Ethical Issues With Prenatal and Preimplantation Genetic Diagnosis by Professor Lawrence Nelson

iStock_000000396261XSmallIt’s not science fiction. Nowadays prospective parents cannot only know the sex of their unborn child but also learn whether it can supply tissue-matched bone marrow to a dying sibling and whether it is predisposed to develop breast cancer or Huntington’s disease — all before the embryo gets implanted into the mother’s womb.” -Esthur Landhuis

Have you heard of “designer babies”?  Or perhaps you saw or read My Sister’s Keeper, a story about a young girl who was conceived through In Vitro Fertilization to be a genetically matched donor for her older sister with leukemia? The concept of selecting  traits for one’s child comes from a technology called preimplantation genetic diagnosis (PGD), a technique used on embryos acquired during In Vitro Fertilization to screen for genetic diseases.  PGD tests embryos for genetic abnormalities, and based on the information gleaned, provides potential parents with the opportunity to select to implant only the “healthy”, non-genetically diseased embryos into the mother.  But this genetic testing of the embryo also opens the door for other uses as well, including selecting whether you have a male or female child, or even the possibility of selecting specific features for the child, like eye color.  Thus, many ethicists wonder about the future of the technology, and whether it will lead to babies that are “designed” by their parents.

Today’s post is an exploration of the ethical issues raised by prenatal and preimplantation genetic diagnosis, written by Santa Clara Professor Dr. Lawrence Nelson, who has been writing about and teaching bioethics for over 30 years.  Read on to examine the many ethical issues raised by this technology.

lnelsonsmLawrence Nelson is a lawyer and an Associate Professor of Philosophy at Santa Clara University.  He has written about and taught bioethics for over 30 years.  He can be reached at lnelson@scu.edu.  This blog is in part derived from his chapter on PGD in A Textbook of Perinatal Medicine, edited by A. Kurjak, 2006 edition, CRC Press-Parthenon Publishers, pp. 179-189.

Prenatal and Preimplantation Genetic Diagnosis

Background:

The overwhelming majority of people on earth, due to a wide range of reasons, beliefs, bodily motives, and attitudes–some good, some bad, and some in the moral neutral zone–reproduce.  They are the genetic, gestational, and/or social (rearing) parents of a child.  Birth rates in some countries are at a historic low (Japan‘s is beneath replacement with the consequent deep graying of an entire society).  In others, mostly in the developing part of the world where infant and maternal morbidity and mortality (not to mention poverty and disease) are quite high, birth rates remain similarly high.

In the economically developed part of the world, the process of making and having babies has become increasingly medicalized, at least for those fortunate enough to have ready access to the ever more sophisticated tools and knowledge of obstetrical medicine.  From the time prior to pregnancy (fertility treatments, in vitro fertilization) to birth (caesarean delivery, high tech neonatal intensive care) and in between (fetal surgery), medical science and technology can help many to reach the goal any good parent should want: the live birth of a healthy child to a healthy mother.

“Medical and biological sciences can together determine whether a fetus will (or might) have over a thousand different genetic diseases or abnormalities”

Parallel to obstetrical medicine, science and technology have progressed immensely in another are over the last 30 or so years.  The Human Genome Project (and the related research it has stimulated) has generated an amazing amount of knowledge about the nature and identity of normal–and abnormal–human genetic codes.  Now the medical and biological sciences can together determine whether a fetus will (or might) have over a thousand different genetic diseases or abnormalities.  Ultrasound examination can look into the womb (quite literally) and see developmental abnormalities in the fetus (such as neural tube defects like spina bifida and anencephaly).  Even a simple blood test done on a pregnant woman can determine whether the fetus she is carrying has trisomy 21 (down syndrome), a genetic condition associated with mental retardation and, not infrequently, cardiac and other health problems.

Pregnant women who have health insurance that covers obstetrical care (and many millions of American women do not), particularly if they are older (>35 years), are more or less routinely offered prenatal genetic diagnosis by their obstetricians.  Chorionic villus sampling is a medical procedure that takes a few fetal cells from the placenta and can be done around 10 weeks after the woman’s last menstrual period.  These cells can then be analyzed to determine the presence of genetic abnormalities.  Amniocentesis is a medical procedure that obtains fetal cells from the amniotic fluid and is usually done later in pregnancy, typically after 14 weeks following the woman’s last menstrual period.  When done by experienced medical professionals, both procedures carry about a 0.5% risk of spontaneous abortion.  The genetic analysis done on these fetal cells can determine the presence of fatal genetic diseases (such as Tay-Sachs, trisomy 13 and 18), disease that can cause the born child much suffering (children with Lesch-Nyan, for example, compulsively engage in self-destructive behavior like lip chewing, while children with spinal muscular atrophy have severe, progressive muscle-wasting), and conditions that typically cause mental retardation (such as Fragile-X and Emanuel syndrome).

PGDAlthough tremendous strides have been made in genetic science’s ability to detect chromosomal abnormalities, precious little success has been achieved in treating genetic disorders directly either prenatally or postnatally.  Some symptomatic treatment may well be available, but almost nothing that will actually cure or significantly ameliorate the effects of the disease.  A pregnant woman who wishes to avoid the birth of a child with genetic disease has little alternative but to seek termination of the pregnancy.

The science and technology of assisted reproduction (in this case in vitro fertilization [IVF]) meets the science and technology of obstetrical medicine in preimplantation genetic diagnosis (PGD).  Embryos are created in vitro by mixing oocytes taken from the woman who intends to gestate one (or more) of them from a donor, and sperm taken from her partner or a donor.  Genetic analysis is performed on one or few cells from each embryo, the loss of which does not affect the embryo’s ability to develop normally once implanted in a womb.  Only those embryos free of detectable genetic abnormalities are then implanted in the woman’s womb in the hope that they will then attach to the uterine wall and develop normally.  While success rates for implantation vary, many women have given birth following PGD.  The main advantage of PGD over chorionic villus sampling and amniocentesis for many women and couples is that it avoid the need for a surgical abortion to end an undesired pregnancy, although it does result in discarding the affected embryos.

What ethical issues are raised by Prenatal Genetic Diagnosis and Preimplantation Genetic Diagnosis?

Prenatal genetic diagnosis (PrGD) and preimplantation genetic diagnosis (PGD) both raise a number of serious ethical questions and problems.

What role does money play in ethical issues with PrGD and PGD?

1.  Both services are quite expensive (especially PGD which is typically not covered by even private insurance and has the added cost of IVF) and are not available to all who might need or want them.  This raises difficult questions of social justice and equity, including whether coverage for these services is morally responsible when social resources for all health care services (those that are life-saving and preventive) are seriously limited.

2.  As PGD is generally paid for directly by the persons who utilize it, ethical questions arise about the means clinics use to attract patients and the information they provide them about its risks and benefits.   Clinicians are in a fiduciary relationship with their patients and are obligated to act so as to deserve and maintain the patient’s trust and confidence that their wishes and best interests are being faithfully served.  Consequently, the marketing of infertility services ought to place the good of patients above other interests (especially a clinician’s or clinic’s own economic interests), should not induce patients to accept excessive, unneeded, or unproven services, and should adhere to high standards of honesty and accuracy in the information provided to prospective patients.

What is the moral status of an embryo?

3.  Both PrGD and PGD result in the destruction of embryos and fetuses.  If, as some contend, all human embryos and fetuses have the same moral status as live-born persons, then they are entitled to basic rights, including the right not to be killed arbitrarily or for the purpose of advancing the interests of other persons.  On this view, both PrGD and PGD would be seriously morally wrong.  The opposing view would hold that embryos and fetuses lack any moral status whatsoever as they lack any properties, such as sentience or other cognitive traits, that determine moral standing and so can be destroyed at will.

Perhaps the more commonly held–and more ethically defensible–position is that human embryos and fetuses deserve some modest moral status because they are alive, have some degree of potential to become human persons, and are in fact valued by moral agents whose views deserve at least some respect and deference from others. Nevertheless, they do not possess the full and equal moral standing of persons because they lack interests and other moral claims to personhood.  Having a modest level of moral status does not preclude the destruction of embryos and fetuses for a morally serious reason or purpose, and the informed and conscientious choice of the persons who created the embryos to prevent the birth of a child with a serious genetic disease or abnormality is widely (though by no means universally) considered to be such a reason

Does PrGD and PGD lead to discrimination against the disabled?

4.  Recently disability activists have strongly challenged what they deem to be the basic assumption underlying PrGD and PGD: reducing the incidence of disease and disability is an obvious and unambiguous good.  They rightly criticize certain views that support this assumption: that the disabled’s enjoyment of life is necessarily less than for nondisabled people; that raising a child with a disability is a wholly undesirable thing; and that selective embryo discard or abortion necessarily saves mothers from the heavy burdens of raising disabled children.  However, the ethical critique of the disability activists goes much deeper than this quite proper debunking of broadly drawn and inaccurate assumptions about life with any disability.  First, they contend that the medical system tends to exaggerate the “burden” associated with having a disability and underestimates the functional abilities of the disabled.  The activists also point out how medical language reinforces the negativity associated with disability by using such terms as “deformity” or “defective embryo or fetus.”  Second, and more importantly, the disability activists claim that the promotion and use of PGD and traditional prenatal diagnosis “sends a message” to the public that negatively affects existing disabled people and fosters an increase in the oppression and prejudice from which they regularly suffer.

“Adults who wish to reproduce are ethically obligated to do so in a responsible manner, and this means gathering and assessing fair and accurate information about what the future might hold for them and the child they might produce.”

Insofar as individual clinicians do, in fact, exaggerate the problems and burdens of living as an individual with a disability or of living with a disabled person as a parent or family member, then they are doing a moral disservice to the people they are duty bound to be helping.  Adults who wish to reproduce are ethically obligated to do so in a responsible manner, and this means (insofar as it is possible in a world about which we have imperfect knowledge) gathering and assessing fair and accurate information about what the future might hold for them and the child they might produce.  Clinicians (especially genetic counselors) should endeavor to provide this kind of information, supplemented–if at all possible–by the firsthand information that comes from those who have actually lived with disabilities of various kinds as parents of the disabled or from the disabled individuals themselves.  On the other hand, these conditions are simply not utterly benign or neutral as each may–and often does–involve what can fairly be described as an “undesirable event such as pain, repeated hospitalizations and operations, paralysis, a shortened life span, limited educational and job opportunities, limited independence, and do forth.” [1]

Discrimination against persons with disabilities is just as morally repugnant as discrimination against persons based on race, religion, or sex, but it is not at all clear that PrGD and PGD reinforce or contribute to this in any manner.  Regardless of how society might change (as it surely ought to change) its attitudes and practices to decrease or, better, eliminate the socially created disadvantages wrongly placed on the disabled–and regardless of how individual persons might change their views on the prospect of knowingly having a child with a serious disability, other persons will prefer not to have a child with a serious disability, no matter how wonderful the social services, no matter how inclusive the society.  It is this individual choice that PGD preserves, although the clinicians who offer PGD have a moral obligation to explore their own and their patients’ attitudes about, and understanding of, disability so these individual decisions can be made fairly and responsibly with accurate information about the real world of life with and without disability.

Should people be able to select the sex of their baby?

