Preimplantation Genetic Diagnosis: Ethical Aspects

Abstract

Preimplantation genetic diagnosis is a procedure, which allows for the selection between embryos before the initiation of pregnancy. Although considered morally controversial, for example, depending on views regarding the moral status of embryos, this procedure seemingly reduces ethical problems in prenatal diagnosis by offering the possibility of selecting offspring without the need to consider abortion. However, counselling of patients becomes more complicated. Also, there are controversies regarding who should be the primary beneficiary, for instance when an embryo is chosen partly to be a suitable tissue donor to a sibling, as well as regarding when benefits outweighs downsides. Moreover, preimplantation genetic diagnosis raises concerns about the connection between the pre‐selection of children on genetic grounds and the discrimination of disabled people. It also raises the ethical problem of whether the selection of future children on the basis of less serious or even nonpathological traits is an acceptable practice.

Key Concepts:

  • Preimplantation genetic diagnosis (PGD), selecting embryos based on genetic analysis before pregnancy by in vitro fertilisation (IVF), gives rise to ethical issues on the basic, clinical and societal level.

  • The acceptability of PGD depends on how one views parental responsibilities towards future children and the moral status of embryos.

  • Prospective parents may consider PGD to be preferable to prenatal genetic diagnosis, since in PGD selection can be made without subsequent abortion.

  • Drawbacks of PGD may outweigh benefits if the procedure of IVF is considered too burdensome, if the pattern of heredity is considered too complex to yield unambiguous genetic information, or if the condition is not considered serious enough.

  • PGD may also be used to select embryos that can become suitable bone marrow donors to seriously ill siblings, which has aroused controversies regarding the instrumentalisation and future well‐being of these children.

  • PGD makes genetic counselling more complex and possibly harder to comply with the ideal of nondirectiveness.

  • The question of which uses of PGD should be allowed can only be answered against the background of the basic ethical issue of what goal PGD should be taken to serve.

  • The goal of promoting reproductive autonomy gives rise to ethical issues of using PGD for less serious conditions or nonpathological traits, which may lead to backdoor eugenics.

  • The goal of preventing (the birth of individuals with) certain serious diseases gives rise to ethical questions of which diseases should be considered serious enough, as well as concerns of a subsequent reinforcement of discrimination and stigmatisation of disabled people.

  • The idea of a list of pre‐defined conditions serious enough for PGD sends the message that people affected by these conditions are more undesirable than others, which may push the situation closer to morally problematic forms of eugenics.

Keywords: assisted reproduction; autonomy; ethics; genetic testing; in vitro fertilisation; policy; preimplantation genetic diagnosis; prenatal diagnosis

References

Baetens P, Van de Velde H, Camus M et al. (2005) HLA‐matched embryos selected for siblings requiring haematopoietic stem cell transplantation: a psychological perspective. Reproductive Biomedicine Online 10(2): 154–163.

Bennett R (2009) The fallacy of the Principle of Procreative Beneficence. Bioethics 23(5): 265–273.

Burgio GR and Locatelli F (1997) Transplant of bone marrow and cord blood hematopoietic stem cells in pediatric practice, revisited according to the fundamental principles of bioethics. Bone Marrow Transplantation 19(12): 1163–1168.

Devolder K (2005) Preimplantation HLA typing: having children to save our loved ones. Journal of Medical Ethics 31: 582–586.

Elster J (2011) Procreative beneficence – cui bono? Bioethics 25(9): 482–488.

Handyside AH, Kontagianni EH, Hardy K and Winston RM (1990) Pregnancies from biospsied human preimplantation embryos sexed by Y‐specific DNA amplification. Nature 344: 768–770.

den Hartogh G (2009) The slippery slope argument. In: Kuhse H and Singer P (eds) A Companion to Bioethics, chap. 28, 2nd edn, pp. 321–332. Chichester: Blackwell Publishing Ltd.

Juth N (2005) Genetic information: Values and Rights. The Morality of Presymptomatic Genetic Testing. Göteborg, Sweden: Acta Philosophica Gothoburgensia.

Knoppers BM, Bordet S and Isasi RM (2006) Preimplantation genetic diagnosis: an overview of socio‐ethical and legal considerations. Annual Review of Genomics and Human Genetics 7: 201–221.

Krahn T (2009) Preimplantation genetic diagnosis: does age of onset matter (anymore)? Medicine, Health Care and Philosophy 12: 187–202.

