystal was considering either McMaster or a hospital in the United States—SickKids said that she was not on ­palliative care.

As is the case throughout Canada’s healthcare system, it is difficult to find conclusive evidence of neglect or wrongdoing when medical care is subpar. But SickKids Hospital is no stranger to euthanasia. Just two years after Canada legalized medical assistance in dying (MAID)—a euphemism for euthanasia—a panel inside SickKids Hospital, co-chaired by the director of its department of bioethics, envisioned MAID for minors without the need for parental consent, a practice unheard of even in the Netherlands, which permits euthanasia for “mature minors.” (Currently, MAID in Canada is legal only for those over the age of eighteen.) The policy was written to address the need for “MAID-providing institutions to reduce social stigma surrounding this practice.” SickKids declined to answer my questions about this policy, including whether it is in force today.

SickKids has historically been at the forefront of letting children die of their disabilities, especially children with Down syndrome. A study found that between 1952 and 1971, of fifty children with Down syndrome and blocked food passages, twenty-­seven were left to die of their obstructions instead of receiving routine medical treatment. In 1979, the institution was lambasted by the Canadian Psychiatric Association, which warned that “this increasingly common act in medical practice is being vigorously promoted by able and influential advocates within our profession and within our society at large,” despite the fact that it was likely illegal without a court order.

Between June 1980 and March 1981, a spree of murders struck SickKids hospital. Over the course of several nights, thirty-six babies and infants died, many of them due to an overdose of digoxin, a drug used to control heartbeats and often used for assisted suicide in the United States. A judge confirmed that at least five of those deaths were murders (though the defense believed the number was closer to seventeen), and yet the judge at the preliminary hearings absolved the only suspect, a pediatric nurse. No one else was ever charged, despite statistical evidence from the U.S. Centers for Disease Control that tied another nurse to the deaths.

Two years later, with the scandal refusing to die down, a Royal Commission of Inquiry investigated the deaths. ­Richard Rowe, the chief cardiologist at the hospital, was asked by the commission whether he disapproved of so-called mercy killing. His response: “almost.”  He explained that since the thirty-six babies had a “minimal chance of surviving,” the motive behind their deaths might “perhaps be that of ­mercy-killing.” It was not true: Many of the children had been likely to survive. Some were barely sick. Adrian Hines described his son Jordan: “He entered the hospital a healthy baby with a touch of pneumonia. He didn’t even have a heart ­condition.” An autopsy revealed that Jordan had died of digoxin overdose, a medication he was never prescribed.  

The main medical associations in Canada declined to condemn the homicides at SickKids. The president of the Ontario Medical Association claimed, “I don’t know if withholding surgery is legal,” while a spokesman for the Canadian Medical Association emphasized that the CMA had revised its ethics code “to allow patients to die in dignity.” When asked by investigators whether the dramatic increase in the number of deaths in the hospital’s cardiac ward could have been caused by euthanasia, the chief cardiologist was vague. “[Euthanasia] may have come into those discussions. We talked of many things and we didn’t keep notes.”

SickKids declined to answer my questions about its history concerning infanticide and discriminatory treatments, the institutional norms that might have enabled them, and what steps, if any, were taken to prevent similar incidents going forward: “At SickKids, we are deeply committed to upholding our core values of compassion, dignity, respect, and equity in every aspect of patient care. Our staff bring extraordinary skill, judgement, and dedication to their work to ensure that every child and family receives the highest standard of care, regardless of diagnosis or ability.”

SickKids Hospital is not the only institution that has allowed children with disabilities to die of treatable illnesses. It accords with the direction of the field of medicine over the past century. The preventable deaths of children with disabilities occur, for the most part, without media interest. To understand why the law and societal outrage have failed to stop this practice, we must trace the history of child murder in North America since 1915.

And we must discard a fiction: that infanticide, being illegal, was not historically practiced by physicians in North America. As the medical historian Martin Pernick stresses, “the history of infanticide by lay people—parents, midwives, and governments, dating back to ancient Greece—was widely discussed in these debates [over selective non-­treatment of disabled children]. But the role played by past American physicians in such decisions is now virtually unknown.”“Therapeutic homicide”—a term used in an editorial of the Canadian Medical Association Journal a decade ago, before Canada legalized euthanasia—is, as a rule, practiced by physicians before receiving legal sanction. Under these conditions, it is uncommon but not rare. Its fatal logic is the starting point for the devaluation and killing of people with disabilities.

Even as Roe v. Wade was being argued before the Supreme Court in 1971, Who Should Survive?, a film produced by the Joseph P. Kennedy Jr. Foundation, dramatized the decision to let a baby with Down syndrome die of a treatable intestinal blockage. The film was based on real deaths at Johns Hopkins University Hospital. Over the course of fifteen days, as the medical team and parents wait, the child dies of starvation.

Near the end of the film, a litany of questions is posed to the audience. “Do all children have a right to life? Who should protect the child’s rights? Do physicians have a duty to preserve life? Does mental retardation diminish the right to life?” The film is quick to note how the excruciatingly slow death of the child affects the nurses and the physician. The child’s interests are not considered. The film merely asks questions, as if doing so were nonpolitical: “The film you are about to see has a beginning and an end—but no conclusion, because it provides no answer to the questions it poses.”

Left unsaid is that a child without Down syndrome, presenting the same physical defects, would never be left to die. A non-disabled baby with a treatable life-threatening illness would receive treatment, even if the parents and medical team disagreed. Anything else would be medical malpractice or child abuse. By contrast, those deemed “profoundly disabled,” whose lives have “no value,” receive no protection.

The slippery slope that Roe’s critics warned of in fact happened in reverse: first infanticide, then mercy killing, and finally eugenic abortion on demand. Legalization followed clinical practice, not the other way around. The logic continues to prevail in the courts, whether in America, Canada, Colombia, or the Netherlands: If passive euthanasia is valid, why not active euthanasia? If prenatal abortion, why not “post-natal abortion”? If disability is a qualifying condition for assisted death, based on the empirical determination of medical experts in view of “medical futility,” then to what extent is consent necessary or even desirable?

Yet the justification for these acts is offered ­only after the fact. Ronald Regan’s 1983 “Evil Empire” speech is more often invoked than read, and most people would be surprised to learn that its early paragraphs are not about the USSR, or even ­communism: They are about evil at home. Every year, publications such as the Washington Post and the New York Times were reporting that thousands of babies were being left to die from hunger or treatable medical conditions—for the sole reason that these babies had disabilities, whether terminal or not, and were deemed “defective.” This reporting sparked the Baby Doe laws after Ronald Reagan’s surgeon general, the pediatric surgeon C. Everett Koop, denounced the nontreatment of viable babies as contrary to medical ethics. In March 1983, the Department of Health and Human Services, under the auspices of a federal law that protected people with disabilities from discrimination—a precursor to the Americans with Disabilities Act—passed an executive action to stop selective nontreatment and starvation. Yet the courts overturned the action, as Congress had not passed the requisite legal protections. In response, Congress passed a weakened amendment to the Child Abuse Prevention and Treatment Act—which the American Academy of Pediatrics continues to claim is irrelevant to physician or institutional standards. So the legal protections enacted by Reagan lapsed.

The practice of selective nontreatment based on disabilities has continued. Though as a medical option this practice is presented as rational, the people it kills are often those with conditions that are at the same time being fear-mongered in the media—whether trisomy 13 and 18, HIV, or Thalidomide poisoning. One senior medical director at a faith-based perinatal center in New York told me, “Back in the early nineties when I started on the faculty, the chairman [of pediatrics] at the time said that although other hospitals were starting to withhold nutrition and hydration from children with terminal illness, that’s something that would never, ever happen at this facility. But you know ten years later, into the early 2000s, it was something that when the parents asked, the ethics committee would often approve it.”

