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?

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

  1. HeidiC says:

    This is a very tricky issue because I do see the potential good of screening a baby for a disease so that a child does not have to live to suffer with a disability. The ethics of this issue essentially comes down to if a fetus or embryo is a human being with equal rights as other human beings. If you base the status of being human on the ability to be rational then you could claim that all prenatal and preimplantation is ethical because we are not destroying any human life. However, what kind of a message would this send to people about those already born with disabilities or babies born to poor families with disabilities because the family could not afford advanced reproductive technologies? If PGD and other similar technologies became commonly used, we would start to see a lot of justice and equality issues appearing. Children born to poor families could be considered not as good as children born to rich families because the rich children were selected or had to pass screening before being born and the children from poor families were not. This would cause a large stratification of society and prejudices would become even more apparent.
    In order to solve this issue, we must analyze some of the basic assumptions of these technologies. Are disabilities a bad thing? Is it better for a child with a disability to have never been born in the first place? If we look at this issue from the perspective of the advancement of society, we may say that disabilities are a bad thing. However, ethically I do not think that we can determine which babies are better than others. Since we ourselves are human, we do not have the right or ability to judge other humans because any judgments would be based on social beliefs and values. Therefore, ethically, we cannot use advanced reproductive technologies to pick babies and we must come to the realization the suffering and disadvantage is part of the way the world operates. Any screening done cannot be done with the claim that the ethical thing is being done but instead with the claim that the screening will improve the advancement of society which may be used as a valid reason but it is not based in ethical principles.

  2. onefatrunner says:

    PGD raises some interesting questions regarding how ethical of a procedure it is. To begin the technology itself should not be considered unethical, but rather how the technology is applied. No technology exists that could not be used in an unethical way. PGD is an amazing technology that helps to prevent the birth of children whose life would be limited by a medical condition. The patients and doctors should be allowed to help prevent medical conditions that would cripple a person and lead to distress within the family. However use of this technology must be limited. Though we are not at this point yet, in the future we may be able to use PGD to perform germline gene therapy. PGD should not be used to perform genetic enhancement on future generations as it takes away a piece of humanity. It could lead to discrimination of people with certain traits in the future. Another unethical use of PGD would be to select the gender of the child purely because the parents want a boy or girl. This is unethical as it implies that one gender is more desirable than the other. The use of PGD should be limited to medical purposes only. Anything further would lead to an abuse of the technology.

  3. Zac says:

    I do not think that it is ethical to determine the sex of your baby. Its messing with something natural, and doing so for selfish reasons. I do not have issues with preventing diseases that would render most to lean unhappy lives. People should not need to get into the business with messing with nature in ways that are not needed, or that are not preventive of anything bad.

  4. NateMay says:

    Beginning with question 1, I agree with the article’s position that using PGD to select sex is at least morally questionable. There is simply not a medical benefit for selecting the sex of your child, besides the case of a deadly or incurable sex linked characteristic, however, I am not sure if we should restrict PGD use to just medical reasons. I strongly believe in autonomy, and preventing a family from shaping their family the way they want – a boy and a girl, two boys, three girls, whatever they choose – troubles me a bit, we don’t prevent how many children people can have after all. However, the possible impact of gender preference worries me, although our society has made great strides in our views on gender, I could see how the introduction of PGD to select gender could greatly reverse that progress. Overall I don’t think I can pick an ethical side on this question, which to me warrants its exploration until its true impact can be seen.
    On to question 2, I do believe PGD does reinforce a negative and oppressive message towards existing disabled people, however this is not an entirely negative thing, it is an unfortunate side-effect of the rise of PGD popularity. My first reaction to this was to think about putting ones-self into the life of a heavily disabled person, would you not wish to have your body and mind back? I thought, why wouldn’t the heavily disabled? The counterargument is of course that they are happy the way they are because it made them who they are, and that society largely exaggerates the “burden” on themselves and their families. But why wouldn’t we “want to provide everything science gives me to [our] patients” to make sure no person, no child has to have limited opportunities or suffer pain? It is every parent’s responsibility to take care of their child no matter their condition, but I believe in autonomy, that every parent should be able to prevent disability if they want, society shouldn’t prevent this.
    Continuing on to question 3, I completely agree with Dr. Steinberg, who I quoted earlier. I strongly believe in the technological imperative, that if we have a technology we have a moral obligation to use it for the betterment of our world, so therefore the positive possibilities of PGD absolutely warrant use by doctors to do their job, to heal and prevent suffering. We should not hinder our scientific pursuits because there is a possibility of misuse or morally reprehensible outcomes; it is against the exploratory spirit of science.

