Pre-implantation Genetic Diagnosis (PGD/Designer Babies) Ethics

Research Article
Screening for fetal and genetic abnormality: social and ethical issues.
G R Dunstan
Author Affiliations: University of London.


Abstract
In answer to questions raised by practitioners, an ethics of genetic screening is located in a tension between liberty and responsibility in three respects: (1) to nature and biological processes; (2) to the disposal of human life; and (3) to the relation of persons to society. Under (1), the obligation to pursue research, fundamental as well as applied, is affirmed, offering the benefit of economy with fetal life, but requiring discrimination between the beneficial, the trivial, and the bizarre. Under (2) the abortion question, when relevant to diagnosed abnormality, is discussed, not in the language of conflicting rights, but of the relation of duties to interests. Under (3) the familial and social dimensions of screening raise questions of the disclosure of information and the keeping or extending of confidences. Last comes the value placed on truth in two related areas of developing practice. In infertility treatment, the donors of gametes are required to remain anonymous. Gene tracing through families requires for its effectiveness some correspondence between assumed identity and genetic identity. This conflict of social policies should be resolved.
http://jmg.bmj.com/content/25/5/290#related-urls


Extending preimplantation genetic diagnosis: the ethical debateEthical issues in new uses of preimplantation genetic diagnosis
John A. Robertson
Author Affiliations: School of Law, The University of Texas, 727 Dean Keeton Street, Austin, Texas, USA. e‐mail: jrobertson@mail.law.utexas.edu

AbstractThe use of pre-implantation genetic diagnosis (PGD) to screen embryos for aneuploidy and genetic disease is growing. New uses of PGD have been reported in the past year for screening embryos for susceptibility to cancer, for late‐onset diseases, for HLA‐matching for existing children, and for gender. These extensions have raised questions about their ethical acceptability and the adequacy of regulatory structures to review new uses. This article describes current and likely future uses of PGD, and then analyses the ethical issues posed by new uses of PGD to screen embryos for susceptibility and late‐onset conditions, for HLA‐matching for tissue donation to an existing child, and for gender selection. It also addresses ethical issues that would arise in more speculative scenarios of selecting embryos for hearing ability or sexual orientation. The article concludes that except for sex selection of the first child, most current extensions of PGD are ethically acceptable, and provides a framework for evaluating future extensions for nonmedical purposes that are still speculative.

Ethical issues in current and expanded uses of PGD
Two main sets of ethical objections make PGD and proposals for its extension controversial. One set of objections arises from the need to create and then select embryos on chromosomal or genetic grounds, with the deselected embryos then usually discarded. Other objections concern the fact of selection itself.
Objections to PGD based on its effect on embryos replay debates over abortion and embryo status that have occurred in many other contexts, from abortion to embryonic stem cell research. People who think that the embryo or fetus is a person will object to creating and destroying embryos, and oppose most uses of PGD. Others believe that preimplantation embryos are too rudimentary in development to have interests or rights, but that they deserve special respect as the first stage toward a new person (American Society of Reproductive Medicine, 1994). Under this view PGD is ethically acceptable when done for good reasons, such as preventing offspring with serious genetic disease. Indeed, PGD may prevent selective abortions for those diseases. A major issue with new uses of PGD is whether they sufficiently benefit important human interests to meet the demands of special respect for embryos that supporters of PGD may require.
A second set of objections arises from the fact of selection itself, and the risks of greatly expanded future selection of embryos and children. Sometimes based on religious views about the nature of human reproduction, ethical objections to selecting offspring traits raises two kinds of ethical concerns. One kind is deontological—the ethical judgement that it is wrong to choose traits of offspring, no matter how well intentioned. Dr Leon Kass has articulated this view, as has the President’s Bioethics Council in the United States, which he chairs. They argue that human reproduction is a ‘gift’ and that any form of selection or manipulation turns the child into a ‘manufacture’ and thus impairs human flourishing (Kass, 1998, 2000, 2002; President’s Bioethics Council, 2002). The second kind of concern is consequentialist. It arises from fears that increasing the frequency and scope of genetic screening of prospective children will move us toward a eugenic world in which children are valued more for their genotype than for their inherent characteristics, eventually ushering in a world of ‘designer’ children in which genetic engineering of offspring becomes routine.
While recognizing the strong objections of some people to PGD on these grounds, the following discussion assumes that the use of PGD to screen for aneuploidy and serious Mendelian disorders is ethically and legally acceptable when performed according to applicable regulatory guidelines. It concentrates instead on new indications for PGD, and asks whether they would also meet ethical standards of acceptability.
http://humrep.oxfordjournals.org/content/18/3/465.full

Posted by Sherissa Chua (29)