Today, in most facilities across the United States, the ethics committee would not need to be involved. Though neonatologists are split on the ethics of withdrawing food and water for ­newborns—surprisingly, more so for the terminally ill than for the disabled—a recent survey of neonatal intensive care units (NICU) published in the Journal of Perinatology found that a majority of NICU units in North America now practice “withdrawal of artificial nutrition and hydration” for newborns. Of those facilities, more than 80 percent reported not requiring an ethics consultation before ceasing all food and water; virtually none had a policy on which diagnoses would qualify a patient for withdrawal of nutrition and hydration. The American Academy of Pediatrics now classifies feeding children as morally optional.

Since this is how disabled children are treated, it is no wonder that the medical field is nonchalant about the fates of children born alive after botched abortions. In January 2019, Ralph Northam, a pediatric neurologist and then-governor of Virginia, caused a furor by describing what happens when infants survive third-trimester abortions:

When we talk about third trimester abortions, these are done with the consent of, obviously the mother, [and] with the consent of the physicians, more than one physician, by the way, and it’s done in cases where there may be severe deformities, there may be a fetus that’s non-viable. So in this particular example, if a mother is in labor I can tell you exactly what would happen. The infant would be delivered; the infant would be kept comfortable; the infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and the mother.

To ask whether this is legal is beside the point. It does not need to be legal to be practiced, since any law is in force only to the extent that it is followed.

There is an irony to the story: In its final summer, the Biden administration, hardly a pro-life administration, quietly reintroduced some of the Reagan administration’s protections. Section 504 of the Rehabilitation Act of 1973 now explicitly prohibits healthcare discrimination based on disability. Thus a newborn with Down syndrome and a heart problem must, by law, receive whatever “medical treatment is provided to other similarly situated children.” But this legal requirement is not enforced. Most hospitals, despite the fears of ethicists, made no changes to their policies, and the media failed to report on the regulation. So the regulation became moot. Last year, a study reported that between 2019 to 2022, adults with both Down syndrome and Covid were more than six times more likely than patients with similar comorbidities to have had a DNR placed on them—a rate far higher than any other illness or disability, including any terminal illness. Yet there was no reckoning among healthcare clinicians or institutions. The soul of medicine does not easily change after a century of practice.

It is impossible not to wonder what would have happened to medicine if the Bollinger ­baby—Allen—had not been killed by his primary physician. After all, Allen was nearly saved. The Chicago Tribune reported on the figure whom Harry Haiselden called a “wild eyed, interfering, hysterical woman,” a certain Catherine Walsh of 4345 West End Avenue, who attempted to convince either the mother of the baby or the physician to spare the boy after the medical commissioner of Chicago had failed to do so.

It is an astonishing piece of journalism, made even more so by the fact that Walsh’s voice was ­uncommon in contemporary debates over the Bollinger baby. Though opposition to Haiselden’s actions was voiced, mostly by Catholics quoted in the press (with opinion more divided among secular, Jewish, and Protestant experts), prominent figures who might have advocated for the child instead ­condemned him. Helen Keller, otherwise an ­advocate for the disabled, endorsed Haiselden’s work as a “­service to society,” since “no one cares about that pitiful, useless lump of flesh.” The Baltimore Catholic Review, published under James Cardinal ­Gibbons, claimed that “no one could be blamed if the child was let die according to nature” and supported Haiselden’s actions.

Yet Catherine Walsh, by her own account, nearly succeeded. She sought and received permission to baptize the child, although the child, unbeknownst to her, had already been christened. All we know is that Catherine belonged to a local Catholic Church; she likely was the mother’s friend. Her comments to the Tribune were quoted in full: 

I went to the hospital to beg that the child be taken to its mother. It was condemned to death, and I knew its mother would be its most merciful judge. I found the baby alone in a bare room, absolutely nude, its cheek numb from lying in one position, not paralyzed. I sent for Dr. Haiselden and pleaded with him not to take the infant’s bloom on his head.

It was not a monster—that child. It was a beautiful baby. I saw no deformities. I patted him. Both his eyes were open, he waved his little fists and cried lustily. I kissed his forehead. I knew if its mother got her eyes on it she would love it and never permit it to be left to die.

“If the poor little darling has one chance in 1,000,” I said to Dr. Haiselden, “won’t you operate and save it?” The doctor laughed. “I’m afraid it might get well,” he replied.

As I left the hospital a man said to me. “I guess the doctor is right from a scientific standpoint. But humanly he is wrong.” “Thank God,” I answered, “we are all human.”

It took five days for Allen to die. Anna Bollinger, the boy’s mother, never recovered from the death of her fourth child. She never saw the child; the medical staff would not permit it. Even amid the savagery of the First World War, Anna’s death almost two years later was front-page news across the country. Her husband, Allen Bollinger, told the Associated Press: “After the baby’s death, my wife fell into a settled melancholy and wasted away. If ever a woman died of a broken heart she did.”

It is callous to claim that a moral lesson can be gleaned from this level of suffering. Yet in 2025, in the lobby of SickKids, the best children’s hospital in the world, I found myself walking away from Mo and Krystal repeating Catherine’s words from 1915: “Thank God, we are all human.”

On August 1, five weeks after the last time I spoke with Krystal, Veya, whose middle name was Hope, died after a nineteen-month fight. Just like Allen, Veya was the fourth child. Her parents managed to move her to another hospital, the same hospital in which she was born. “Through the incredible team at McMaster [Hospital], God brought deep healing to our hearts from the trauma we left Sick Kids with,” Krystal wrote on her Instagram account. “Her last days were tender, peaceful, and full of love.”

Image by Lyfhospital, licensed via Creative Commons. Image cropped.

The post Practitioners of Infanticide appeared first on First Things.

“Even one suicide is one too many,” New York’s Governor Kathy Hochul has said. Throughout her term in office, the governor has prioritized suicide prevention, investing a billion dollars in mental healthcare and increasing funding to support veterans.

Given this, it’s deeply unsettling that Gov. Hochul has announced her intention to sign a bill that would legalize physician-assisted suicide for terminally ill New Yorkers.

It’s tempting to imagine that “Medical Aid in Dying” (MAiD) is not really suicide—or that if it is, it’s “justifiable suicide.” Yes, it looks a lot like suicide: Someone intentionally overdoses on pills, hoping to never wake up again. And yes, people choose MAiD for the same reason that anyone finds suicide attractive: The future seems bleak and—on the whole—not worth living through. But it can feel different because the person is terminally ill. He or she is reasonably likely to die within six months, and the expected progress of the disease may be pretty scary. When people are terminally ill, we rightly give them access to more aggressive pain relief—even if it means they may die sooner. And many people feel that it’s compassionate to offer MAiD to the dying, at least when they request it.

But the reality is that MAiD legalization devalues terminal lives and puts terminally ill people in a terrible position. Suddenly, it’s up to them to decide if their lives are worthwhile or if they’re too much of a “burden” to others. Instead of offering MAiD to the dying, we must offer them hope: hope that their final days are meaningful and valuable.

And the lives of the terminally ill are immensely valuable. People can often achieve great things while they’re terminally ill. Sometimes these are things that they would not have been able to achieve when they were healthy. This can happen whether they’re aware of it or not.

While dying of pancreatic cancer, my grandmother gave me something that she couldn’t give during the healthy part of her life—and my father-in-law did the same thing while dying of glioblastoma. It’s hard to describe what exactly this is, but I think it’s that vulnerability, dependence, and even loss of control can allow you to radiate love in a new way. When they were healthy, my father-in-law and my grandmother were both generous and loving people, and they were also very able people. My father-in-law was a pediatrician, and my grandmother was nicknamed “the CIA” because she was so effective at tracking what was going on in the lives of the hundreds (or thousands?) of people she cared about. Seeing them persist in loving everyone while losing their abilities and being in pain and being taken care of made something very clear: The way they treated us when they were healthy was not just about having an identity as a “helpful person”; they loved us no matter what role they would have to take in the relationship. And they were able to persist in their love while undergoing something very difficult.