  5. Nathan Yung says:

    1. I personally side with the people who would like to balance their family and sexual selection may be a way to do this. I also would like the sex of my child to be a surprise and find out what fate has decided. I think that sexual selection is the expression of people’s hopes for their own ideal family and I am ok with this as long as there is no overall societal drive for one sex over another.
    2. I do not feel that there is a definitive correlation between wanting the best for your children and oppression and prejudice against the disabled. I would not want for my child to develop Huntington’s Disease or any other genetically linked disease. I will continually support medical research in all fields to help alleviate the problems that these that these patients have. There are still discrepancies about how the handicapped live their lives and until the entire populace is aware that they live equal lives to people without any disabilities then there is a difference in how these two populations of people live.
    3. I agree that as a physician he should not be a filter for his patients and offer all the services he can to assist in the patients own choice. However, if society deems certain applications of science to be unlawful then those services should not be offered. Dr. Steinberg is operating within the law and offers a service to his patients. Until a service becomes unlawful it can be offered and this is what Dr. Steinberg is doing. Just because we can do something doesn’t mean that society has deemed it acceptable.

  6. Jeff Langdon says:

    1) Gender selection is under normal circumstances, an unethical decision because the motivations behind the decision are of utmost importance. As a decision, gender selection shouldn’t be taken lightly. I think a situation in which it would be ethical to gender select could be a ‘desert island’ scenario in which there is a small population that will only get smaller unless more females are created. However, this is such an improbable situation, I hardly deem it relevant. To me, it seems as though Gender selection is a further attempt to seize control from God’s hands, that is, we want to be the controllers of our destiny and our children’s destiny. This is of course, comes from culturally being an American, but I don’t think it’s necessarily a good thing.
    2. I think PGD certainly can further increase opposition to disabled people, although I can understand not wanting to bring a child into the world who will suffer from a disease, who are we to judge that their life isn’t one worth living? It’s a call that I don’t believe we have the authority to determine.
    3. I disagree with Dr. Steinberg’s reasoning on the basis that not everything that science gives is 1. good. 2. should be given to everyone, and 3. I question whether or not he has pure motivations. The responsibility of a doctor is to heal patients, not to create super humans. He is overstepping his role as a doctor, even though he has the ability to do so.

  7. Jonathan Ang says:

    1. It’s conditional. I think it should be fairly obvious to most people that selecting for or against a debilitating condition, e.g. Tay-Sachs, is of much more import than selecting for a particular sex in an embryo, but even so, there are good cases in which I think allowing for a couple to select for sex is ethically permissible, and even important. The example in one of the texts about using PGD to determine sex early on as opposed to waiting, and then abandoning the child if it’s a girl, in certain communities seems to me to be a good case of when this would be ethically correct.
    2. I don’t think it personally affects me in that way, but I can’t say without searching for statistical surveys that indicate one way or the other. A better framework I think would be “What are your views on disability? Obviously it varies from disability to disability, but in general, do you think being disabled in some form is as disabling as one might think? Or, in other words, do you look down on persons of disability for the simple fact that they are disabled?” Does PGD in and of itself dictate how I think of such people? No. Are we taught by culture and by socialization to overly pity the disabled? Perhaps, and that is an interesting thing to ponder. Would such a mindset lead us to oppress and act with prejudice against the disabled? I don’t know. Again, personally, I don’t feel that I act negatively against persons afflicted with a disability, but it is something that I am willing to say is possible at the systemic level.
    But maybe I’m wrong; maybe the question is simpler to answer than I thought. Maybe the fact that PGD exists primarily to screen for fatal genetic diseases by itself tells us that we as a population are afraid of genetic disorders that lead to death, and further, that we’re afraid of being affected in such a way ourselves. Individually, then, it makes sense to want to use science to eradicate disability from the human gene pool. And then, of course, it makes sense that the claim that societies systematically oppress persons with disability is already valid. Then, in this sense, yes, PGD would reinforce such a message.
    3. I don’t completely agree with his statement. The answer is rather obvious. People may not want what’s best for them. For example, say there is a young woman who, for whatever reasons, is quite irresponsible sexually, and thus requires abortion of perfectly healthy fetuses quite frequently. Should the doctors allow it? Legally, yes, perhaps they should. Science and medicine have provided for the technique, and it is indeed quite alright for the patient to request the procedure. But socially, is it alright? It seems to me that placidly providing such services is a sort of acceptance for her behavior, that she shouldn’t think seriously about the concept of relationship, and that society is okay with it. That barring her having been repeatedly raped, it is okay to disregard the consequences of numerous unprotected sexual encounters. Yes, it may be “okay,” but it seems to me to be quite self-defeating for the society to accept such behavior.
    Perhaps that was a terrible example. Another one: Let’s say there is a young man who is quite depressed, although otherwise healthy, who wants to commit suicide. Should it be permitted to him at an assisted suicide clinic? No! The science is available, but it should not be provided to him.
    So there are cases where patients should not be provided with all of the available procedures that science can offer. The patient may not need the service, and by providing it the doctor is acting unethically for their own financial gain, or the service may itself be unethical in the given conditions.