Lewis CM, Pinel T, Whittaker JC and Handyside AH (2001) Controlling misdiagnosis errors in preimplantation genetic diagnosis: a comprehensive model encompassing extrinsic and intrinsic sources of error. Human Reproduction 16: 43–50.

Malmqvist E (2008) Good Parents, Better Babies: An Argument about Reproductive Technologies, Enhancement and Ethics. Linköping, Sweden: Linköping Studies in Arts and Science, No. 447.

Munthe C (1999) Pure Selection: The Ethics of Preimplantation Genetic Diagnosis and Choosing Children without Abortion. Göteborg, Sweden: Acta Philosophica Gothoburgensia.

Munthe C (2000) Selected champions: making winners in the age of genetic technology. In: Tamburrini C and Tännsjö T (eds) Values in Sport. Elitism, Nationalism, Gender Equality and the Scientific Manufacture of Winners, pp. 217–231. London/New York: E & FN Spon.

Parfit D (1984) Reasons and Persons. New York: Oxford University Press.

Rechitsky S, Kuliev A, Tur‐Kaspa I et al. (2004) Preimplantation genetic testing with HLA matching. Reproductive Biomedicine Online 9(2): 210–221.

Savulescu (2001) Procreative beneficience: why we should select the best children. Bioethics 15(5–6): 413–426.

Sharp RR, McGowan ML, Verma JA et al. (2010) Moral attitudes and beliefs among couples pursuing PGD for sex selection. Reproductive Biomedicine Online 21(7): 838–847.

Sheldon S and Wilkinson S (2004) Should selecting saviour siblings be banned? Journal of Medical Ethics 30: 533–537.

Simon A and Schenker JG (2005) Ethical consideration of intentioned preimplantation genetic diagnosis to enable future tissue transplantation. Reproductive Biomedicine Online 10(3): 320–324.

Spriggs M (2002) Lesbian couple create a child who is deaf like them. Journal of Medical Ethics 28: 283.

Stein E (1998) Choosing the sexual orientation of children. Bioethics 12: 1–24.

Steinbock B (2002) Preimplantation genetic diagnosis and embryo selection. In: Burley J and Harris J (eds) A Companion to Genethics, pp. 175–190. Malden: Blackwell Publishing Ltd.

Testart J (1995) The new eugenics and medicalized reproduction. Cambridge Quarterly of Health Care Ethics 4: 304–312.

Thornhill AR, deDie‐Smulders CE, Geraedts JP et al. (2005) ESHRE PGD Consortium. Best practice guidelines for clinical preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Human Reproduction 20(1): 35–48.

Watt H (2004) Preimplantation genetic diagnosis: choosing the ‘good enough’ child. Health Care Analysis 12(1): 51–60.

Further Reading

Arribas‐Aylon M, Sarangi S and Clarke A (2011) Genetic Testing: Accounts of Autonomy, Responsibility and Blame. London and New York: Routledge.

Buchanan A, Daniels N, Wikler D, Brock DW and Wilker DI (2000) From Chance to Choice: Genetics and Justice. Cambridge, UK: Cambridge University Press.

Davis D (2010) Genetic Dilemmas: Reproductive Technology, Parental Choices, and Children's Future, 2nd edn. New York: Oxford University Press.

Glover J (1984) What Sort of People Should There Be? Harmondsworth, UK: Penguin.

Glover J (2006) Choosing Children: Genes, Disability, and Design. New York: Oxford University Press.

Harper PS and Clarke AJ (1997) Genetics, Society and Clinical Practice. Oxford, UK: Bios Scientific Publishers.

Harris J (2007) Enhancing Evolution: The Ethical Case for Making Better People. Princeton and Oxford: Princeton University Press.

Harris J and Holm S (eds) (1998) The Future of Human Reproduction. Ethics, Choice and Regulation. Oxford, UK: Clarendon Press.

Parens E and Ash A (eds) (2000) Prenatal Testing and Disability Rights. Baltimore, MD: Georgetown University Press.

Wilkinson S (2010) Choosing Tomorrow's Children: The Ethics of Selective Reproduction. Oxford, UK: Oxford University Press.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Juth, Niklas(Mar 2012) Preimplantation Genetic Diagnosis: Ethical Aspects. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0005223.pub2]