5.  Both PrGD and PGD identify the sex of the embryo or fetus.  This raises the question of whether it is ethically permissible for an embryo to be discarded or a fetus to be aborted because of sex.  The selection of an embryo’s sex via PGD is done for two basic reasons: (1) preventing the transmission of sex-linked genetic disorders; and (2) choosing sex to achieve gender balance in a family with more than one child, to achieve a preferred order in the birth of children by sex, or to provide a parent with a child of the sex he or she prefers to raise. [2]  While little extended ethical debate exists regarding the former, sex selection for the purpose of preventing the transmission of sex-linked genetic disease, the latter is the subject of heated ethical disagreement.

Picture 1The ethical objections to sex selection for nonmedical reasons can be grounded both in the very act of deliberately choosing one sex over the other and the untoward consequences of sex selection, particularly if it is performed frequently.  Sex selection can be considered inherently ethically objectionable because it makes sex a determinative reason to value one human being over another when it ought to be completely irrelevant: females and males as such always ought be valued equally and never differentially.  Sex selection can also be ethically criticized for the undesirable consequences it may generate.  Choice by sex supports socially created assumptions about the relative value and meaning of “male” and “female,” with the latter almost universally being considered seriously inferior to the former.  By supporting assumptions that hold femaleness in lower social regard, sex selection enhances the likelihood that females will be the targets of infanticide, unfair discrimination, and damaging stereotypes.

Proponents of the ethical acceptability of sex selection would argue that a parent’s desire for family balancing can be–and typically is–morally neutral.  The defense of family balancing rests on the view that once a parent has a child of one sex, he or she can properly prefer to have a child of the other sex because the two genders are different and generate different parenting experiences.

To insist [that the experience of parenting a boy is different from that of parenting a girl] is not the case seems breathtakingly simplistic, as if gender played no role either in a person’s personality or relationships to others.  Gender may be partly cultural (which does not make it less “real”), but it probably is partly biological….  I see nothing wrong with wanting to have both experiences. [3]

An opponent of sex selection for family balancing can argue that good parents–whether prospective or actual–ought never to prefer, favor, or give more love to a child of one sex over the other.  For example, a morally good and admirable parent would never love a male child more than a female child, give the male more privileges than a female, or give a female more material things than a male simply because of sex or beliefs about the child’s “proper”gender.  A virtuous and conscientious parent, then, ought not to think that, or behave as if, a child of one sex is better than one of the other sex, nor should a good parent believe or act as if, at bottom, girls are really different than boys in the ways that truly matter.

“Sex selection is at least strongly ethically suspect, if not outright wrong”

The argument in favor of sex selection for family balancing has to assume that gender and gender roles exist and matter in the lived world.  For if they did not, then no reason would exist to differentiate the experience of parenting a male child from that of a female.  However, it is precisely the reliance upon this assumption to which the opponent of sex selection objects: accepting–and perpetuating–gender roles inevitably both harms and wrongs both males and females, although females clearly suffer much more from them than males.  While some gender roles or expectations are innocuous (e.g., men don’t like asking for directions), the overwhelming majority (e.g., males are–and should be–aggressive, women are–and should be–self-sacrificing) are not.  Consequently, given that sex selection is inevitably gendered and most gender roles and expectations restrict the freedom of persons to be who they wish to be regardless of gender, sex selection is at least strongly ethically suspect, if not outright wrong.

[1]  Steinbock B. Disability, prenatal testing, and selective abortion. In Parens E, Asch A (eds): Prenatal Testing and Disability Rights 2000; Washington DC, Georgetown Univ. Press: 108-123.
[2]  Ethics Committee of the American Society for Reproductive Medicine. Sex selection and preimplantation genetic diagnosis. Fertility and Sterility 1999; 72(4): 595-598.
[3] Steinbock B. Sex selection: not obviously wrong. Hastings Center Report 2002; 32(1): 23-28.

Watch: “Designer Babies” Ethical? L.A.’s Fertility Institute Says Prospective Parents Can Choose Physical Traits, Not Just Gender, from CBS NEWS:

Questions
1. Is it ethical to use preimplantation genetic diagnosis to select the sex of your child?

2. Consider the arguments presented about PGD and the ethical issues it poses in regards to disabilities. Does PGD reinforce a message about the disabled that, as disability activists claim, “negatively affects existing disabled people and fosters an increase in the oppression and prejudice from which they regularly suffer”?
3. In the video above, the doctor interviewed named Dr. Steinberg says, “Of course, once I’ve got this science (of PGD), am I not to provide this to my patients? I’m a physician. I want to provide everything science gives me to my patients.” Do you agree with Dr. Steinberg’s reasoning? Why or why not?

90 Responses to “Ethical Issues With Prenatal and Preimplantation Genetic Diagnosis by Professor Lawrence Nelson”

  1. Richelle Neal says:

    1. To answer the first question, it depends the individual, couple, or families’ motive to use PGD to select the sex of their child. If the family has a deadly, recessive sex-linked genetic trait that the parent(s) either have or know that they may be carriers, then in my opinion it is completely acceptable to pick the sex of the child. That is, if they are picking the sex of the child that is guaranteed to not have the disease. However, it then needs to be decided what is a “deadly” or incurable disease. Colorblindness is x-linked, it is incurable, but is it deadly? Is it a disease? More thought needs to be put into how society will view what is an acceptable “disease.” Lastly, I think I fall into the category that most individuals would on choosing the sex of a child because a family wants a boy to carry on the family name, or a girl because they may like the role that stereotyped genders give our society (i.e. self-sacrificing, quieter, less aggressive) – it is immoral.

    2. I had never thought about the perception individuals who have a disability currently might view regarding this present discussion. I completely agree, it does seem that we, as a society, are saying that there are “desirable” traits and having mild retardation to Down syndrome is not one of them. In addition, where would the line be drawn for what is physically disabilitating? For example, would ADD be? And what if it wasn’t, would you tell those people currently living with ADD that they don’t have a disability and they should be able to hold their own attention? There are so many ethical questions that are stirred up by this question, that a few sentences are not enough to even begin to address them, and on top of that, it is solely only my opinion.

    3. Yes and no. To an extent a doctor can be seen as a service job, in which case the customer or client (the patient in this case) can have what they want. On the other hand, you can never give everyone what they want. Sometimes, it is a case of not being able to, and sometimes it is because you ought not to. As a society, we need ask the question if designer babies are morally acceptable. Even though it is a start, it cannot just be me, a class of students, or a group of doctors and scientists deciding this. I can say that even though I see where Dr. Steinberg is coming from in giving his patients what they want, it sometimes is not the ethically correct thing to do. Just because science has made great advances doesn’t mean everyone should jump on the bandwagon.

    • Benny Tran says:

      I agree with you Richelle, I believe that the development of PGD is a technology that has inadvertently allowed society to become prejudice against human disabilities. Excluding extreme cases, like Lesch-Nyan, PGD has given humanity a tool in which it is able to make a choice whether a person will live or die due to properties that they see to be “unfit”. Justifying their decision on the child’s quality of life and burdens of living, parents may choose to cease the existence of that life and choose a physically fit child in its place in their pursuit of happiness. This right to choose a fit or unfit offspring shows that society has lost its empathy for those who are disabled. Moreover, where do you draw the line on whether PGD is justified for that particular disability? How much of a reduction in an individual’s quality of life justifies its disposal? Would you kill your grandfather because he has Parkinson’s disease and you know his quality of life will decrease dramatically over a few years? This is an issue that is not easily resolved and as this technology becomes available to more of the population, there must be policies in place to prevent the unjust disposal of life due to one’s own perception of a severe disability.

      • carrie litchman says:

        PGD has dangerous potential. Like most things involved in medicine, I am opposed to any use of PGD that is purely cosmetic or may do more harm than good. Even some seemingly good-natured potential uses for PGD are often unneccessary and unethical. For example, if we begin screening our children for diseases before they are born, where does it end? It has been proven that genetics only contributes partially to the expression of most diseases. In my opinion, there is no “perfect” human being, and PGD left uncontrolled will only present new problems.
        PGD does have many positive qualities. If parents are both carriers of a fatal or devastating disease, PGD may prevent extreme suffering for the potential infant and financial strife for the parents. Women’s bodies have been conducting similar procedures since the beginning of humankind. If an embryo is too genetically flawed, the woman’s body will spontaneously abort the embryo. In my opinion, any use of PGD that extends too far from this natural procedure may become unethical.

    • Amanda says:

      If a child is going to have a genetic disease that can be prevented by selecting the sex of the child, I would condone sex selection. However, if a parent is selecting the sex of a child based on their own preferences, it would seem to me that they want a girl or a boy because of the ancient stereotypes on boys and girls. A parent who selects the sex of the child is likely to propagate these stereotypes, which is something society in general has been trying to be rid of for decades. I don’t think anyone is arguing that all forms of PGD are immoral. Certainly parents can improve their lives and the life of their child if they know ahead of time a child is going to have down syndrome, for example, and can prepare themselves. Families with children with disabilities have different experiences, and in my experience the quality of the child’s life is mostly dictated by the parent’s opinion of the child. I think it is wrong to force a family who will not give a child with a disease the extra love and attention he or she needs to have this child. Both the child and the parents lose in this situation.

    • Lanesha says:

      Having read the section on Ethical Issues with Preimplantation and Prenatal Genetic Diagnosis, not only do I have a better understanding of both concepts but also have a clearer stance on the issues at hand. Though my position on these issues have not changed, I feel I have more of the necessary information to arrive at my own conclusions. I feel that Preimplantation and prenatal genetic diagnosis in the long run will do more harm than help. I sympathize with those who engaage in these procedures in an attempt to conceive helathy babies but “tailoring” or “designing” you embryo to fit your ideal child is a step too far. I argue this due to the possible social impacts of such science. Given that all individuals have been socialized into thinking in certain ways about what is considered beautiful and what’s not, giving people the option to design their embryos may illustrate just that (chossing eye color etc). I have seen the movie “My Sister’s Keeper” and that is a perfect example of how things can take a turn for the worse. I couldn’t imagine being “created” as a means of survival for someone else. Undergoing surgery regularly all for the purpose of saving a sibling’s life while I lose chances to fully live out mine. What are the children who have been designed to think? They could never ask their parents well if I had huntington’s disease or brown eyes instead of blue or if I was a boy instead of a girl, would you still love me? The simple fact is their parents preferred them they way they because they chose them to be that way. It’s a very sticky situation. Why do parents want to play God?

    • Dustyn Uchiyama says:

      I do not think that it is ethical to use Pre-implantation Genetic Diagnosis to choose the sex of the child unless it is done so to prevent passing on sex-linked diseases. The only intervention that technology should have is in the arena of health for either the mother or child. Using technology to choose a baby based on its sex is abusing the technology and almost making it a cosmetic luxury. Parents are going to pursue the “picture perfect” family—almost suggesting that it is more important the sex of the children rather than the way they are parented. Such use of this technology would enable the upper class to make a perfect family, which could have social implications. Those who have the “perfect family” may be selective with whom they associate, creating a gap between natural and “chosen” families.