I’m not sure if either of them were aware of how much they achieved in the final months of their lives, but it was extraordinary. They showed us who they are. They showed us their love. And they also showed us what it looks like to die well. 

Now, obviously it would be wrong to ask my grandmother or my father-in-law to go through all of this just for my sake. And it’s tempting to imagine that offering MAiD to people in their situation is simply about making this kind of suffering optional. A MAiD advocate might say, “If you want to stay alive to bless your family and friends just don’t get MAiD. But if your prognosis is particularly scary, or you’re not feeling up for it, or you don’t think your final days will be a blessing to anyone (or if you’d just prefer to give your kids cash), MAiD allows you to skip the whole thing. It’s just an extra option.” But this is a deeply unrealistic way of thinking about this.

The reality is that MAiD is not really about making death better for the dying; instead, it’s about making their death more convenient for everyone else. Or, to put it more charitably, MAiD is about sparing the dying from needing to inconvenience anyone.

We can see this clearly if we look at the reasons that people request MAiD. In the U.S., people typically do not list pain as a reason for requesting MAiD. We actually have very good pain control available, at least for people with terminal illnesses. (The pain situation can be trickier for those without terminal illnesses.) In fact, the only way in which MAiD is “superior” to palliative care is that it’s cheaper and more convenient for medical providers and family.

Instead, people request MAiD to avoid disability. In Oregon, the state with the longest-standing assisted suicide program, the most common reasons for requesting assisted suicide involve loss of autonomy, loss of ability, loss of “dignity,” and a fear of “burdening” others.

But the terminally ill are not “a burden.” To the extent that their illness is “inconvenient” to others, this inconvenience is worth it. Because they are worth it. We owe it to the terminally ill to tell them this. Both individually, and also as a society.

We cannot hand them a loaded gun and say, “If you feel like you’re too much of a burden, we respect that assessment.” This is essentially what MAiD legalization does.

And inevitably, the availability of MAiD will lead to situations where many people feel like they have to choose MAiD, even if they don’t want it.

Conscientious parents may worry that they are “wasting” their kids’ inheritance on their own treatment, or “inconveniencing” their kids by dying on an uncertain timeline with home hospice, rather than dying efficiently, at an agreed-upon time, via state-sanctioned suicide.

More broadly, the availability of MAiD will lead to norms against natural death, at least in certain circumstances. You’ll begin to hear snippy comments about old so-and-so who put his children through hell by not killing himself at the appropriate time. And you won’t want people making those snippy comments about you.

It may be that a tiny fraction of the terminally ill actively want the right to end their own lives—but this simply is not worth it, particularly when it means that many other people will feel like they have no choice but to end theirs.

The terminally ill give us so much, and we owe them something in return. At the very least, we need to let them know that they’re needed and valued, that they are not “a burden.”

Gov. Hochul, please tell terminally ill New Yorkers the truth: Their lives are incredibly valuable. And to do this, you’ll need to veto MAiD in New York.

_{Image by Metropolitan Transportation Authority, licensed via Creative Commons. Image cropped.}

The post Governor Hochul Must Veto MAiD in New York appeared first on First Things.

The pope is right to call attention to the birth dearth, but he should focus less on urging economic stimuli to promote childbearing and more on reminding people of the cultural and theological goodness of getting married and having children. This aspect has been lost even among Catholics.

People marry in the West later than ever before. All sorts of informal “arrangements” and “partnerships” compete with marriage. Even when people finally do tie the knot, there still seems to be a cultural detachment between marriage and parenthood. It’s as if the latter requires a separate decision.

Yes, parenthood is distinguishable from marriage but, in the ordinary run of things, marriage leads to parenthood. The fact that these only theoretically distinct institutions have now in practice become separate, and that parenthood somehow seems to require justification even after marriage, is not Catholic thought. That this statement may shock some people suggests how far even Catholics have drifted from thinking like Catholics.

Economic factors do have major impact on young people’s decisions to become husbands and wives, fathers and mothers. I do not deny the need for socio-economic reforms to counteract those negative influences. Somebody with post-college debt who can’t get a solid starter job or needs to “prove” himself in that job is deterred from marriage and family. That should not be the case. As Szijjártó stated, “children are a blessing,” a blessing that should not be contingent on money nor make a young family socio-economically worse off if they receive that blessing. I’d like to hear that more from popes and bishops than foreign ministers.

But while economic factors affect decisions about marriage and parenthood, they should not fully define them. Most people don’t say, “Hey, the standard deduction for dependents went up, let’s have a baby!” The fertility uptick in countries that have enacted aggressive economic support for family life is nothing to write home about: Hungary’s fertility rate in 2023 was 1.51, far below the minimum 2.1 level necessary for population stability. The limited impact of economic incentives tells us that the roots of this problem are cultural.

We often prioritize the economic over other aspects of life. When parents talk about grooming their child for “success,” that usually means the “right” schools for a “good” job. Rarely does it mean finding a good spouse and being prepared for marriage. Which is why perhaps the pope repeatedly has talked about loneliness: If we overvalue career and undervalue family, why are we surprised people live and die alone?

That’s why I caution against separating the economic from the cultural aspects of the parenthood crisis while also insisting that the latter takes priority over the former. In American experience, the uneasy political bed shared by economic and social conservatives almost always led to the priorities of the former being top of the list while the “social agenda” was pushed to the bottom.  

If we think the fertility crisis can be solved by tax exemptions, expanded childcare, and loan forgiveness, we are in for a rude awakening. Those things can help, but not unless parenthood is once again valued in and of itself. Until it is, the buffering effect of those social and financial benefits may simply reinforce a self-centered lifestyle focused on one’s own wants and pleasures. Consider housing: Zillow has been called the “new porn” of thirty- and forty-somethings who are fixated on looking at house profiles. Declining libidos now seem to get their rise from imagining buying expensive McMansions with nobody in them. Why? What’s a house for?  

Once we recover the value of parenthood, then the “boost” those socio-economic policies might afford can redirect energies in the right direction. But the cultural baggage that has devalued parenthood is formidable; its votaries still loathe to leave the stage. When elites still talk about the “wanted” child as the North Star, inbuilt is the assumption that children can and sometimes should be “unwanted.” When “planning” for parenthood takes center stage, unplanned parenthood is inevitably seen as anything from an “accident” to a curse. When economics trump family, children (to borrow Brad Wilcox’s terms) cease being a “cornerstone” of marriage and become “capstones,” the crowning achievement in the résumé of life. It’s why people defer parenthood until late in their childbearing years. They then demand a technological fix for their disappearing fertility, manufacturing their babies in test tubes to carry out their late-blooming “parental project” (as former Paris archbishop Michel Aupetit called this process). It’s a process shaped by parents in their interests and specifications, not the child’s good and his unique characteristics.

Fixing the fertility problem first requires fixing the culture. In that respect, while his lobbying is appreciated, Pope Leo XIV might best begin by talking about the ongoing truth and relevance of Humanae Vitae.

The post The Fertility Crisis Will Not Be Solved by Economics Alone appeared first on First Things.

I reflected on this during a Catholic funeral Mass for a family friend where the priest spoke of the welcome home to eternal life. I was taught that God is merciful and compassionate, and so must we be. This includes permitting a merciful option to those facing the unimaginable and searching for comfort in their final months in this life.

Lost on the governor is the irony that for almost all of Church history, those who took their own life were denied a Catholic funeral and burial, so grave a public scandal was suicide deemed. While current norms reflect an understanding that such persons may not be responsible for their actions, due to physical or psychological distress, those entrusted with their care ought to be. 

