Academic journal article Forum for Applied Research and Public Policy

Empowerment or Danger

Academic journal article Forum for Applied Research and Public Policy

Empowerment or Danger

Article excerpt

We can now diagnose genetic disorders in a petri dish, but increased knowledge doesn't always bring increased wisdom.

In recent years, the options available to prospective parents have blossomed. Increasingly powerful diagnostic methods and new treatments have created a number of alternatives for those unable or unwilling to reproduce in the usual way. Each new development, from test-tube babies to surrogate mothers and sperm donors, also provides interesting fodder for ethicists.

These breakthroughs also elicit increasingly divergent judgments. Mainstream bioethicists do not appear overly concerned. Conservatives, however, fear these techniques will upset the established order, and some feminists believe they may harm or exploit women and children.

Gene Screen

Preimplantation genetic diagnosis is one of the latest wrinkles in the rapidly developing field of reproductive technologies. A genetic counselor may recommend such diagnosis in cases where a couple is at risk for a harmful genetic condition that can be passed on by one parent, such as Huntington's Disease, or by a potentially dangerous or fatal combination of the parents' genes, such as that causing sickle cell anemia.

In general, diagnosing genes connected with specific diseases requires that an embryo be created outside the womb through in vitro fertilization. To increase the likelihood of a live birth, up to three embryos free of the problematic gene may then be implanted in the woman's uterus. Any extra embryos that show no signs of genetic problems may be frozen for later use in case the attempt is unsuccessful. Embryos carrying the problematic gene are discarded.

Preimplantation diagnosis, however, is just one approach for parents concerned about genetic risks. Other alternatives include:

* Going forward with pregnancy without any intervention and accepting the possibility of conceiving a child with an inherited disease;

* Preventing conception between partners and either adopting or remaining childless;

* Using a different reproductive technology to circumvent the problem, if it originates with one of the partners, such as donor insemination or contract pregnancy;

* Choosing prenatal diagnosis through traditional means such as amniocentesis with the option of aborting affected fetuses.

Given these alternatives, prospective parents and society in general could benefit from a moral assessment of preimplantation genetic diagnosis. Three issues are critical to such an assessment. First, preimplantation diagnosis raises issues that are specific to the techniques involved, which in themselves might cause harm to the developing embryo. Second, preimplantation diagnosis depends on in vitro fertilization, a procedure that raises its own moral issues, which have not received a great deal of attention by the mainstream in spite of the widespread use of the technologies. Third, preimplantation diagnosis raises the broad question of whether to perform prenatal diagnosis at all, either in a normal pregnancy or in the process of embryo implantation.

First, Do No Harm

The central moral issue is whether the process of studying the genetic makeup of the embryo may harm the developing fetus and result in damage to the child.

Once the fertilized egg has become multicelled, one or two cells are removed and studied for the relevant disease by examining their DNA, using a technique known as a polymerase chain reaction or by using a fluorescent dye. These cells are discarded after testing, but the worry remains whether developing embryos subsequently implanted in the mother are harmed by having cells peeled from them in this way.

Studies in mice and domestic animals suggest that the process is safe because each embryonic cell appears to have the potential to grow into a complete organism, so a few missing cells shouldn't make any difference. …

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