      Dr. Steinberg’s comments are very controversial for multiple reasons. First, should a patient not be educated of all of his/her options? Is it unethical to disclose information from financially disadvantaged families to prevent them from facing the fact that there is technology that could treat something but it is unattainable to them? How do you control or guide the way new technology is utilized? I believe that above all, any technology or medical innovation should be available to anyone and everyone, or universal access. This would eliminate dilemmas where a family is aware of possible interventions but feels guilty because it cannot afford them. I also believe it to be unethical to withhold information from a patient. As a doctor, you should provide a patient with all of their options, after that, it is up to the patient to decide action. The doctor cannot force the patient’s decisions but instead can advise the patient using his medical knowledge. To withhold information is unethical because it is manipulating the patient’s decision even if it is unintentional. Ultimately, this ethical argument can be avoided by regulating which technologies make it to the public. In other words, the doctor should provide the patient with a full understanding of all their options—regardless of his own opinions (he can provide his advice though). What technologies he informs the patient of is not in his control—it should be regulated by higher authorities.

  2. Katie says:

    When it comes to sex selection, I also think that it is only justified in the case of preventing a harmful sex-linked disease or disorder. Personally, I would never be able to choose the gender of my child, but I can understand how parents would want to for ‘family balancing’ or carrying on a name. But do mothers that have all male children love them any less than mothers who have a boy and a girl? Will a father love his daughter any less because she won’t pass on his name? I’d like to say no, but I have a feeling that in some cases there may be regret, disappointment or resentment. Another question is whether or not these feelings affect the children and parents more than the social consequences of wide spread sex-selection would. To me it seems unnatural to be able to choose gender for non-medical reasons, and this is one case where I don’t mind having reproductive freedom limited.

    There is a difference between having a disability and having a disease that will either kill you or dramatically reduces your life span. As long as PGD is used to avoid fatal genetic problems I don’t see it as affecting people with disabilities in a negative way.

    I can see where Dr. Steinberg is coming. What’s the point of sequencing the genome and continuing to do research in order to annotate genes and discover the basis for diseases if we’re not going to use that knowledge to save lives and help ease suffering? Unfortunately he was including PGD for ‘cosmetic’ purposes, which I don’t think should be widely used.

  3. Ankita Kohli says:

    1. I believe that using PGD for gender selection is unethical except in cases where there is the incidence of passing on a harmful sex-linked genetic disease to a child. Choosing the sex of a child is immoral because at that time the parents are not thinking in the interests of the child, they are thinking of what they want their child to be. They are inadvertently putting expectations on the child before he or she is even developed to the fetal stage, based on the sex and the parents’ reasons for choosing that sex. Parents who conceive naturally also have some expectations from their children or an envisioned future for their child. But in the case of gender selected children the parents might be more disappointed as their “chosen gender” child may not turn out to be what they expected, despite the amount of money they invested in the procedure for sex selection. I think that gender selection may not be that big of an issue in developed countries like the United States where gender equality is more advanced than that in under developed countries like India where the male gender is perceived to be more valuable. Nevertheless, there do need to be laws regulating the use of PGD to select gender for non-medical reasons.
    2. I do not believe that PGD is adversely affecting the disabled people or as the disability activists claim increasing the oppression or prejudice directed at them. We have the technology of PGD at our disposal and if parents have access to it they should use it to prevent the birth of a child in danger of developing a deadly disease. It would be wrong to bring a child into this world knowing that it would live a life of pain and suffering. The parents of the child will also be hurt looking at the pain their child is experiencing. I do not see the attitudes of society changing towards disabled people just because there are less disabled children being born. I also think that it is unfair on the disability activists’ parts that they are going against PGD based on the fact that because enough disabled children are not born in the future society will start to neglect the disabled.
    3. I both agree and disagree with Dr. Steinberg’s statement that it is his duty to provide his patients with everything Science has to offer. This would be a good argument in the case of Molly Nash, where the doctors involved actually gave the Nashes a new option of using two different technologies together, IVF and PGD, which had never been done before. They were using everything Science had its disposal at the time. On the other hand, Dr. Steinberg mentioned the use of PGD for “cosmetic” enhancements, which I am not comfortable with. Using PGD in cases of deadly diseases is acceptable but I think it is completely wrong to choose a child based on physical attributes like eye color. Dr. Steinberg is right in providing all the available scientific options available for PGD but there has to be somebody to help manage parents as they process all of this information, think about the advanatges and disadvantages, and come to a decision about what they want to do. I agree with Dr. Arthur Capaln when he says that who gets to decide which hair color or eye color is better. I also like Dr. Arthur’s Caplan’s suggestion about parents receiving ample counseling before they make such decisions.

    • Isabelle Nguyen says:

      1) It’s hard for me to agree with the notion of PGD in general because although it has the ability to provide parents with healthy children it provides modern day parents with the avenue to choose.We would hope that physicians offering this technology are not knowingly offering PGD to allow parents to pick and choose certain traits, but that is in good faith. It would not surprise me that in countries like China that if couples have the money, they are able to select the gender of their child. PGD though a technology that can be used for good, it has the ability to be abused especially by modern parents who feel that it is within their right to choose what and who their child should be.For PGD in particular it is hard to set up middle of the way parameters before we start making far too many exceptions.

      2) I would have the say that PGD might not adversely affect the disabled community, but it definitely has the ability to. If PGD becomes a societal norm, like getting a polio shot (until a new polio strain arises), polio becomes a thing of the past in a country like the United States. Those living with polio might not see the same attention to find a cure because the rest of society has found a “cure”. PGD might be another polio vaccine for the West in which it seeks to nip the problem at the bud.

      3) Like Anikita, I agree that the duty of the doctor is to provide everything science has to offer within reason. Which is difficult to say because that leaves the burden of judgment on the physician.Somehow the line between prevention and superficiality has to be drawn for PGD.

  4. Kyle says:

    1. Is it ethical to use preimplantation genetic diagnosis to select the sex of your child?

    The issues surrounding the use of PGD for sex selection must be considered through two distinct ethical lenses. Through one, we must assess sex selection PGD as a diagnostic tool of medicine, which may prevent the transmission of genetic diseases from parent(s) to offspring. However, through the other, we must consider sex selection PGD a cosmetic and individual procedure, used only for the purpose of vainly choosing the sex of a child.

    It is ethical to use PGD as a means to screen for sex if said screening is used to prevent the genetic transmission of a lethal or highly disabling disease. If used as a diagnostic tool, PGD has significant medical benefit. PGD allows parents to prevent the transmission of sex-linked disorders and/or the birth of a child with a life-altering disorder, which may result from an abnormal pregnancy. Thus, if a family has a familiar history of an X-linked disorder, such as Huntington’s disease, they may use PGD to screen for embryos that do not have the disease— proceeding to only implant the non-diseased embryos into the mother. However, the use of this type of PGD sex selection must be carefully regulated. It must be restricted to diseases that carry the risk of lethality or a probability of significantly affecting the life of the child. It cannot be used to screen for embryos containing genes for colorblindness, hemophilia, or other non-lethal disorders and thus manageable disorders.

    Yet, if PGD sex selection is used for cosmetic reasons, it is not ethical. Choosing the sex of a child for cosmetic reasons assigns a value to one’s sex. If the child has a 50% chance of becoming a male or female, parents have generally have no preconceived expectations regarding the sex of their child. However, if a parent has the ability to choose sex, they may expect a child to live up to certain gender roles, to carry on a familial name, or to behave as the parents expect. Such expectations place a heavy burden on any child and therefore outweigh the reproductive freedoms associated with sex selection in PGD.

    2. Consider the arguments presented about PGD and the ethical issues it poses in regards to disabilities. Does PGD reinforce a message about the disabled that, as disability activists claim, “negatively affects existing disabled people and fosters an increase in the oppression and prejudice from which they regularly suffer”?

    No. The use of PGD does not attempt to discredit the humanity of those who suffer from various disabilities. The disabled portion of society offers a dynamic level of diversity to our society, and puts in to perspective how fortunate those without disabilities are. However, I do not think that most disabled persons would chose to remain disabled if given the opportunity to alleviate their disability. The suggestion that PGD, a method of preventing genetically caused disabilities detracts from the quality of life for a disabled person then seems illogical. If these activists suppose that PGD increases “oppression and prejudice,” do not then, stem cell research, pharmaceuticals, and clinical medicine provide the same negative effects? These current therapies are in place to allow people to live healthier lives, in which they prevent disabilities; also, through their practice, they suggest that a non-disabled way of life is preferential to that of the disabled. New technology cannot be restricted under the guise that it may leave a portion of the population behind—for if it is, novel developments in therapeutics will cease, and we will have to revert to a primitive state of health care. PGD merely offers a novel way to prevent disabilities from occurring in the first place, and in doing such it does suggest that disabilities are not desirable; yet, it does not imply that we should divert current awareness or resources away from the disabled population.

    3. In the video above, the doctor interviewed named Dr. Steinberg says, “Of course, once I’ve got this science (of PGD), am I not to provide this to my patients? I’m a physician. I want to provide everything science gives me to my patients.” Do you agree with Dr. Steinberg’s reasoning? Why or why not?

    Physicians should most certainly not provide everything that science offers as a potential therapy or service for their patients. I agree that Dr. Steinberg should provide PGD to his patients; however, I do not support his decision to offer sex selection merely based upon cosmetic reasons—for my fore mentioned opinions (in question 1), I therefore stand solid with this position. Furthermore, I think it foolish to claim, as Dr. Steinberg has, that a physician should “provide everything science gives [him].” If this is the case, physicians should offer doctor assisted suicide, eugenic counseling, and other highly controversial practices. Often, as we discover more of the human body, we find systems, drugs, and tools that allow us to practice better medicine; yet, science has a dark side as well. As these technologies arise, we also gain exposure to the very technologies that may hurt us. Therefore, before any scientific and medical breakthrough is implemented within a clinical setting, it must be considered within the light of ethical analysis and assessed as morally and ethically appropriate.

    • Conor says:

      How incredibly insightful!

    • blackjacket says:

      Kyle, you mentioned something in particular above that I think many people are overlooking when it comes to this type of genetic manipulation, and that is the social implications of assigning value to a sex. I agree that, when one sex is favored over another we are further reinforcing the constraints of gender socialization, a problem that extends past the balancing of families, and far into the success or failure of a human being born into great expectation. Parents are not just balancing the scales in choosing sex, instead they are selecting what society has come to define as a male or female. I would argue that this undermines gender identity, suggesting that our biological sex is synonymous with our gender identity, which is not always true. In the end, choosing a sex is the same as creating a person, or at least having an expectation for that person to fill, which doesn’t seem fair.

  5. Allison says:

    1. Is it ethical to use preimplantation genetic diagnosis to select the sex of your child?

    I think that in the case of sex-linked disorders it is morally acceptable to choose the sex of your child. However, in the case of merely preferring one sex over the other in a certain pregnancy without the risk of a sex-linked disorder it is a much more controversial issue. We must take into account the motives for why the parents would choose one sex over the other and the implications of doing so.

    On a small scale, parents might choose to sex-select for a girl because they have had two boys already; they want to balance out their family and experience raising a girl. To me this is a valid argument. However, consider how the boys might interpret the fact that their parents do not want another boy so badly that they are going through all these measures to obtain a girl. Does this change how acceptable sex selection is when a disease is not in the balance? Here I might be tempted to say that the sex of any child (without the risk of a sex-linked disease) should be left to chance. This chance in giving birth to a girl or a boy is just one of many that parents take when conceiving a child and I believe that it is very important for the formation of relationships based on unconditional love within families. However, I realize that reproductive freedom is not something to be taken lightly or unnecessarily restricted. Realistically, I do not see the regulation of this practice within the United States anytime soon. Yet, this does not mean that we should not consider the problems that might arise as a result.