None of that denies the genuine pain that terminally ill patients and their loved ones often experience. The problem of suffering is precisely that—a mystery that challenges even persons of deep faith. For Christians, the mystery is revealed, if not solved, in the Cross on which God himself took on the depths of human suffering and pain. In the long shadow of Calvary, suffering becomes not a problem to be solved but an invitation, admittedly not always welcome, to share in that same redemptive work. Thus can St. Paul exhort believers to “complete what is lacking in Christ’s afflictions” (Col. 1:24). 

The merits of the Passion are infinite; what is lacking is our own participation, becoming channels through which that treasury of grace can flow to every person. That process stretches the soul, expanding it outward beyond oneself. Such magnanimity extends to those who care for the sick and suffering, often calling forth heroic self-sacrifice and eliciting deeper wells of love. And God remains neither silent nor indifferent to such pain. He who can no longer suffer, but whose glorified body yet bears the wounds, suffers along with them. The word compassion, evoked by Gov. Hochul in her apologia, literally means co-suffering: accompanying those in pain, carrying that cross with them, and loving them to the end.

That message did not come across to Gov. Hochul in the Mass she attended, perhaps in itself an indictment of modern-day Catholic funerals that are heavy on saccharine sentimentality and light on the sobering reality of death and judgment. Instead, the governor invokes the principles of “choice and freedom,” as she “proudly” connects this legislation to her championing of abortion rights and same-sex marriage. Indeed, there is a through line: Why can a human person considered burdensome or unwanted be legally killed only at the first stages of life but not the last? And the nominalism that attempts to redefine marriage through linguistic gymnastics (“marriage equality”) here employs the same Orwellian tactics, calling the deliberate killing of an innocent person “medical aid” that is not “about shortening life but rather about shortening dying.”

The governor, though, lacks the courage of her own agonized convictions. If this decision is really about “bodily autonomy” and “an individual’s deeply personal decisions,” why limit the right to die only to those who are terminally ill? Why should it otherwise remain a felony in New York State to assist someone in taking his own life? Such is the slippery slope that inevitably follows upon this precedent. Wherever assisted-suicide has become legal, the restrictions have quickly loosened. As seen so many times with abortion, the definition soon expands to cover not just physical health, but mental and emotional health as well.

For all the guardrails that Hochul touts (for example, a physician must be certain that a patient has less than six months to live, an assessment that presumes divine omniscience), such an expansion becomes inevitable when the “dignity and sanctity of life” are no longer inherent qualities, but now placed on a sliding scale of subjective criteria. Once we admit that life may indeed not be worth living, such guardrails quickly fade into irrelevance. What pressures, even self-imposed, will the dying now face so as not to burden their own loved ones, emotionally and financially? What abuses and errors in judgment will result in an outcome that can be regretted but never reversed? The governor wishes only to allow people to “speed up the inevitable.” But death remains inevitable for every one of us, and its timeline is not ours to determine. 

Gov. Hochul concludes her contorted rationale by invoking gauzy language of spending one’s final days “with sunlight streaming through their bedroom window” and hearing “the laughter of their grandkids echoing in the next room.” That is, until the plug is pulled. No, there is no sunlight or laughter in this bill, but only darkness and sorrow. The governor now heads into a re-election campaign having burnished her credentials as a champion of the culture of death, leaving those most vulnerable, at life’s beginning and end, without the legal protections that their God-given dignity demands. Regardless of the outcome in November, Gov. Hochul has made New York a colder, crueler, and more callous state.

The post Kathy Hochul, Champion of the Culture of Death appeared first on First Things.

“We have a statute and obligation to prove the manner and cause of death of the deceased who pass away in our county,” Peoria County Coroner Jamie Harwood told a local news outlet. “Every death in my county falls under my jurisdiction, whether it be a natural cause death or a motor vehicle fatality or whatever that looks like,” he continued. “Our job is to make sure that the deceased as well as their peripheral family get justice for that death.”

If this legislation is signed, however, physician-assisted suicides will be exempt from that mandate. For many, this is a shocking and seemingly blatant stipulation: Why would “dying with dignity” advocates make this change, if not to shield assisted suicide deaths from further scrutiny? 

Advocates will tell you that the legislation treats physician-assisted suicide like any other anticipated death overseen by a physician. As is the case in hospice or hospitals treating chronically-ill patients, attending physicians have the authority to sign death certificates without involving a coroner. The problem, however, is the nature of suicide and narcotics-related deaths. Both, according to Illinois state law, require further investigation.

The Reproductive Health Act (RHA)—a 2019 bill that paved the way for Illinois’s current status as a national “abortion oasis”—also included language to sidestep coroner oversight. Described at the time as “a simple clean-up bill” regarding the state’s abortion policy, the RHA language was pasted into an unrelated bill in the eleventh hour and passed in the middle of the night on the last day of the legislative session—much like the physician-assisted suicide legislation.

Of course, it was far from “a simple clean-up bill.” In addition to removing old language that criminalized abortion, pro-abortion Democrats also wiped away virtually all regulations and restrictions to abortion with this single bill. And buried in the bill was language that relinquished abortion clinics of the obligation to report maternal and fetal deaths to the county coroner’s office, shielding them from coroner oversight by placing them in the same privileged category as hospitals.

But whereas hospitals fall under the jurisdiction of the Illinois Department of Health, subjecting them to regular inspections and strict regulatory standards around cleanliness, emergency preparedness, and staffing, abortion clinics performing surgical abortions are categorized in Illinois as “ambulatory surgical treatment centers.” These centers are technically regulated by the Department of Public Health, but the standards are different. What’s more, Illinois is infamous for allowing decades to pass without providing any onsite reviews or inspections. This inconsistency means that—unlike hospitals—standard compliance is not actively verified by the state.  

Notably, they also have a vested political interest in concealing potentially fatal outcomes, which is apparent when abortion providers infamously request “no lights or sirens” when calling 911 to request emergency help for a client.

All of this—the hard work to conceal and avoid accountability, writing around existing laws so as not to be held to the same standards as everyone else—is representative of a very clear pattern among the far left, which simultaneously relies on the government for access and funding while exploiting every possible avenue to avoid answering to that same government.

Shouldn’t this give us enough reason to pause? Shouldn’t advocates of abortion and physician-assisted suicide be enthusiastic about legitimizing these highly controversial medical “procedures” by following the letter of the law, if only to silence the objections of those who oppose their practices altogether? If this is a truly legitimate and dignified process, one would assume there is nothing to hide.

The post Illinois Coroners Push Back on Assisted Suicide Bill appeared first on First Things.

The bill reads like physician-assisted suicide legislation in most other parts of the country plus Canada, so most of our concerns are derived from the lived experiences of those who’ve been harmed by such laws. Specifically, it allows qualified terminally-ill individuals to receive an “aid in dying” prescription from a physician in order to “die peacefully.” While the bill claims to address many of the concerns that have arisen in other states (such as inadequate mental health assessments and inappropriate disposal of unused lethal drugs), we know the truth: Any bill that allows a vulnerable individual to legally solicit the help of a licensed physician in his own suicide is an inherently flawed one. 

I remember discussions surrounding this legislation as early as seven years ago. My organization, Illinois Right to Life, knew it was only a matter of time before it would be introduced in the general assembly. We began working closely with Patients’ Rights Action Fund, a 501(c)4 organization, to raise awareness among legislators about how such laws could coerce disabled and chronically-ill individuals into choosing death out of concern for burdening their families. 

For years, our efforts were successful. Even some of the most pro-abortion Democratic lawmakers expressed doubts over the legislation, particularly in light of the many real-life examples of abuses that have occurred in states like Washington and Oregon, where legal suicide first debuted in the United States. 

As recently as October 15—two weeks before the final vote was held—our lobbyists were confident that pro-suicide Democrats did not have the votes needed to pass this legislation. Nevertheless, we remained vigilant. After a successful campaign to oppose it during the spring session, we launched the fall veto session (a two-week stint of meetings and votes for legislators before the end of the year) with emails to activists across the state, urging them to reach out to their legislators once again and remind them to oppose this bill. 

Clearly, something changed. 

