Prospective parents using the IVF services provided by clinics associated with the Fertility Institutes company can have their embryos screened for genes associated with over 400 hereditary diseases, as well as gender determination and even eye color. Despite the objections of some bioconservatives, it is now generally agreed as a matter of reproductive liberty that it is ethical for parents availing themselves of assisted reproductive technologies to screen for genes that confer higher risk for hereditary diseases, and then select those without the traits for implantation.
Researchers are now developing and deploying screening tests that take into account the interactions of hundreds of genes that increase the risks of disease conditions like aetherosclerosis or diabetes. The Wall Street Journal reports that the company Genomic Prediction has just begun offering its Expanded Pre-Implantation Genomic Testing for just such polygenic disease risks.
Sex selection of embryos with the goal of avoiding sex-linked hereditary diseases is now, for the most part, also ethically uncontroversial. The American Society for Reproductive Medicine notes that there is no ethical consensus with respect to non-medical sex selection. It is, however, noteworthy that a 2017 survey of several hundred American IVF clinics reported that 72.7 percent of the clinics offered sex selection. And among those clinics offering sex selection, 93.6 percent of them reported performing sex selection for family balancing, and 81.2 percent reported performing sex selection for elective purposes (patient preference, regardless of rationale for the request).
One often expressed concern is that pre-implantation sex selection will skew male-female population sex-ratios. Certainly, this effect has been well-documented in some traditional cultures in which techniques such as sex-selected abortions have been used to favor the birth of male children. However, there is very little evidence that such strong preferences for male children exist in many industrialized countries. For example, a 2006 survey of Americans probing their views on sex selection reproductive technologies found that 50 percent wished to have a family with an equal number of boys and girls, seven percent wanted more boys than girls, six percent wanted more girls than boys, five percent wanted only boys, four percent only girls, and 27 percent had no preference.
If using pre-implantation genetic diagnosis (PGD) to select embryos to avoid disease and to choose the sex of future children is ethical, what about other characteristics? As an example of what may soon be possible, The Journal cites an ethical conundrum posed by Stephen Hsu, a founder of Genomic Prediction.
An IVF doctor has two healthy, viable embryos and must choose which to implant. One has a hypothetical risk score that indicates the embryo is at high risk for struggling academically in school. The second embryo has a score indicating the future child likely won't struggle. Do you tell the parents?
"It seems ethically not defensible to withhold the information from the parents," he says, "and ethically defensible to reveal it to them."
Hsu is right: Withholding information that might be relevant to a person's reproductive decisions would be clearly unethical.
Not everyone agrees. For example, Josephine Johnston, director of research at the Hastings Center bioethics think tank, tells the Journal that she recognizes that parenting often comes with "the understandable desire to give your child advantages," like height, or musical talent. However, allowing parents to select among IVF embryos for such traits, she adds, "can seem awfully close to a eugenic mind-set, where we thought we can sort the worthy and fit from the unworthy and unfit." In addition, she argues that selecting against gene combinations that increase disease and disability risks, and in favor of those that confer health or psychological benefits, would risk increasing societal prejudice against people who are currently disadvantaged by diseases and disabilities through no fault of their own.
Allowing parents using IVF to test for and choose gene combinations that have a greater chance of endowing their prospective children with benefits like health and academic success is not ethically comparable to the state-mandated eugenics programs that involuntarily sterilized some 60,000 citizens in the United States (not to mention the Nazi horrors). In fact, legally forcing them to forego such testing is an exercise of state-mandated eugenics, since the government is deciding for parents what sorts of offspring they will be allowed to have.
But what about allowing parents to choose among IVF embryos for such apparently incidental genetic traits like eye color? The Journal cites a couple who availed themselves of such testing offered by a Fertility Institute clinic. The testing indicated that in a group of five of their embryos, one would be likely to have blue eyes.* The couple pointed out that testing for eye color is just one more thing once they've already started looking at an embryo to rule out diseases. As it happens, the couple has decided to start their family the old-fashioned way, allowing the random combination of their genes to determine their offspring's eye color. In any case, if the screening technology is safe and effective, there is no compelling ethical reason to limit this exercise of reproductive liberty.
*Aesthetically speaking green, hazel and brown eyes are superior, but some of my best friends dauntlessly endure the burden of blue eyes.
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