    On a larger scale, unregulated sex selection might lead to an imbalance of the sexes within certain populations. In countries like China of India where the men are given more freedom and value than the women, who are viewed as subordinate or inconvenient this could pose a real problem. Already in these areas we see the abandonment or abortion of girls merely because they are girls. This has already lead to increase in crime and a large population of men who will never find a woman to marry. This severe lack of women leads to the view of women as a commodity rather than a normal contribution to society. Some would say that sex selection via PGD is just another form of sexism that would exaggerate the issues already plaguing society.

    • Christine Le says:

      I agree that regulation of this would be almost impossible in the United States, as we have not found regulations for most technology yet. The only solution I see is to let people use sex selection even if others are morally opposed to it. Even if we try to evaluate the intentions of the parents, who’s to stop them from lying and saying that they are doing this to prevent any x-linked diseases, when really they just prefer all girls or all boys? No one can force them to screen for these x-linked diseases, and they could just say that the information came from the other members of their families. Of course, this is me being skeptical on the honesty and integrity of society, but I do not see a better way of going about this issue without proper regulation of this technology.

      • Matt Weiss says:

        Just because regulations have not been used on past technologies does not mean we should not pursue them in the future. A part of moving forward technologically is being responsible for the use and proliferation of that technology. Unregulated sex selection could have drastic societal impacts. As it is customary in most cultures to prefer male children, the sex ratios would be thrown off. This could lead to more social issues such as increased crime, by young single men due to the simple fact that there are not enough women for the increased ratio of males. This is a very real consequence that needs to be avoided. And unless social norms shift globally to equilibrate the desire for male and female children, regulation is the only way to prevent this future.

      • CMRose says:

        I agree with Christine that it would be impossible to regulate sex selection in the United States, and I would even go as far as to say that there should be no attempt to regulate sex selection. Maybe I am a techno-optimist, but even if we get more males in the short term, wouldn’t that make females more “valuable” in the future? Using these types of arguments in favor of regulation is very difficult. It would be more appropriate to discuss the ethical implications in terms of access because before people will have a chance to impact society they will first need to have access to the technology.

      • Sandra says:

        I agree with everyone on this matter. Regulation is a very important aspect of new and currently used technologies. But as a techno-optimist, I believe technology should be viewed with a grain of salt and held with caution. A little fear combined with sex selection technology will go a far way in minimizing the risks to future generations.

  6. Bryn Willson says:

    1. Is it ethical to use preimplantation genetic diagnosis to select the sex of your child?

    In order to discuss the ethics behind sex selection by PGD, it is important to look at what the couple’s motives are for choosing this method of producing a child. For example, a couple could choose to go through IVF and PGD to have a girl because the mother is a carrier of an x-linked disorder. Therefore, if this couple decided to have a child naturally, and had a boy, the boy would have the disease. By pre-screening for a female, this couple would see awesome benefits, not only to the potential child, but to the healthcare system as a whole. Preventing a child from being born with a debilitating disease would not only save the family a lot of time, pain, money, and suffering, but it would also save health insurance companies hundreds of thousands of dollars. Money spent on years worth of tests, prescriptions, and surgeries for this single child could have been saved if only they had screened for a female using PGD. Thus saving money to be spent on those whom are unable to have such a luxury as to screen for disease before implantation at all.

    With privilege comes great responsibility. Therefore, although PGD is not something that can be offered to all because of its cost, those that can afford it could potentially free up medical costs to be spent on those that can not afford such treatment. Perhaps coming up with a better way to vaccinate the poor or even offer less expensive medical insurance to those who today cannot afford it because it is too expensive.

    On the other hand, if the motive of the couple is to have a boy because they want to carry on their family name, or already have two girls and “need some balance,” I do not believe that this is an ethical reason to screen for a certain sex. Once the realm of choosing the sex of ones child for frivolous reasons, or rather for no medical benefit to the child, than we are opening up a Pandora’s box to designer children. The whole gender balance of society, when even tipped slightly in one direction, like in China currently, could mean disastrous consequences. Gender inequality in terms of the trafficking of women and increase in crime rates are two effects that have already been seen in many societies. Therefore the best way to deal with the issue of sex selection is on a case by case bases, focusing on the motives of the couple.

  7. Sandra says:

    1) I am partial to how the blog laid this issue out, while it is ethically troubling, it is not innately wrong. The ethics of sex selection depends largely in the situation that the family is in. Biologically, the family could have a sex-linked recessive genetic disorder, and to avoid having the strong possibility of an afflicted son, will chose to have a daughter. In this way, sex selection works to save lives and avoid a potentially lethal phenotype. However, sex selection on the basis for societal status or advantages is morally wrong because you are denying the child a right to their own future. Another ethically troubling matter is there is no quantifiable way to determine if someone is selecting for/against a certain sex during the PGD process, unless they outright admit to it.
    2) I never considered that the rise of PGD would instigate negative attitude to those currently disabled in today’s society. PGD will reinforce the message that being disabled is an affliction of the poor and inaccessible. It is saddening that PGD could not have helped those that are currently disabled. However, it is daunting because if PGD was used before their development, those disabled now would neither be implanted (thus not exist) nor have their genes altered, if applicable. As PGD becomes more widely accepted and practiced, unfortunately having a disability will become a stigmatism that indicates lower social statuses and limited resources.
    3) Science has always had the mentality that progression should be made for the sake of progression and any advances should be used to the benefit of society. And to better society, medical procedures and applications must be accessible to the public. What Dr. Steinberg needs to remember is that just because science gives us freedoms into unknown areas, the public must be educated on the implications of their decisions. It is more than informed consent, but just that the community as a whole must be able to fully understand the consequences of the science. Ethics must race along with science and create rules and guidelines. Only then when everything is on the same page then can science be willy-nilly applied to the public.

  8. Conor says:

    1. Is it ethical to use preimplantation genetic diagnosis to select the sex of your child?

    I agree with all of those who posted above in that using PGD to determine the sex of a child may be ethically acceptable when used to prevent the most severe types of sex-linked diseases. I also agree with those who stated that it should be legally regulated. Clearly there are a number of ethical dilemmas that are raised by the use of this technology for reasons other than the prevention of such diseases.
    As Arthur Caplan said, “when you move away from diseases, who is to say what the better trait is? Those sorts of things are very subjective and in some ways driven by our culture.” From a moral standpoint there is a staggering difference between preventing debilitating diseases and “designing” your PGD babies. The former aims to protect the quality of life by ensuring a baby will be born healthy and disease-free while the latter turns the procedure into customized baby-manufacturing.
    In terms of regulation PGD should only be legal to determine the sex of a child in the case that it can prevent a serious or debilitating sex-linked disease such as Huntington’s. Therefore any clinic performing the procedure should be legally obligated to test that the parents are carriers of such a disease before operating. The commercial use of PGD turns babies into commodities and takes us a step closer to a eugenic society.
    Caplan also raised the ethical issue of access when he said that this use of PGD would be “something available to the rich and will not be something that the poor get to do.” Legal regulation could also help in this regard. The issue of access could be overcome if the government not only legalized the use of disease-preventative PGD, but also subsidized it for families of lower income.

    2. Consider the arguments presented about PGD and the ethical issues it poses in regards to disabilities. Does PGD reinforce a message about the disabled that, as disability activists claim, “negatively affects existing disabled people and fosters an increase in the oppression and prejudice from which they regularly suffer”?
    Absolutely not; the use of PGD in this matter is actually contrary to such beliefs. When used to prevent the birth of children with disabilities it is not an act of oppression or prejudice, but rather an understanding of the difficulty and suffering that surrounds the lives of those born with disabilities and their families. The use of PGD to prevent future generations of suffering from such disabilities is a way of appreciating the gravity of the suffering itself.

    3. In the video above, the doctor interviewed named Dr. Steinberg says, “Of course, once I’ve got this science (of PGD), am I not to provide this to my patients? I’m a physician. I want to provide everything science gives me to my patients.” Do you agree with Dr. Steinberg’s reasoning? Why or why not?
    I strongly disagree with Dr. Steinberg’s reasoning because it carries no moral or ethical weight whatsoever. As a medical practitioner he should be obliged to practice and promote only the scientific techniques that are conducive to the health and well being of his patients (and their offspring). He should also not be permitted to blindly advocate such techniques without providing the family with all of the ethical background information necessary to make such decisions. Just because a medical procedure is scientifically feasible, does not mean it should be practiced without providing the participants with full medical & ethical council. I found it quite disturbing that Dr. Steinberg treated his patients more like consumers; as long as he provided them with the scientific tools he had available, he was happy to abstain from any ethical decision-making.

  9. Nick says:

    3. In the video above, the doctor interviewed named Dr. Steinberg says, “Of course, once I’ve got this science (of PGD), am I not to provide this to my patients? I’m a physician. I want to provide everything science gives me to my patients.” Do you agree with Dr. Steinberg’s reasoning? Why or why not?

    Absolutely not. Science has, for the most part, allowed humans to enjoy the quality of life we enjoy today. From the discovery and use of tools millions of years ago to relatively modern technologies such as computers or automobiles, science has generally improved the quality of life for people on this planet. However, there are certain capabilities that we as humans simply should not attempt to control. Let me be clear- I’m not saying PGD is a technology we should or should not attempt to control, simply that there are certain abilities that should be beyond our scope of control as humans. Nuclear bombs, reproductive cloning, and in the vein of Frankenstonian hubris, the ability to control life after death. Granted, the last example isn’t a currently viable technology, the point is that there are certain powers we simply ought not to have.

    That is not to say we shouldn’t develop these technologies- simply that we should not necessarily use them. Nuclear technology has since given physicists the ability to simulate infinitesimally small subatomic events that have given us a better understanding of the world around us. Cloning may be used for therapeutic uses to provide viable tissues in patients who need organ transplants. The potential for future knowledge provided by these technologies merits continued research in their respective fields, but we must learn to draw the line between knowledge and application of that knowledge.

    Furthermore, simply because something exists does not mean we as humans are entitled to it. Too often in this information age do people become complacent with amenities that would have been nothing short of a miracle even a decade ago. This is especially crucial with the rapid filling in of the gaps in our knowledge of the human genome and PGD. The ability of PGD to identify sections of our genome is expanding every year. How long will it be before we can identify and select for or against the genes coding for eye color, or- if it exists- the gene(s) responsibility for homosexuality. Those with access to the greatest privileges have the tendency to take those same privileges for granted and tend to use them for vanity. PGD is a powerful technology that has the capability to help many families with a history of devastating genetic disorders, but also has the power to sacrifice thousands of embryos in pursuit of vain cosmetic and non-necessary procedures.

    In short, we are not owed anything by science, but rather should respect the power that it has to improve our lives and to use that technology only when necessary.