As is characteristic of Illinois Democrats when they want to see an unpopular bill become law, the vote was called in the middle of the night on the very last day of the session. It scraped by with the exact number of “yeas” needed to pass. 

While we hope that the governor will withhold his signature, the pro-life people of our state are mourning yet another loss in our legislature. It’s a reminder of the evil that pervades our government—not only through corruption and fiscal irresponsibility (which our state is unfortunately known for), but also through the cruel failure to protect our society’s most vulnerable.

The significance of passing such legislation on All Hallows’ Eve cannot be overstated. While Halloween has become a secular tradition over time, historically, the eve of All Saints’ Day was a solemn evening of prayer—a memento mori opportunity, if you will—to remember the faithful who came before us and contemplate the inevitability of death. 

Certainly, death is inevitable—but it is also the will of God that the timing of such remain outside our grasp. It’s a tough argument to make, especially in a culture that does not tolerate religious arguments in the public square and values individualism and “choice” above all else. Even Christians sometimes support physician-assisted suicide when confronted by deep suffering and appeals to compassion. According to those who promote it, to “die with dignity” is to avoid the humiliations that coincide with death and impart suffering on loved ones. Why not avoid humiliation, when death is all but certain? 

Fr. Walter Ciszek, who famously documented his own decades-long suffering as a missionary in a Russian gulag, offers a profound case for enduring humiliation, which Christ transforms into glory:

It is only natural to resent humiliation. We recoil from humiliating experiences because they are an affront to the dignity of our persons—which is another way of saying that our pride is hurt. That is the key to the problem, and it is then that we do well to recall who we really are and who God is. If we see nothing beyond the experience except the hurt and the unpleasantness, it can only be because we have lost sight, for the moment at least, of God’s will and of His providence. For humiliations arise out of circumstances, situations, and people that God presents to us each day—and all these are but a manifestation of His providence. So, we must learn to discern in such things, even in the humiliations, occasions for a deeper conformity to the will of God. Christ had to suffer opposition and contradiction and, yes, humiliation in doing His Father’s will; yet he was constantly intent on forgetting self entirely and glorifying the Father by His actions. If we are truly to imitate Christ in our lives, we must learn to do the same.

In other words, “dying with dignity” is a euphemism. To choose one’s death is to deny one’s dignity, to deny redemptive suffering and the protection of providence. “We know that in all things God works for the good of those who love Him” (Rom. 8:28). Any arguments in favor of ending a vulnerable human life will always contradict the dignity of the human person, who is made in the image of God.

Let us remember, as we celebrate the Octave of All Souls over these coming days, these additional words by Fr. Ciszek: “Just as all men share in the disobedience of Adam, so all men must share in the obedience of Christ to the Father’s will. . . . It is not the Father, not God, who inflicts suffering upon us but rather the unredeemed world in which we must labor to do His will, the world in whose redemption we must share.”

The post Illinois Chooses Death appeared first on First Things.

That scheme burst into public view this summer when California authorities raided a sprawling mansion in Arcadia, removing fifteen children from the home of Guojun Xuan, sixty-five, a former Chinese government official, and his partner, Silvia Zhang, thirty-eight. Among the children was a two-month-old with a severe head injury. Authorities ultimately discovered twenty-one children, all with American birth certificates naming the couple as parents. Most were born to American women recruited online through “Mark Surrogacy,” an agency the couple secretly owned.

Neighbors said the mansion resembled a business, with a reception area and rows of nursery-style rooms. Investigators soon traced the couple’s network beyond surrogacy. Properties linked to Xuan were tied to narcotics, gambling, and firearms trafficking. His business partner, Haoren “Dragon” Ma, is a convicted felon who served time for orchestrating more than eight hundred fraudulent asylum applications for Chinese nationals. Xuan himself is a prominent pro–Communist party figure, part of a larger network extending Beijing’s reach abroad. For more than two decades, he also served as a senior official in Xinjiang province, where China has waged a campaign of repression and genocide against the Uyghur people.

The Arcadia story was no surprise to those familiar with the surrogacy industry. In the last year alone, a Chicago veterinarian was arrested on child pornography and abuse charges just days before he and his male partner were set to collect their surrogate-born son. In Pennsylvania, a registered sex offender was exposed online after posting videos with the child he and his partner obtained through surrogacy. YouTubers Shane Dawson and Ryland Adams welcomed a son the same way, sparking outrage after past videos surfaced of them joking about pedophilia and child rape. These cases reveal a simple truth: In much of the country, there are virtually no barriers to buying a child.

Surrogacy in the United States is governed almost entirely at the state level, and many states have adopted permissive frameworks that treat surrogacy as a private contract rather than a public concern. No states, for example, legally require intended parents to undergo background checks or home visits, which are standard practices in adoption.

It was a welcome development, then, when Reem Alsalem, the United Nations Special Rapporteur on violence against women and girls, released a report warning that “the practice of surrogacy is characterized by exploitation and violence” and urged governments to begin “tak[ing] steps towards eradicating surrogacy in all its forms.”

These cases reveal a culture willing to turn children, mothers, and even American citizenship into commodities that foreign powers can use for access and influence. In doing so, they hollow out the meaning of family, nation, and human dignity.

America’s surrogacy laws are underwritten by an absolute commitment to bodily autonomy. In practice, this commitment entails a simple syllogism: It is within a woman’s rights to do as she pleases with her body, even consent to a surrogacy contract. But that logic collapses under scrutiny. Consent is not a shield against exploitation, and an agreement on paper can conceal far deeper pressures at work.

In the United States, it is estimated that only 2 percent of contracts are altruistic, or unpaid, suggesting that lower-income women are attracted to surrogacy for financial reasons. (Surrogate-mothers can make up to $75,000 in the United States.) When New York legalized commercial surrogacy in 2021, for example, altruistic surrogacy was already legal, but very few women volunteered without pay. Legalizing commercial surrogacy was championed as “necessary” to recruit enough surrogates—an implicit admission that money, not altruism, drives supply. Across the U.S., laws prohibit the sale of organs and criminalize prostitution precisely because there are some things that should be safeguarded from market influence. Renting reproductive capacity belongs in that category.

Even if money were no factor, there is another problem. True consent requires an honest understanding of risk, and surrogacy is far riskier than the industry acknowledges or is required to disclose. A 2024 population-based study of nearly one million singleton births in Ontario found gestational carriers had the highest rates of severe maternal morbidity compared to IVF and natural births (7.1 percent vs. 4.6 percent vs. 2.4 percent). Postpartum hemorrhage and hypertensive disorders were also markedly higher among surrogates. Other analyses show surrogacy pregnancies are up to three times more likely to end in C-section and five times more likely to result in premature birth. Moreover, postpartum recovery is harder without breastfeeding or skin-to-skin bonding; oxytocin levels remain lower, with downstream effects on recovery and mental health.

Finally, when things go awry, surrogacy contracts can reveal mismatched expectations between the purchasing parents and the surrogate-mothers. Take Melissa Cook, who conceived triplets after signing a surrogacy contract. She was horrified to discover that the purchasing father—a single man who was deaf—was unable to care for three children and wanted her to abort one or two. When she refused, he threatened her legally. 

Similarly, Brittney Pearson was diagnosed with an aggressive form of cancer a few months into her surrogacy pregnancy. She delayed her treatment until the child was twenty-five weeks old, to give him a chance at life. When the intended parents, a male same-sex couple, found out the child may have health complications, they asked her to have an abortion. She refused, but in the end, they denied the child life-saving care at birth. Bodily autonomy may give surrogate-mothers absolute control over the baby during pregnancy; but they lose all rights over the child the moment he is born. 

Surrogacy contracts are written by and for adults, yet the one most affected has no voice. Indeed, the only distinction between a legal commercial surrogacy agreement and an illegal baby-selling arrangement is the timing of the contract. It’s a difference of degree, not kind, and doesn’t change the underlying reality: Money is exchanged, and a child is transferred.