    • Emily Scroggs says:

      I agree that there are certain technologies that humans should not try to control. However, I do agree with what Dr. Steinberg is saying. He is a doctor and he has a duty to heal the sick and help those that are in need in any way that he can. If a technology comes along that enables him to carry out his duties as a physician, he cannot ignore this opportunity. On the other hand, he has just the same duty as a physician to do no harm. In this sense, if a technology comes around that he feels would do less benefit than harm to his patients, he has the right to not allow his patients access to this technology. I think the way that Dr. Steinberg phrased his statement was inappropriate because it makes it seem like he would allow the science in any circumstance; however, I believe that he meant this within the context of the science providing benefit to his patients in which case I do agree he has the duty to provide the option of PGD to his patients.

      • Sandra says:

        I agree initially that technology should not be used for the sake of technology and advancement. But as Emily says doctors are obligated under the Hippocratic oath to do all within their power to heal the sick. So there needs to be instituted a division between taking risks with a patient’s life with a uncontrolled technology and just using the technology for its own sake.

  10. Maissam Noori says:

    The issue of social justice and equity in PGD is almost universal for other areas of our healthcare system. In my opinion, government does have the moral obligation to provide PGD (for that matter basic healthcare) in cases that are medically needed. PGD needs to be regulated just like any other medical procedure, and all risks and side effects need to be disclosed. An embryo, in my opinion, is not a living person and therefore has no moral rights. If any living cell is entitled to a moral right, then can we apply moral rights to a lettuce? The ethical argument used by disable community does not make any sense to me. The point of PGD is not to discriminate against other people or to belittle disables. The goal is to give and unborn child a better chance of survival and a better quality of life. In my opinion, the most challenging ethical issue with PGD is that, how much are we willing to “abuse” this technology? With “abuse” I mean, the use of PGD for cases that are not medically required such as selecting a child’s gender or creating a “perfect child”. Any of those two are unnatural and unnecessary and in my opinion ethically wrong and unwarranted. But, we human beings like to push our boundaries and it’s only the matter of time that we get into the business of creating “perfect children”.

  11. geoff klein says:

    I tend to agree with many of the comments that have been posted, in that PGD provides dramatic life improvement and an exciting new aspect to health care-preventing disease by preventing the afflicted individual from being born. However, as stated there are some very troublesome issues that accompany this technology. The way it is being used now, despite drawing some debate, seems to be for the most part, ethically sound. The question lies in the future; how will this technology be adapted to the demands of the market? As we have studied with many technologies, their original use and development often have nothing to do with the way they are used down the road. For example, how hard is it to imagine people with enough money handpicking every trait their child has physically, as well as choosing from a handful of genetic advantages determined before birth. This is all almost possible now, and how much longer will it take for the technology to be improved to the point where these types of prebirth decisions are offered to couples willing to pay for them, after all what parent doesn’t want the most success for their children? The only answer is careful and constant regulation, something that to this point has been very inconsistent and broad, leaving plenty of loopholes for those who care to look for them. Its not that PGD is dangerous and should be discontinued, because the prevention of autosomal recessive diseases that are proven to be deadly are a great medical development. However, in my opinion careful observation and regulation is the only thing that will keep this technology from being used abused the way that plastic surgery is these days.

  12. Kate Rawlings says:

    It seems the issue most discussed above is that of sex selection via PGD. While that is definitely a controversial ethical issue, I believe the most interesting point brought up in the post was that concerning discrimination toward those with disabilities. While there is no question that those with disabilities suffer certain discrimination in society, I find it a bit farfetched that PGD only heightens the social stigma– at least currently. Currently, PGD is effective in testing for the presence of debilitating diseases, such as Tay-Sachs or cystic fibrosis, not simply disabilities. I cannot understand how deciding not to allow a child to suffer the pain of Tay-Sachs or Huntington’s Disease perpetuates discrimination against disabled persons. While others may argue with me about this point, it seems like the only compassionate, loving action to take as a parent. Obviously, it is possible that as we learn more about the genetic code, PGD will be abused and designer babies will be a possibility. There is no question that there will be hard questions concerning which mutations are “disabilities” and which are “diseases.” But this fact does not mean that all genetic mutations must be accepted in the pursuit of a society that does not discriminate against the disabled. Persons, children especially, should not be allowed to suffer simply to prove a point. The prevention of Tay-Sachs or Lesch-Nyan is not an act of oppression toward disabled persons; it is an act of compassion toward the potential child.

  13. Sblock says:

    1. To determine how ethical PGD is, I think it depends on the motives of the parents. Sex selection can ensure the child does not get an X-linked disease, resulting in a healthy daughter rather than a sick male. If the parents are using PGD to rid their child of a life of suffering and disease, I think it is justified because it is in the best interest of the child and their quality of life. However choosing sex for the sake of having a boy or girl in my opinion is ethically questionable. In the article it discussed this being ‘morally neutral’ however, I think having a healthy child is the main objective of PGD. If the parents do not have any heritable diseases they are trying to avoid, choosing the sex for the personal satisfaction of the family seems unnecessary. In my opinion, using PGD excessively is not moral. PGD will start with sex selection and naturally create a cascade of options that will be developed so parents can choose even more and more traits of their children. I think choosing the traits of an unborn child takes away from the unique characteristics and traits the child will have, because the parents are concerned with how they want the child to be opposed to how they naturally are.

    2. I agree that PGD fosters a bad message to the existing disabled. If society is making a conscious effort to not have children of disease, it would undoubtedly make those with disease question if their parents would ‘want’ them if they had the choice. PGD would give those with the disease the impression that society does not want them, that they are outcasts, and they are not beneficial to the human race because they are disease laden. This could be interpreted as blatant discrimination against those with disease and society’s perception towards those with disease would become even more negative.

    3. The physician who claims he has the motivation of solely spreading scientific knowledge is questionable. Because self-interest exists and because PGD is very costly, it is hard to imagine that a physician would not be working for science as well his own financial benefit. Because PGD is not 100% accurate in many cases, the doctor could manipulate scientific knowledge to persuade his patients to pay for PGD when it might not work.

  14. LTracy says:

    In response to the third proposed question, I believe Dr. Steinberg is somewhat misguided it what he owes to his patients. I do agree that he should provide everything science gives him to his patients, but his avenue of science seems wasteful. As a physician he should be investigating scientific applications that alleviate present and future pain and suffering. In the instance of choosing hair and eye color, I do not believe these factors can be claimed to cause suffering. Instead, scientific knowledge and research should be targeted to help treat diseases. Creating a clear definition of disease is crucial but also quite laborious. Instead, I will make a claim as to what is not a disease. It is clear that modifications to cosmetic qualities do not qualify as a disease and should not be modified with PDG.

  15. nschwedhelm says:

    1. When it comes down to ethics around selecting your child’s sex in preimplantation genetic diagnosis I think it is the motives behind the choice that raise ethical issues more so than the choice itself. While many religious people would argue that selecting your child’s sex interferes with the will of god and the course of human nature; I personally think that there are circumstances where selecting the sex of your child is justified and ethical. If a couple is choosing to use PGD to select to have a healthy baby girl and avoid an X-linked life threatening disease that could potential be passed down to their child, if they were to have a boy; then I think selecting the sex of your child is ethical. PGD gives us so many possibilities and opportunities to avoid diseases however; it also brings about many issues and opportunities for the technology to be used in unethical and unreasonable ways. I am in full support of PGD when it is being used to prevent disease but I think there is the potential for many lines to be crossed when it comes to parents physically hand selecting the genetic makeup of their child. It concerns me that without certain restrictions and ethical regulation there is the potential for PGD to be miss used and miss treated.

  16. Haley Banbury says:

    Because of my religion, I am still on the fence with PGD as a whole –whether using it for medical purposes, such as disease prevention, is acceptable to me. Part of me believes in trusting the natural methods for conceiving without having a say in the genetic makeup of your child. However, one thing is certain to me — using PGD for sex selection is morally and ethically wrong. I think it is beyond selfish to choose the sex of your child to ensure gender balance in the family. Life is a miracle and I think it should continue to be treated as such, not characterized by a checklist of choices for personal, selfish motives.

    I agree that PGD perpetuates the negative perception that society holds about disabilities and people living with disabilities. I knew someone who had trisomy 21 (down syndrome) who enjoyed life so much and brought so much joy to her family and friends before she passed away last year. The people in her life were better off because they had her to love. Their lives were of course affected by the lifestyle of taking care of her, however, they have admitted to being better people because of her. I think living with and taking care of people with disabilities makes society more compassionate, gives society people to admire, and has the power to humble society.

    In regard to offering all science has to offer to patients, I disagree with Dr. Steinberg’s reasoning, only because I feel the negatives outweigh the positives with cosmetic genetic designing. Like I said, creating an embryo that is disease free that otherwise would live a life with a disability is one thing, but designing cosmetic traits of humans is suspect. What about leaving it to chance? It has worked since the beginning of time, and just because the technology is available, doesn’t mean we should use it.

  17. Tina Iguchi says:

    PGD is a wonderful advancement in the world of genetic technology – if used correctly. I can understand the point of view that it may cause the issue of discrimination against people with disabilities but I do not view PGD in this way. People born with disabilities can be viewed as an asset to our society, helping us learn to be more tolerant, empathetic and more understand to those who are different from us. Yet, if you put yourself in the position of a parent who does not have the means to raise a child with a disability or a life-threatening disease such as Tay-Sachs, cystic fibrosis or Huntington’s Disease, then PGD would be a great option as opposed to having an abortion after the embryos grow to become a fetus. Using PGD in selfish ways to choose the gender of your child or to creating “designer” babies is clearly crossing the lines of moral issues, as they are not disabilities nor are they a disease that will affect the child’s life in a negative way. I do not believe that using PGD to ensure your child is born disease free is a discriminatory act, but simply a less emotionally traumatizing option for parents who do not have the means to raise a child with a disability or disease.

  18. Cathbadh says:

    On the question of sex selection, I feel that the idea that to raise a child of the different gender is a different experience assumes the answer to another question: a different experience from what? From another, say, boy? This wrongly assumes that rearing another child of the same gender will be the same. That, of course, is complete bogus. Raising one of the girls is completely different than raising the other. Regardless of gender, each child you raise will have a different personality, bodily features, thinking habits, etc. Since when are brothers the same? There may be biological similarities (two penises or two vaginae), but that in no way means the experience will be the same.

    When one has the choice to eliminate a genetic disease from his or her baby, I think most people would choose to avoid the disease at all costs. Indeed, people who have grown up with a genetic ailment wait impatiently and some go to extremes to find relief from their condition. The benefits from avoiding the disease at birth are obvious: a simpler and more secure life, smaller medical bills, more freedom, etc. On the other hand, the benefits from having the disease, are much more subtle, and sometimes not guaranteed: a greater respect and appreciation for life, a more complicated personality, a deeper connection with those of whom you share you burden, etc. Personally, as I’ve had my own experiences with chronic genetic illness, I would probably not wish to mess with my child’s genetic makeup. Yes, seeing your child suffer under a horrible ailment that came about simply because of a more agile sperm and the available egg will bring any loving parent to tears. Yet seeing that same child grow and mature in spite of the hardships will bring the warmest glow of pride to even the most bitter parent.

  19. Alexandria Shearer says:

    2. Consider the arguments presented about PGD and the ethical issues it poses in regards to disabilities. Does PGD reinforce a message about the disabled that, as disability activists claim, “negatively affects existing disabled people and fosters an increase in the oppression and prejudice from which they regularly suffer”?

    The line between a disability and a minor setback to some worldly goals is not very clear, especially because some disabilities are the result of genes that serve to aid humanity in other ways. Sickle cell anemia is considered a disability, but the gene for sickle cell anemia grants a degree of resistance to malaria. This suggests “disability” may be, in part, a social construct. Therefore eradicating a specific disability with PGD technology is an assertion that the “disability” weighs out the unique abilities of the embryo.

    I do think this sends a negative message to the disabled persons, as we so call them. The choice to give life to one embryo over another is a choice that implies a person loves one embryo more for not having a disability.

    As a Catholic, I am inclined to believe that each embryo has a different soul. Therefore it is not the single child that you are loving and wish to partake in a full life without a disease or disability, it is the healthy child that you choose to love over the unhealthy one.

    I realize this probably isn’t popular with many people who want to have kids, but I feel that parents should either love and accept wholeheartedly what they conceive (disease, disability, and all), or not have kids if they want to prevent suffering.

  20. LF says:

    In my view, preimplantation genetic diagnosis (PGD) is a boon to prospective parents who use the technology because as with any other medical decision, the more knowledge patients have, the better informed decision they can make. Specifically, detailed information about their future child will enhance the ability of soon-to-be parents to prepare for the enormous undertaking of raising a new human being. It would be unethical to keep creating and discarding needlessly a great number of otherwise healthy embryos until one is acquired that fulfills a laundry-list of superficial characteristics deemed “perfect” by paying clients. However, this is not the same as allowing consideration of traits to influence selection from an existing group of embryos, since out of a single batch of embryos (a number necessitated by the in vitro fertilization process), only one or a few will be implanted anyway. Perhaps one working-class family decides it would be irresponsible to implant an embryo that PGD confirms will have a disability because they lack the requisite fiscal and time resources to properly care for a child with special needs. Maybe one lesbian couple (not necessarily representative of all or most) feels they would be better equipped to raise a daughter as their first child. The goal of any reproductive technology should be to encourage responsible parenting and to provide a resulting child with the best nurturing environment possible; to this end, more – not less – information helps.

  21. Nairie says:

    For my blog comment, I chose to respond to Question #1:
    Is it ethical to use Pre-implantation Genetic Diagnosis to select the sex of your child?

    After reading Professor Nelson’s blog, the only reason that I believe is valid for parents to choose the sex of their baby would be to prevent “the transmission of sex-linked genetic disorders.” Parents, who cannot financially and emotionally afford to raise a child with genetic defects, will wish to raise a child that is free of genetic disorders. Therefore, if a sex-linked genetic disease is present in their family, it would be reasonable for them to try to prevent that disease from being passed onto their children. And if one way to prevent the continuance of that disease is to select for a child with a specific sex through PGD, then the parents are fully justified in doing so.

    However, I agree with the arguments that Professor Nelson makes in regards to the fact that parents should not be able to choose the sex of their child for reasons such as achieving gender balance, achieving a preferred order in the birth of children by sex, or to raise a child with a sex that the parents prefer. I believe that these reasons show exactly how PGD can be abused and taken advantage of. It is understandable that some parents may want to choose against a genetic disease that runs in their family, but being a female (or a male) is not a genetic disease. Having a male or a female is up to chance; there is a fifty percent chance of having a child of either sex. And as Professor Nelson mentioned, sex selection does closely fall along the lines of valuing one sex over another. Parents that are in favor of sex selection are thus placing a distinction between both genders and are implying that being one gender is more advantageous than the other. In my opinion, sex-selection is another example of sexism, in that one gender is superior in its abilities over the other gender. And in the words of Professor Nelson, this thought is “outright wrong.”

  22. QuinnP says:

    Should a PGD be used to select for gender?

    As mentioned, in the case of sex-linked disorders, the consensus seems to be absolutely, if the health of the child is ultimately dependent on gender, then there are no ethical dilemmas regarding sex-selection.

    The issue of sex-selection, in general, however presents a much more interesting ethical issue. I don’t think the ethicality of such an act is relevant at all, and here’s why:

    The instant PGD is accepted as a means to select general traits of a child, with the obvious medical exceptions, we, as a society, will have accepted the feared “designer baby” concept. It may be easy to say that selecting for gender, eye color, or hair color are inconsequential and acceptable, but that selecting for IQ or athletic ability are not. But by establishing that the inherent traits of a child can, in fact, be “selected” we will find ourselves in an environment where the “acceptable line” is continuously pushed further and further back. Selecting a child’s gender may be a glamorous concept, but in doing so, we would be venturing tragically close to a slippery slope that ends in the complete selection of child traits.

  23. ADewey says:

    I agree with many of the posts thus far and with Dr. Nelson that except in cases of screening for X-linked disorders, sex selection is not ethically responsible because it can act as a gateway for selecting other “desirable” traits even to the extreme of the movie GATTACA.

    What I would really like to expand upon is the view that PGD creates even more negative attitudes towards disabilities. I believe that this is really a question of the difference between a disability and a genetic condition that causes an individual to be in pain and have a significantly reduced life span. For example, an individual who is deaf because of a genetic mutation, will live out a full and fulfilling life despite their “disability.” Whereas a baby born with Tay-Sachs starts moving backward in development starting at one year old and slowly suffers until it dies around age two causing a large amount of pain for the baby and emotional pain for its family. In this case I believe that it is acceptable to select against Tay-Sachs but not deafness. I believe that this is a distinction that needs to be decided for every condition for which we create a test.

    Also, I have an issue with the fact that only families that can afford IVF and PGD have access. If our goal is to eliminate certain diseases from our society then we should make it available to anyone who wants it, provided it’s PGD for diseases that cause individuals to suffer.

  24. DBibee says:

    I am extremely confused about the objection to PGD as something that would create a bias against the disabled. There is nothing about PGD that devalues disabled persons, but it certainly devalues the conditions they might carry. There is nothing happy about cystic fibrosis, although people with CF may live happy lives in spite of their condition. Using PGD to select against CF doesn’t mean that people with CF are less valuable as moral, human beings. It is reasonable to want to eliminate the expression of that disease in the human population, however, because it can cause such terrible damage. Wanting to protect future generations from the suffering that many may experience as a result of a genetic disorder does not mean that those people who suffer are less valuable, but that the condition they have is not something desirable.

    The greatest ethical question facing PGD is the moral status of embryos. For those of us who hold a belief that a developing embryo is as valuable as an adult, the idea of discarding any embryo is abhorrent. The danger with PGD is that many would disregard the value of these embryos, taking us into a “brave new world” where we view birth as simply another aspect of our consumer lives–designer babies, each with the perfect characteristics, for our materialistic culture to “consume.” It is my belief that the greatest ethical problem faced by our society today is the widespread disregard of the value of embryos, elevating our whims over the sanctity of life that is housed within pre-born children. Is the life of an infant worth less than the life of an adult? Can we say that a young (pre-born) infant is worth less simply because it is at a different stage of development? The disregard of human life at any age should not be The danger of PGD, although it provides a means to alleviate the possible suffering through genetic disorders, is that there will become wanton disregard for the lives of embryos. Each of those potential lives has value, and they should not be treated as simply cells in a petri dish.

  25. Marshall says:

    To address this question, I think it is not ethically wrong to use PGD to select the sex of a child. The beginning of the article states that the cost of PGD is very high and the parents need to pay the bill themselves as the insurance companies do not cover PGD. I think most rich people and people who know PGD and can afford PGD are mostly highly educated people. They have less sex preferences of the child. Also PGD also can help a child to avoid sick genes on the sex-linked disorder and avoid the future caring costs. Moreover, from the economic point of view, even though there may be a sex preference in the short run, but there is no sex preference in the long run. If we assume that parents like boys and more male babies are born and less females are born in the short run. The supply of boys increases and the demand for females increases. However, the supply of females decreases because of the short run sex preference. Thus, the females start to gain economic power and have more advantage in the marriage market and in the society. Families will tend to born more females and bring the sex back to the equilibrium.

  26. josie says:

    Preimplantation genetic diagnosis, while providing parents with the chance to deliver disease-free babies, can also lead to discrimination and have other negative consequences. PGD’s use should be limited to individuals who are either carriers of a disease or directly affected by it themselves. In these cases, a couple may produce a child with a debilitating medical condition that is in pain or is otherwise incapable of leading a happy, productive life, and PGD should be allowed to prevent this from occurring. However, a couple should not be allowed to use PGD to choose the sex of their baby or choose other physical traits that pose no medical threat to the potential child. Although PGD provides parents with healthy children, it also leads to the destruction of embryos deemed undesirable for one reason or another. Embryos deserve some extent of moral status, and should not be discarded because potential parents want a boy or girl. Not only does this lead to gender discrimination, but embryos are discarded solely based on the fact that parents want their child to be of a particular sex. In my opinion, using PGD to determine the sex of the baby is unethical because healthy embryos are being destroyed for superficial reasons. The line must be drawn between cases in which two parents could produce a child with a debilitating mental condition and want to use PGD, and parents who want to use PGD because they personally prefer a boy or a girl.

  27. Kaptajn5 says:

    PGD should not be used when it comes to selecting the sex of a child. Although sexual discrimination is acceptable in some countries, in the U.S. it is not, and therefore this should not be allowed since it is a directly discriminating against a certain gender, even if the family just wants “balance.” If trying to avoid any sex-related diseases, it is still a form of discrimination. What if millions of families decided to only have male children, what would happen to the population of a country? Obviously it would start to stall, then what happens,do families decide to have only female children? This would then result in an age gap that some may look down upon, and a lot of families will not have offspring to carry on the name. Basically, racial discrimination could have more than just one superficial effect, which is the rejection of a certain gender, it can have social, cultural and economical damages too. With regards to it being another way to discriminate against people who are disabled, it is also wrong. This is just another way to make these people feel unwanted and made an outcast by a culture that seems to be focusing more and more on one’s physical appearance. The disposal of the embryos that are “infected” with disease is a genocide, and it is not 100% positive that the child may have the disease that it is predicted to have. Having a disposition to the disease does not guarantee that it will develop the disease, and therefore it is just denying the chance for a life to flourish. If PGD becomes more economically accessible to the masses, will society soon become a GATTICA? Although it is a reach to make the statement, in todays world anything is a possibility if enough effort is place behind a project.

  28. Brad Chun says:

    I believe that preimplantation genetic diagnosis is only ethically justifiable if intended to prevent the proliferation of genetic diseases. Both utility and Ross’s prima facie duty of beneficence point to this conclusion, because prevention of genetic diseases will decrease the stress and pain associated with dealing with disabilities, and PGD helps future progeny in accordance with beneficence by preventing genetic disease. Of course, some may argue that the moral status of an embryo is equal to that of an adult on the basis of future or potential rationality, and if someone is fixed on this point of view, then it is nearly impossible to argue the justification for PGD. However, I believe that physicians have a moral obligation to not withhold any technologies which is known to be effective in the treatment or prevention of disease. Parents have a duty to reproduce in a responsible manner, and therefore it is their obligation to take all possible steps to prevent their child from harm, like the self mutilation associated with Lesch-nyhans syndrome. Thus, if parents have the means to have PGD, they ought to utilize it, especially if the parents are afflicted or carriers for a disease.
    However, if the intent behind PGD is to select for a certain sex or desirable physical characteristics, then I believe PGD is wrong. One’s sex or physical traits like eye color will not have a serious detriment to the quality of life of one’s offspring, and thus the duty if beneficence no longer applies. I believe the benefits do not outweigh the cost of destroying viable embryos, and question whether parents who place such a high importance on these factors are fit parents at all.