Defenders of surrogacy often claim that surrogate-born children experience no psychological harm. That conclusion rests entirely on a single longitudinal study led by Professor Susan Golombok. The U.K.-based study began in 2003 with forty-two surrogate-born children and ended at age fourteen with only twenty-eight children left in the study. Golombok’s study relied mostly on mothers’ self-reports, combined traditional and gestational surrogacy, and operated in an altruistic-only regime unlike U.S. commercial practice. 

At age seven—often when children learn of their origins—surrogate-born and donor-conceived children did worse than naturally-conceived peers, echoing adoption literature’s age of realization. Despite the clear methodological limitations, this single study is repeatedly cited by lawmakers and researchers to justify surrogacy. But there is a crucial difference between no harm and no known harm. Ultimately, such children have no legal representation and bear the greatest risk. 

While appeals to bodily autonomy have overshadowed legal efforts to regulate or reduce commercial surrogacy as a moral issue, a different set of concerns has begun to capture the public’s attention: international cross-border surrogacy, citizenship fraud, and national security concerns. 

When I began researching international commercial surrogacy—a practice banned in most developed nations—I was struck by how little oversight exists in the United States. Foreign citizens can contract with American surrogates, and under the current reading of the Fourteenth Amendment, surrogate-born children gain and maintain the full rights of U.S. citizenship, including a birth certificate, Social Security number, and passport, even if the intended parents are foreign nationals who plan to raise the child abroad. Worse still, authorities do not know who these children are, where they live, or how many exist.

A 2024 report in the American Society for Reproductive Medicine’s journal Fertility and Sterility found that U.S. international surrogacy cycles nearly doubled from 2,758 cycles in 2014 to 4,905 cycles in 2019. (A single cycle refers to the process of implanting an embryo(s) into a surrogate-mother in hopes of conceiving a child.) Of all foreign nationals purchasing surrogate-born children, 41 percent are from mainland China, with France (9.2 percent) and Spain (8.5 percent) next in line. The study noted that the most common demographic taking advantage of this industry are Asian men over the age of forty-two. This isn’t exactly the crowd you picture knitting booties and singing lullabies.

“As long as you know what you want and you have money, having children in the U.S. will always bring advantages,” one Chinese case worker at a surrogacy agency told NPR. Those advantages are substantial. Once these U.S.-citizen children turn twenty-one and meet residency requirements, they can sponsor their parents and siblings for immigration. Some agencies even advertise surrogacy as a “cheaper alternative” to investor visas.

The surrogacy industry itself openly markets this outcome. As one  admits, “For international intended parents, the certainty of their child obtaining U.S. citizenship at birth is a significant factor in choosing the U.S. for surrogacy.” In plain terms, citizenship has become a product for sale alongside the child.

The scandals that opened this essay show what happens when a nation turns reproduction into a marketplace and reduces women to their wombs. That is why the U.N. Special Rapporteur has urged an end to surrogacy altogether, and why the United States must act to stop cross-border arrangements before we keep selling children for citizenship, or something worse.

California, where many of these surrogacy abuses took place, has some of the most detailed state laws regulating the industry. It’s not a question of more or better regulations. What we need are courageous leaders who boldly declare that some human goods—mothers, children, citizenship, and the bonds between them—are too precious to sell.

The post The Surrogacy Exploitation Crisis appeared first on First Things.

The broader question of reproductive technologies like in vitro fertilization (IVF) creates real tension within the Christian and pro-life communities. Just last week, the Trump administration announced initiatives to make fertility treatments more affordable, including a deal to reduce the cost of IVF drugs. While our culture often insists that children are burdensome, Christians must continue to resist that narrative. We recognize that raising children is one of life’s greatest blessings and affirm that life begins at conception; that each human being bears a soul before being fully knit together in the mother’s womb. Yet within the pro-life movement, debate continues over which technologies align with biblical ethics. IVF has allowed many couples to have biological children when they otherwise could not, but it also raises deep moral and theological concerns.

Millions of embryos—human lives—are now frozen in storage around the world, often referred to as “babies on ice.” The process of creating and selecting embryos introduces troubling ethical issues: Embryos are often genetically screened and discarded or indefinitely frozen. Even the collection of sperm and eggs involves morally and medically questionable practices. IVF severs the intrinsic connection between marital intimacy and procreation, reducing conception to a laboratory procedure, and ultimately, to the commodification of human life itself.

In the United States, IVF operates with minimal federal oversight compared to nations like the United Kingdom, where every clinic is licensed and monitored by the Human Fertilisation and Embryology Authority. By contrast, U.S. fertility centers are largely self-regulated; about 10 percent fail to report outcomes to the CDC, and there are no federal limits on the number of embryos created, frozen, or discarded in the process. This lack of oversight only compounds the ethical problems, opening the door for further exploitation.

The prospect of turning ordinary skin cells into eggs, and eventually into embryos, takes this one step further. It transforms human life into a product that can be easily created, bought, and sold. Such technologies, rather than dignifying life, further commodify it and deepen the fractures in marriages, family, and society.

While the administration’s intent to make family-building more accessible may appear aligned with pro-family values, it also exposes a deep inconsistency. One cannot champion life while simultaneously embracing practices that bring about its destruction at the earliest stage. This moment invites Christians to consider what it means to be fully pro-life, where conviction outweighs convenience.

It is tempting for Christians to celebrate any policy framed as “pro-family.” Yet Scripture reminds us that children are not manufactured goods but divine gifts. “Children are a heritage from the Lord, the fruit of the womb a reward” (Psalm 127:3). God’s design for family life is not arbitrary; it reflects his character and the relational nature. From Genesis onward, we see that human life springs from the union of man and woman; a creative partnership that mirrors the image of God himself (Gen. 1:27–28). Technologies that bypass or distort that design risk placing human ambition above God’s thoughtful design.

The White House’s announcement should prompt sober reflection among Christians, even those who have long supported this administration. To be pro-life means to defend human dignity at every stage and in every context, even when it challenges our preferred political leaders. We can celebrate the desire to support families while refusing to accept the destruction of embryos as a price of convenience.

This is a moment for the church to model integrity; to affirm good where it exists, to call out what is wrong, and to remember that our ultimate allegiance is to the Author of life himself. As James 1:17 reminds us, “Every good and perfect gift is from above.” Children are not owed to us; they are entrusted to us. To pursue parenthood apart from the moral order God established is to confuse gift with entitlement, creation with control.

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Perhaps the most bizarre intervention in the Lords’ debate came from the former archbishop of Canterbury, George Carey, who informed his noble colleagues that “The Christian faith has very little to say directly about [euthanasia]” and warned his fellow-bishops in the Lords not to “risk our legitimacy by claiming that we know better than the public and the Other Place [the House of Commons].” Which brought to mind five hilarious minutes in that marvelous BBC satire Yes, Prime Minister, when the generally hapless prime minister, Jim Hacker, puzzled by a Church-proposed candidate for bishop whose agnosticism and left-wing politics he finds bizarre, is instructed on the state of the Church of England by the cabinet secretary, the smoothly cynical Sir Humphrey Appleby: “The Church of England is primarily a social organization, not a religious one . . . part of the rich social fabric of this country. So bishops need to be the sort of chaps who speak properly and know which knife and fork to use.”

To which Sir Humphrey might have added, “but need not exhibit any familiarity with the Fifth Commandment.” 

Happily, there were far more trenchant and morally informed voices raised in and around the Lords’ debate.

Writing in the Spectator, columnist Douglas Murray noted, correctly, that “there is no country in which euthanasia has been introduced in which the slope from the arena of palliative care has not slipped into the killing of the mentally ill, the young, and those who feel they have become a burden on their families or the state.”

In the House of Lords on September 19, Lord Moore of Etchingham spoke movingly about the Beachy Head Chaplaincy Team, which offers counseling to those about to jump from the beautiful cliff at Beachy Head in Sussex—“the number one suicide spot in the world,” to which “online suicide forums” provide directions and instructions on how people can “jump to their death,” something attempted at least once a day. The chaplaincy team engages these disturbed souls on their nine-minute walk from the nearby parking lot to the edge of the cliff. And Lord Moore notes, “Offered the right mixture of professionalism [in counseling] and human kindness, people change their minds. Of those 271 with whom the chaplaincy intervened this year, only 57 even reached the cliff . . . only four actually jumped.” 

Lord Alton of Liverpool, a veteran pro-life leader, reminded his colleagues in a written statement that “euthanasia of the weak was practiced in the ancient world but was rejected as we became more civilized and recognized the equal and inherent worth of each person, regardless of ability or disability, age or capacity.” Wasn’t the “assisted dying” bill a regression from that civilizational advance? Would it not be more civilized and humane to offer the terminally ill the hope of a peaceful death through a deeper investment in palliative care?

Lord Moore and Lord Alton, both of whom I am proud to call friends, understand the truth of what Douglas Murray also wrote: that the “argument and rationale” for “assisted dying” has been boiled down to “compassion.” “Everything is about ‘understanding,’ ‘listening,’ ‘speaking for,’ and ‘alleviating’ the sufferings of others . . . all other judgments and rationales being put to one side.”

This descent into emotivism and sentimentality has profound consequences for society as well as for individuals. As Lord Moore concluded in his remarks to the Lords, “The Bill does not support the freedom to kill yourself: that, we already possess. It confers a right to kill yourself with the active assistance of the state and doctors, and at public expense. . . . Under this legislation, the [medical] professionals will, by definition, be people wishing to fulfill a person’s wish to die. No one will be present to advocate the choice of life.”

Compassion is entirely admirable. Misconstrued and then distorted by being detached from reason and biblical morality, it becomes an agent of what Pope St. John Paul II aptly called the “culture of death,” which threatens the moral foundations of Western civilization.

George Weigel’s column “The Catholic Difference” is syndicated by the Denver Catholic, the official publication of the Archdiocese of Denver.

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The approval of the chemical abortifacient, which raises the number of legal American mifepristone manufacturers from two to three, met immediate disapproval from pro-life leaders. Trump’s press secretary, Karoline Leavitt, claimed the ball Biden set in motion was impossible to stop, but many in Washington seemed to agree with Sen. Josh Hawley when he said FDA Commissioner Marty Makary had “broken trust and faith.” Peter Laffin at the Washington Examiner described the debacle as a shattering of Trump and Vance’s “pro-life facade.” 

In reality, the Trump-Vance ticket was never pro-life, though rather less pro-abortion than the alternative. As Laffin notes, Vance committed to keeping mifepristone accessible before the election, and Trump affirmed he was “very unlikely” to limit access to it immediately after. Trump has since ordered the Justice Department to protect mail-order abortion pills, as though he felt the need to reassure his critics on the left that he will not be using the Comstock Act. 

Trump himself is only haphazardly pro-life; Vance, despite his Catholicism, seems almost eager to liberalize the abortifacient drug. Moreover, with the Covid-era federal provision for mail-order abortions, it would be difficult to overstate just how easy accessing mifepristone already is. It is available by mail from countless worldwide sellers, legitimate or otherwise, making state-level abortion bans largely meaningless at preventing chemical abortion. To understand this is not to say the second Trump administration has been a failure, but to recognize the reality of politics at play. A full 63 percent of Americans favored keeping mifepristone available in 2023, according to Gallup. Banning mifepristone might matter to the president of the United States, but not before it begins to matter to the American people.

Medically, there are very good reasons to reconsider manufacturing mifepristone. Mifepristone caused sepsis or other life-threatening side effects in 11 percent of women who used it in at-home abortions, according to an Ethics and Public Policy Center review of insurance claims related to some 865,000 mifepristone prescriptions between 2017 and 2023. It may contaminate water supplies, too, though the Environmental Protection Agency seems reluctant to study this; former EPA employees voiced fears that traces of the drug might be tracked in water pipes and used as legal evidence against women who ingest mifepristone in states with abortion bans. (EPA had no such qualms using the same surveillance technology during the Covid-19 pandemic, to identify which communities had the greatest rate of infection.) Both of these pale in comparison to the main effect, of course. Mifepristone results in death in 95–99 percent of unborn children who are exposed to it before ten weeks of pregnancy. 

It is strategy, more than chemistry, however, that drives FDA approval of generic drugs. Approving more generic mifepristone is another way of saying market economics will be given freer rein in the abortion industry: Increased supply results in decreased demand for the name brand drug, Mifeprex, and therefore decreased prices across the board. Once a handful of generic brands are allowed to circulate, the drug in question—like acetaminophen (Tylenol) or hydroxychloroquine—becomes unremarkable. That is, expanding access to mifepristone is not only fashionable, it is ideal to the politician who is tired of being asked about it. It is easier for everyone if the question of when life begins becomes irrelevant amid the onslaught of cheap products. 

Like many Americans, Trump has a natural distaste for the concept of baby killing. Also like them, his instinct is not half so strong when applied to first trimester abortions, when the human person hidden within the womb is so much harder to envision. Without a Christian ethic of human value, it is hard to make a convincing case for protecting the invisible child. Chemical abortions, which typically occur at or before ten weeks gestation, only make the occasion feel more private, an isolated decision that a woman may imagine involves only one person, herself. The question of violating a doctor’s conscience, for example—what Erin Hawley sought to press before the Supreme Court in FDA v. Alliance—is limited to the scenario of an emergency botched abortion; otherwise, all agency and responsibility is put in the hands of the mother. 

No one actually wants abortion to be a truly private act, of course. Generic mifepristone demonstrates this well. As the abortion pill becomes more common, it will more commonly be the source of lawsuits and horror stories, as that 11 percent of women who experience deadly side effects represents a more sizable number of victims. All of modern medicine has side effects, and medical malpractice insurance exists for a reason. Yet unlike the woman whose baby is aborted in a clinic, the woman who takes mifepristone at home has no doctor, no nurse, and no technician to blame if something goes wrong, much less if everything goes horribly right. Mifepristone lays the burden of responsibility squarely on her shoulders, as the sole agent of her child’s death. Maybe something went wrong, maybe she was mistaken about the nature of the drug, maybe she regrets her decision, it matters not: By putting more killing in the hands of mothers with practically no oversight, the FDA is giving women the unfettered freedom of choice abortion advocates have been begging for for generations. It is a responsibility they almost certainly are not prepared to meet.

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At the outset, Douthat probes the accuracy of ­Siddiqui’s claim that her company provides reliable genetic information. Those familiar with Elizabeth Holmes and the deceptive practices of her company, Theranos, have learned to be wary of biotech entrepreneurs, who have an interest in hyping their products. And there’s a utopian side to biotech, which likewise encourages overselling results.

As the interview proceeds, Douthat turns to important moral questions. Siddiqui makes much of her desire to provide parents with the tools to help their children avoid suffering. She cites her mother, who began to lose her vision as a young adult. Who would want her child to endure a genetic disease?

But as Douthat points out, employing technology to weed out embryos with defects amounts to ensuring that people like Siddiqui’s mother will not be born—indeed, it implies that it would have been better if her mother had not been born. Something like the Nazi category of “life unworthy of life” hovers uncomfortably in the background of Orchid and its use of technology to identify defective DNA in embryos so that implantation and birth can be avoided.

And then there’s the inconvenient fact that IVF produces more embryos than can be “used.” The term itself introduces the unsettling notion that human life is something we make available to ourselves for our own purposes—or disposal. When it comes to current technology, if the goal is eugenic selection, there’s no way around the need to produce embryos outside the womb so that the biological material for ­genetic ­testing can be gathered. And they must be frozen, held in reserve so that, once test results are received, the parents (owners?) of the embryos can make their ­selections. 