  29. DF says:

    I do not think it is ethical to use preimplantation genetic diagnosis to select the sex of one’s child. Preimplantation genetic diagnosis should only be used as a means to prevent genetic diseases that are certain to be transmitted to one’s offspring. If it is used for other means it is representative of eugenics, which is not ethically acceptable. People, by nature, do not have the ability to choose the sex and physical, or mental, characteristics of their offspring. Therefore, actions taken that would constitute such a selection are not ethical and should not be made available. I can see how disability activists could interpret the use of PGD as offensive to those with disabilities and that it fosters prejudice towards the disabled, but I also think that the use of PGD could be utilized to prevent the suffering of many individuals. The benefit of such an elimination of suffering outweighs the cost of discrimination towards disabled individuals and therefore the use of PGD for the means of eliminating the suffering of an individual should be allowed.

  30. Sonali Ekanayake says:

    Allowing parents to design their children and selecting the sex, is unethical because it is not just. By deciding the sex of your child, one sex is going to be more favored than the other. Each fetus has the potential to become a rational being, which is what each human is regardless of sex. Therefore, no one sex should be favored or selected in implanted embryos. Additionally, the benefit to PGD, which is removing potentially life threatening diseases from embryos, is very presumptuous. I say this because it is a very naïve outlook on the future of the child. The fact is that no one can be certain of the nature or consequence of a particular disease. This approach relies heavily on guaranteeing the fate of a child, which follows Mill and Bentham’s principle of utility. I disagree with this approach because a child may be predisposed to any number of diseases but the extent of each cannot be certain. The disease could be mild or severe but only time will tell.

  31. AMurphyHagan says:

    PGD and PrGD re-introduce eugenics in a new technological package. The question is whether, eugenics may now actually have something positive to offer. This technology promises to prevent deadly recessive diseases such as Tay-Sachs and Harlequin Syndrome, which would be an acknowledged “good.” At the same time, this technology could be used to discriminate against persons with disabilities which is “just as morally repugnant as discrimination against persons based on race, religion, or sex.” Selection inevitable entails a process of discriminating one option in favor of the other. The issue I see with this technology is that there are no ethical guidelines to determining which traits can be reasonably identified as undesirable. So far, it appears this technology also fails to delineate the ethical difference between targeting diseases versus targeting traits. Sex-selective abortions and infanticides of children with disabilities are already practiced throughout the world (though these practices are widely considered to be an abuse of human rights). Doesn’t this bringing this technology into clinics simply “re-package” similar eugenics practices? Can designing genes also design genocide?

  32. Adam Trujillo says:

    PGD and PrGD are just more examples of how far medical technologies have advanced. I believe there are certain applications for these tests but using the information and manipulating in a way that fits the family best is immoral. Personally, I do not see it unethical to know that your baby has a good chance of inheriting an incurable disease and choosing traits that will decrease that chance. But, when it comes down to choosing a certain gender i believe it to be immoral because it will offset the balance of nature between males and females. Choosing one sex over another will create much discrimination among gender, choosing a sex because it may prove easier to parent becomes a major ethical issue. The balance might shift towards one sex and a “God-complex” might set into place that will disturbs the natural order of things. Nature has always been survival of the fittest and this creates a society that deletes certain portions of genes and may have major implications that we are not yet aware of.

  33. Nicholas Giustini says:

    The question of whether PGD is an ethically justifiable practice is a complicated one. People may argue that, because we have the technology available to us, we should have the choice to use it as we please. The key aspect regarding this issue comes down to whether or not a person believes fertilized—and subsequently dividing eggs—may be considered “human persons” with rights.
    In a case where PGD can be used to test for genetic diseases, if you believe that a person’s sentience and general rights begin when he is physically born, then principles such as beneficence and non-malficence would both say PGD is ethically allowable, and even the correct course of action. The potential child would receive a benefit, as he would be free of many genetic diseases, but no harm would be done as no “people” would be hurt.
    On the other hand, if you were to believe that a fertilized egg equals a human being with rights, then it would be morally abhorrent to perform such a procedure. While you may end up improving the life of one person in the process, you would have to discard multiple “people” for the sake of one, which definitely causes harm. The principle of utility would say this is wrong because many more are harmed than helped and Kantian ethics would decree that you are using all the other potential people as means to an end.
    Other uses of PGD, such as selecting for trivial traits such as sex or eye color seem morally irresponsible to me. Why would you play around with such questionable technology just for some semblance of superficial improvement for your potential child? Choosing a different sex isn’t beneficial for the health of the child, but it does cause harm to all other embryos you are discarding; whether or not you believe that the other embryos are people is irrelevant—you should not always do something just because you can.

  34. Victoria Watson says:

    I think it is absolutely fascinating that we live in a time where technology is advanced enough that there is the ability to perform preimplantation and prenatal genetic diagnosis. Although it is quite a feat for mankind, the implications that come about as a result of these new technologies do become ethically overwhelming. This issue can be looked at under many different extremities. In one case, I feel it is fair for couples to want to know whether the fetus may be susceptible to genetic diseases or abnormalities. However, the issue then becomes, if yes, the fetus will be prone to a disease, is it ethical to terminate that life? At what point is the fetus considered a person who deserves to be respected under basic human rights? Moreover, if parents are to decide to abort, society is given a discriminating message towards any current disabled individuals. In the case of the movie, My Sister’s Keeper, I struggle with how raising a child for the genetic match of a sibling can be just, since the child did not have a say in the matter at the time of fertilization. Furthermore, these testing procedures are expensive, and it is fair that some have access to such testing over others? And for those who have the money, is it fair for them to determine the eye color, hair color, sex, etc. of their baby and to take away the diversity of human birth? The topic of preimplantation and prenatal genetic diagnosis is extremely controversial and difficult to approach because, as with all ethical dilemmas, there are pros and cons to each side of the argument. Overall, however, I feel that if these tests are used for the ultimate well being of the child, then one may argue that preimplantation and prenatal diagnosis are ethically acceptable.

  35. Randy Holaday says:

    With PGD, as with any recent medical technology, there is an ethical line that needs to be drawn between what should and should not be done, how far to use the technology towards an end. I think PGD should be used to help doctors in their constant strive for non-maleficence. In fact, I think we are morally obligated to use whatever means necessary to ensure that children with horrible and painful illnesses like spinal muscular atrophy will never have to experience that pain in their short lives. But when PGD begins being used for things like gender, eye color, etc., the method starts being used towards a social end rather than medical. Regardless of the justification used, this method of PGD will necessarily be influenced by social biases and not for the embitterment of the child’s or the parent’s health or quality of life, and is therefore ethically wrong. However, even this analysis has a gray area, and that would be in the case of preventing disabled babies from coming to term. To this, I would have to say that that choice must be made individually by the parents—whether or not they are willing and able to take on such a responsibility.

  36. Brian Winter says:

    On the first question, yes I do think it is ethically defensible to select the gender of a child in certain cases. As the article suggests, certain diseases and undesirable traits may be linked to the sex of a child, and therefore selecting a child of the opposite sex to prevent a genetically transmitted disease should be alright, and in my opinion encouraged. Additionally, use of PGD and IVF to screen for and help prevent serious diseases or physical deformity also raise many questions both ethically and for some, religiously. The situation is difficult because if we are treating an embryo as a live and morally independent life, this process may be a violation of its autonomy and a violation of the natural link that would occur between a person and the divine. Some may argue that these diseases and difficulties are by some design of a higher being and that to interfere with this would be wrong. Additionally, some would argue that screening for and preventing the birth of children with genetic conditions is a type of prejudice against the physically or mentally disabled. I have a hard time buying this argument. It is completely possible to have a society which openly and equally accepts individuals with physical and mental disabilities, while simultaneously preventing or treating the genetic diseases which caused them to be born that way. Do we have an ethical duty to limit the suffering which comes along with many of these disorders? Do we have a duty to our children to eliminate any barriers to their potential happiness and success? These questions are difficult to answer, and the proliferation of technology that may lead to more widespread genetic discrimination is a real danger, but if PGD and IVF are used simply to prevent serious diseases and improve the basic quality of life for individuals, I would have to support families who opt to utilize these technologies.

  37. Meridith says:

    Arguments about if PGD to is ethical or not are based on how one defines a rational being. From a kantian perspective it would ethically be wrong if one considers a fetus to be a rational being. The decision to select based on sex, physical traits, or medical disabilities would be the equivalent of doing the same in society. Selecting fetus’s based on “positive traits” would be supporting discrimination based on genetic characteristics. It is important to avoid pain and suffering. But if avoiding pain and suffering means making a life or death decision for another person is that still just? Can you make life or death decisions for another person based on a perceived quality of life? Using PGD would socially be expressing that children and adults with disabilities or genetic diseases are the result of a “defective embryo or fetus.” Negative associations will increase oppression and prejudice against disabled individuals and send the message that they are undesirable and a burden. It’s my belief even though technology has advanced to allow us to be able to select for particular traits it not right to “play god”.

  38. Zach Shikada says:

    First of all, as a religious person, I cannot fully endorse either PrGD or PGD on the basis that they are dangerously close to “playing God”; furthermore, they are both practices that can be very closely linked to both “designer babies” and germ-line gene therapy, two human implements, the first being frowned upon and the second too controversial to practice.
    However, when taking a utilitarian approach, there are several key positive benefits for these practices. The principle of utility, that being the principle stating that an action is as right as its ability to promote overall happiness, would (barring certain cases) definitely support this practice. If a doctor is able to detect and prevent a disease from afflicting an individual, is it not his or her moral obligation to take the necessary steps to do so? By preventing the disease, the net happiness is increased.
    Nevertheless, the reason that I cannot place my support behind this is based on a couple reasons that I have brushed slightly upon before. While I do see genetic testing for the sole purpose of embryonic gene detection ethically justifiable, there is too much potential for abuse for me to support it. The concept of “Savior Siblings” is drastically unethical, as there is a serious violation of Beneficence occurring on behalf of the child being cut open. There are huge questions on autonomy already when regarding PGD and PrGD, the number growing exponentially when regarding germ-line gene therapy.
    Thus, due to the potential for abuse, I cannot support this – while I do recognize it for its very real uses, it would be foolish to believe that humans would be able to keep that science pure without transforming it to create designer babies and the like. Thus, based upon the principles of autonomy and beneficence (and thus not even using the class discrimination argument), there is too much potential for danger to be able to support this practice.

  39. miki ueoka says:

    I think that PrGD and PGD used for determining a child’s sex or to select desirable traits is ethically wrong. That is an area where I believe science interferes with nature, and while I understand not everyone may share the same religious values as me, I do think it interferes with God’s will. Ethically, parents are supposed to be responsible for their children and child rearing, and especially in determining the sex of the child, it creates strong discrimination amongst the sexes. The ethics of using PGD to prevent disease and harmful disorders is far more complicated. Ethical principles such as utility or Kant’s prima facie duty of benevolence suggest that preventing the birth of children that are prone to disease and disability is ethically correct and therefore should be done. However, PGD discards the unused and unwanted embryos, and even genetic screening can ultimately lead to abortion to avoid the children’s suffering, which is another ethical dilemma in itself. Also involved in this issue is that of discriminating against the disabled. Caring for a child with a developmental disability or other disorder can be a difficult process, and the life of a child with a disability can be painful as well. While it seems like preventing the birth of a child with a disability and preventing the possible suffering that can be associated with it would be a good thing, we must consider the message that this sends to those living with developmental disabilities. I have been working with adults/seniors with developmental disabilities for a few weeks and while some are both physically and mentally impaired, they have managed to use their ability to it’s full potential. Who are we to say that they should not be given the chance in the first place?

  40. ASalas says:

    Initially I was unfamiliar with the concepts of preimplantation genetic diagnosis and “designer babies.” After reading this article I was appalled. I understand the reasoning behind screening fetuses for embryos for genetic abnormalities and how it may prevent the reproduction of a future child with genetic diseases. I also understand why people have preferences for eye color and characteristics of a child such as the sex but this is not natural. According to natural law, right and wrong is based on the determination of nature. Choosing the sex and characteristics of a child is unnatural and is not the way it was intended to be. Moral order is the way God intended it. Who is to say that a sex, an eye color, or a hair color is better than another?

  41. Brianna says:

    I’m just going to come right out and say that I do not think that choosing the sex of your baby based on wanting to have different experiences is unethical. But how many choices finally classify a “designer baby?” A main ethical issue looks at whether or not it is okay to look for disabilities in an embryo. If this leads to an abortion, I believe it is unethical, but if it leads to parents being able to better prepare for having a disabled child, I think it is alright. If we just start getting rid of embryos with signs of disabilities, wouldn’t that show that those children are valued less? However, the point is brought up about whether or not you would want your child to live with a painful disease, where it would not even be able to enjoy its life. Anything ethical issues around “designer babies” should always come back to what the intentions of the parents are: are they choosing for themselves or at they choosing for their child?

  42. nschwedhelm says:

    Preimplantation genetic diagnosis has opened up many new doors when it comes to having a child. PGD has the potential to be referred to as “playing God” because it goes against nature and allows parents to have the option to make choices about their child’s genetic make up. This raises questions regarding the parent’s intentions for choosing their future child’s genes as well as issues around consent. Consent can be seen as a problem because parents are choosing the genetic makeup for their children without giving them the chance to choose for themselves, this doesn’t seem like a huge deal at birth but years down the road PGD babies may not like that parts of their genetic makeup were “designed” by their parents. When it comes down to ethics around selecting your child’s sex in preimplantation genetic diagnosis I think it is the motives behind the choice that raise ethical issues more so than the choice itself. While many religious people would argue that selecting your child’s sex interferes with the will of god and the course of human nature; I personally think that there are circumstances where selecting the sex of your child is justified and ethical. If a couple is choosing to use PGD to select to have a healthy baby girl and avoid an X-linked life threatening disease that could potential be passed down to their child, if they were to have a boy; then I think selecting the sex of your child is ethical. PGD gives us so many possibilities and opportunities to avoid diseases however; it also brings about many issues and opportunities for the technology to be used in unethical and unreasonable ways. I am in full support of PGD when it is being used to prevent disease but I think there is the potential for many lines to be crossed when it comes to parents physically hand selecting the genetic makeup of their child. It concerns me that without certain restrictions and ethical regulation there is the potential for PGD to be miss used and miss treated.

  43. psychoticnewt says:

    The advantages to utilizing the techniques of PGD and PrGD prove undeniable in the prevention of suffering caused by life-altering and debilitating diseases or disorders. Such technologies allow for parents to both screen for potential health issues and execute their autonomy in carrying out an informed decision to either preemptively terminate a pregnancy that will undoubtedly cause suffering for a future child, or carry the child to term and embrace the trials, tribulations, and consequences that a disabled or “sick” child brings with it – both for the child itself and for the family of the child. Ultimately, a “choice” in this reproductive freedom implies that there exists the capability to make an informed decision based on options available, future expectations, and the limitations of a current situation. Such a decision, furthermore, allows for affirmation of control over one’s own life, career, education, and family, as in making such a personal decision, individuals are allowed to exert freedom and empowerment in their own lives.
    Conversely, the utilization of PGD and PrGD emerge as ethically deplorable in cases in which such technologies are used to ensure the creation of a child conforming to the cosmetic/aesthetic preferences of the parent(s). As in this case, such advances in technology are, in my opinion, misused, as choosing gender and physical attributes do not aim at the prevention of physical and emotional suffering.

  44. anne volmert says:

    Parents should not be able to decide/design their child’s gender on the basis of justice. Justice can formally be defined as the principle that people ought to be treated the same-unless they differ in relevant ways. One of the primary ethical concerns of such parental decisions is that this technology could lead to a preference of one gender over the other or of particular superficial traits such as hair and eye color.

    The engineering of ‘Savor Siblings’ has ethical issues with regards to the ‘Savor Sibling’s’ rights to 1) autonomy and 2) beneficence. Children genetically designed as ‘Savor Siblings’ my have their rights to autonomy and beneficence are taken away as they are cut open and utilized in the medical treatment of their sibling, without true consent. Utilizing such technologies, therefore, has some serious ethical considerations which, in my opinion, overshadow the potential good that can come out of ‘designer babies’ – particularly because many of the positive ramifications this technology offers remain, at this time, somewhat idealistic and uncertain.

  45. Alex Harkins says:

    If technology has given doctors the power to help fetus’ avoid horribly, painful and life-ending diseases, I feel they have the right and obligation to take action. However, like many topics similar to PGD, we must be careful about how far this technology is stretched and to what means it is used. If used to insure the gender of the baby in order to avoid a disease, it is one thing; if parents decide the baby is going to have blue eyes, that’s another. At some point, ethical issues arise dealing with playing God; some think practicing PGD, if misused, can encroach on God’s responsibilities. Unfortunately, I believe the unethical direction towards more people creating ‘designer babies’ is set and irreversible. However, if used in a proper, moral way, PGD is an incredible step for humanity.

  46. Margaret says:

    The article Professor Nelson presents is a scary awakening to how much we have taken health matters into our own hands and removed the natural forces involved. As it stands, PGD allows the parents to choose if they want to have a baby, have it healthy or not, and what the sex of the child will be. Rather than letting the genes fall where they lie, they have completely taken power away from nature and handed it to the parents. Not being particularly catholic, I think the Roman Catholic Church and their beliefs about natural law have this correct. They reason God intended humans to create life following the moral order of creation, therefore it is the parent’s obligation to maintain any child they create. Yet by placing parents in the driver’s seat, PGD is going against nature and “playing God” by discarding unsatisfactory embryos. Is it wrong for a family to want to know if they will have a disabled baby or not, no. But where humanity is dangerously playing with fire is using IVF and then deciding which desired children will live. Also where is the perseverance of human dignity? If a couple is picking what sex they want, as Professor Nelson said, it again becomes a matter of which sex is more desirable, and thusly profitable to have. By using such techniques as these, we are going against nature, trying to force something which potentially shouldn’t occur. A parent my want a blonde hair, blue eye child, but no matter what it is still their child, and they should take ownership in what they created.

  47. mbpadilla says:

    This is proof that technology has come long way since the invention of ultrasounds.
    Savior siblings, are brought into this world for the sole purpose to save/ help someone’s life and although they were genetically modified I feel like, we would be doing the greatest good for the greatest amount of people if we all perceived the world as savior siblings. Even though the savior siblings will be brought up caring for someone else’s life it does not mean they lose all autonomy it just means that they are leaving a more collectivist lifestyle.

    In all actuality I feel morally torn with the big picture surrounding ‘designer babies’. In one sense I find it almost mandatory for someone to have the option of genetically modifying their baby if the family has a history genetically inherited harmful diseases such as alzheimers, through preimplantation genetic diagnosing. This would satisfies Ross’s Prima facia duty of beneficence, by genetically modifying someone to not have a potential harm in their future. I am still torn on the issue because to what extent will the human population take ‘designer babies’? Will they modify a baby to have all the physical characteristics that the parents want for their child or will they modify the genes that code for intelligence. Its a slippery slope that can go down the same pathway as plastic surgery, where the patient goes to see the doctor for personal reasons not just for medical issues.

  48. Paul Bruno says:

    It is entirely unethical to use PGD in order to select the sex of a child due to the possibility of widespread infanticide if the practice gained larger acceptance. The only grounds in which sex selection would be ethically permissive would be if there was a reason for stopping the expression of a deadly, sex-linked genetic disease. The choice of gender in this scenario would outweigh the potential life-threatening issues associated with a genetic disease. It would be morally permissive to choose the sex of a child assuming that the resulting decision would stop the unnecessary suffering of another child. Although PGD does allow for the selection of “healthy,” non-genetically diseased babies, it also creates a stigma against the current “disabled” individuals in the world such as those people with down syndrome. Although it might create a certain stigma, parents need to consider whether or not they have a duty to present their child with the best chances for success and happiness at the expense of creating a stigma towards a minority group such as those with down syndrome. Also, the issue of cost for PGD also plays an issue for genetic screening since a majority of these genetic diseases are quite costly to families. With the current cost of PGD, it leaves out the majority of Americans without access to this technology which is significant because it is most likely “rich” Americans who have the money for PGD and also have the resources to take care of a genetically diseased child. This brings up the issue of the access to PGD technology for those Americans who would be most affected by the financial implications of a genetically diseased baby.

  49. jcuadra says:

    This article shows us that technology has touched every territory possible. Man kind has always dreamt of wanting to be able to pick and chose what type of child he/she would like to have, and now, it is possible. But can’t we say that we are playing God then? I feel as though the days of excitement and pure joy for having a child have somewhat ceased due to such advancements as these. Parents are now using their unborn child as a tool, so basically using them as means to an end. I do not support this way of thinking because of the strong sense of guilt that I would imagine parents feel in doing this, and if one feels that strong sense of guilt, perhaps it is our inner voice telling us that it is not right. Yes it is possible to argue that you really are saving a life, but the means in how this is done, I’m sure does not sit well in some people’s stomachs.

  50. Alexandra says:

    For the purpose of sex selection, PGD or PrGD appear to be ethically immoral because they have the potential to reverse the progress made for sexual equality or to disturb the natural equilibrium of males and females, if their popularity grows. However, I do believe that prenatal or preimplantation genetic diagnosis is ethically permissible for the predetermination of genetic diseases that would result in death or suffering. PGD could be used in way that would be a discrimination against the disabled, if an embryo had an abnormality that did not affect happiness or health. However, if an Utilitarian rational assessment of a lesser of two evils is made using case by case circumstances and stakeholders’ group not limited to the parents, then PGD can be an ethical good. I believe a decision group of doctors, parents, ethicists would have enough varied rationality to weigh the cost of abortion or embryonic disposal to the cost of a certain disease or abnormality. Also, I believe a Utilitarian greater happiness for society could be achieved because these types of diseases could be slowly removed from humankind’s genetic pool. While I believe abortion is a choice that is immoral in most cases, the principle of double effect would make termination of a pregnancy morally justifiable if PrGD or PGD diagnosed a 100% probability of a fatal or suffering disease. The “bad” effect would be the termination of a future human being, but the “good” effect would be the prevention of a life of suffering.

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