Siddiqui reports that she and her husband have ­sixteen embryos on ice, ready for “when the time is right.” She wants two boys and two girls, whom she will pick out of the embryo tray, guided by the Orchid reports as to which enjoy the most genetically auspicious profiles. (If you’re starting to feel queasy reading this, you’re not alone.)

Throughout the interview, Siddiqui repeatedly emphasizes that her company is helping parents make choices. If you have moral concerns, then you can steer clear of this technology. Nothing is being imposed! Or is it? For this celebration of empowerment is silent about the embryos, who are objects of choice rather than subjects. It’s a convenient omission.

Douthat is skeptical of Siddiqui’s claim that nobody is or will be coerced. The utilitarian logic of embryo eugenics will not be satisfied by the single criterion of free choice. Things will go further, as they always do. How can a responsible society allow people to bring children into the world the old-fashioned way, when that method ignores genetic screening, which promises to limit disease and suffering? Here is Douthat’s entirely plausible speculation:

I think it very likely, in the future where the Orchid process becomes a kind of norm, that you get a whole set of medical pressures. Like, what are you, a bad parent? You are not going to test your [prospective] kids? You could imagine a kind of tipping point or cascade where you go from “This is a choice that a certain number of parents do” to “This is the expectation that the medical system imposes on expectant parents.”

In fact, we are already at this point. Today, tests are performed on pregnant women that often end with strong counsel in favor of abortion, if results show the possibility of genetic defects. The pressure will only increase as the technological means for eugenic selection become more effective.

Douthat also wonders whether a technological and calculating approach to bringing children into the world fundamentally alters the meaning of motherhood and fatherhood. Certainly, the husband and wife must do something to produce a child. There is a choice. They need to engage in sexual intercourse. But there’s a ­greater element of givenness. The child “comes,” as it were, not always, but sometimes. In the language of the Bible, the child is begotten, not made. 

Douthat presses his question: “If 90 percent of babies are born through IVF, and having sex and having a baby out of that becomes this weird thing that the Amish do, aren’t you pushing some really important and intimate aspect of human experience out of human experience?” Put simply, isn’t a eugenic approach to childbearing ­dehumanizing?

Siddiqui finds the question baffling. She cites her company’s maxim: “Sex is for fun, Orchid and embryo screening is for babies.” The moral myopia is astounding. But is it surprising? As Siddiqui points out, because of the almost universal use of contraception, “Sex is already for fun and not for babies 99 percent of the time.” She goes on to underscore the utilitarian dynamic that’s very likely to ensure that Douthat’s worries are well founded. Siddiqui: “I think that the vast majority of parents in the future are not going to roll the dice with their child’s health.”

Count me among those who see danger and darkness in Siddiqui’s prediction. In the early decades of the twentieth century, many elites became convinced that communism and socialism marked a new and higher stage of progress. Economic life had to be brought under the control of reason. It needed to be planned and managed at every level. At first, good results seemed to flow from this approach. After a visit to the Soviet Union in 1919, the American journalist Lincoln Steffens intoned, “I have seen the future, and it works.” But soon enough, “rational ­planning” brought inefficiencies, sclerosis, oppression, and mass starvation.

In my lifetime, elites became convinced that we were called to engineer a new, more diverse, inclusive, and equitable culture. This dream of reason motivated a massive effort to uproot traditional social norms, even to the point of regulating the use of pronouns. The upshot, as we now know, is not a wonderful culture of rainbow solidarity, but instead a ­dysfunctional, sour, and polarized society ­populated by atomized, unhappy people, many of whom are debilitated by mental ­illnesses or suborned by self-destructive addictions. Again, “rational planning” failed. An engineered culture is as dysfunctional as an engineered economy.

We are now poised to embark on an even more ambitious dream of reason, one that aims to improve upon the crude mechanisms of evolution. This eugenic project, advanced under the flag of choice, is sure to follow the pattern of earlier dreams of reason. God’s created order is minute and complex. Our eugenic efforts will disrupt the natural order in ways we cannot foresee, creating a genetic ecosystem as clotted and broken as the economy of the Soviet Union.

The greatest threat posed by eugenics practiced on a mass scale is not that it will succeed, and that we will be dehumanized by a brave new world—although that, too, may come to pass. No, the more profound peril rests in its almost certain failure and the resulting mess we will make of the fundamental building blocks of life.

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Orchid could only exist in an age where IVF is common (one in fifty American births) and used far beyond its original purpose as a remedy for infertility. American IVF has already offered parents around the globe the chance to choose the gender of their child (broadly illegal elsewhere). It enables commercial surrogacy, and it opens the door to mix-and-match gametes for three-parent families. But more than anything, it is the extreme extension of the idea that parents are their children’s authors, rather than the stewards of children received as a gift. 

Siddiqui has been clear that she hopes to see insurance cover embryo screening, and her analogies for her services suggest that she hopes it will become near universal, if not mandatory. When Siddiqui got criticism from parents grateful that they’d received children they wouldn’t have “chosen,” she shot back: “Trusting God doesn’t mean skipping the car seat. You still buckle your child in because protecting them is part of your job. The same is true for their genome. Hoping for the best is not the same as guarding them from preventable harm.”

It’s important to note first that Siddiqui is not offering CRISPR gene therapy, which could indeed snip out a sickle cell gene and spare a particular child pain. She is suggesting that parents protect themselves by selecting which of the children they’ve conceived that they feel most inclined to parent. Her product is not about curing, it is about choosing.  

Parents may have lost some of their antibodies to this pitch, however, if they do think of their children’s lives as entirely the parents’ fault. Extreme orthorexia during pregnancy, anxieties about attachment parenting after delivery, texting children throughout the school day all betray a fear that children are fragile, easy for parents to ruin. Some amateur (and professional) therapists encourage clients to look back to their parents to figure out how their bad parenting is to blame for present misfortune. 

The whole world is clamoring with the question: “Rabbi, who sinned, this man or his parents, that he was born blind?” Fewer and fewer parents can rest in the peace of hearing Christ’s answer: “Neither this man nor his parents sinned, but this happened so that the works of God would be displayed in him.” Each of us bears wounds, natural or spiritual, few of which have a clear genealogy of fault. To be a human person is to be exposed and permeable, to harm as well as healing. No parent (save Joachim and Anne, Mary and Joseph) will raise a sinless child. No child (save Jesus) has a sinless parent. 

But in a secular age, the best foil to Siddiqui’s pursuit of perfection may be economist Emily Oster. In her pregnancy guide, Expecting Better, Oster is upfront with her reader that she will not give a guide to eliminating risk. Driving risks to zero is impossible, and even getting them to the realistic minimum is rarely worth the parental sacrifice. As an economist, Oster is well aware of the 80–20 Pareto rule of thumb—that 80 percent of the desired result is often available with 20 percent of the effort. Focusing on the most manageable risks (such as knowing the signs of preeclampsia) provides moms with huge benefits. Chasing down the last little risks (defensively microwaving deli meat) provides a minimal risk reduction while being onerous. 

Parents should think about how they spend a non-zero risk budget. As a mother, I want to teach my children to balance prudence and trusting profligacy. It’s ok to extend yourself a little farther than you think you can reach. You can try hitting a note at the edge of your range at karaoke in front of your friends. You can go sit with a sick friend and sometimes bring the germs home to all of us for a miserable week. You can fall on your first swing on the monkey bars and probably be ok, but maybe break your arm. 

Whether your children have their genomes scrutinized or not, it’s hard to know, moment to moment, what talents they’ll be gifted. All we know for sure is that they (and us) are asked to spend them to the last. We want to meet Christ empty-handed, having let all the gifts that he has given us pass through our hands to wherever he directs them. 

I hope my children are healthy. I hope they are happy. I hope, most of all, that they are holy. I want better for each of them than I could author if I held them tightly.

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