  8. Katelyn says:

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

    I don’t think it is ethical to use PGD to select the sex of a child. I feel it is an abuse of a technology that should be used for prevention of disease. This makes me wonder what is next and what gives us the right to pick and choose what kind of child you can have. I wasn’t designed to my parents’ preferences, neither was my generation and all generations before mine. The human race has survived, parents have survived when their child did not have the sex they wanted, or eye color, hair color, even intelligence they desired. Sex selection raises issues of access. PGD is expensive and not covered by health insurance. Poorer parents who might want to use this technology cannot because of cost. The misuse of PGD furthers the gap between rich and poor: not only do the rich have more money, advantages in society, and better opportunities to move upward than the poor, but they can now design their babies as well. This is not right or just. Wealth is not an ethical criterion to exclude and separate groups from the other. However, if sex selection via PGD becomes commonplace, the rich will be completely excluding the poor, not only based on wealth, but on the genetics of their children as well.

    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”?

    PGD, for me, is ethical problematic. While the potential to prevent disease is great and a wonderful aspect of this technology, it makes me ask: should we even be doing this? Eugenics has been prevalent in cultures throughout the world with the desire to eliminate a certain trait, race, or disease from a society under the guise of betterment of the culture or for the common good of society at large. PGD can easily be put into this category. Eliminating disease and disability by refusing to implant embryos with the genetic causes can be viewed as necessary for the common good, after all no one wants to have a disabled child, and a scientific advancement. It truly is increasing, however, the negative stigma that disease and disability has in America today. There is no better way to discriminate or exclude a group from functioning society than to ensure they are never born to begin with.

    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?

    Just because we have the ability to do something does not mean that we should. I have the technology available to me to kill, steal, and so on, but I don’t employ it just because I can; that would be reckless, irresponsible as a user of technological artifacts, and ethically wrong according to utilitarianism, it does not promote the greatest amount of good and has negative consequences. In the same way, just because science has created a new reproductive technology does not mean it should be readily available, offered, and used. I believe that Dr. Steinberg is ignoring the hippocratic oath he took when becoming a doctor: first, do no harm. PGD for disease prevention can be justified through this doctrine: by not implanting diseased embryos, the doctor is preventing the harm that could be done to the future child as a result of the disease. However, sex selection by PGD places undo harm and expense on a family for a seemingly unnecessary procedure. First, sex selection is not 100% effective yet. This means that there is a possibility a couple can pay a lot of money for a girl using PGD and actually a male embryo implants and develops. Then the couple faces a difficult decision: abort the embryo because it wasn’t what they payed for or raise a child they obviously did not want/expect. Second, the collection of oocytes and implantation after IVF is extremely unpleasant for the mother-to-be. Putting someone who does not need the procedure (i.e. who is fertile and in no need of assisted reproductive technologies) is causing her undue harm. IVF as well is not 100% effective and could be putting the mother-to-be through pain and extensive hormone treatments for no result, no implantation, no baby. Dr. Steinberg needs to reassess the oath he took and look at his priorities. I don’t believe he does this procedure for the satisfaction of helping people, but is employing and advertising PGD because it is expensive and a lucrative business to be in.

  9. Amy Munekiyo says:

    PGD certainly raises huge ethical concerns. The most troubling to me is in regards to how physicians, institutions, and society can control the difference between using PGD for therapeutic rather than eugenic purposes. Dr. Steinberg’s statement pertaining to new scientific technology and access to patients should raise some red flags. I don’t believe that just because physicians have the scientific means, they should be providing new technological advances to their patients. Developments such as PGD should require us all to stop, slow down, and think about the ethical and moral issues surrounding open access to the science. It shouldn’t be a foot race to see who can provide the new science the fastest.

    Using PGD purely as a means to select for the sex of your child seems unethical to me. However, if therapeutic reasons are guiding the decision of the parents (for example a deadly recessive disorder runs in the family) then allowing PGD along with extensive genetic counseling may be the best possible option for the parents.

    Thus PGD could be offered to couples who have an elevated risk of having a child with a genetic disease. Would it be ethically appropriate for PGD to be used as a means to avoid a future onset of Alzhemier Disease, what about Huntington’s Disease or Tay-Sachs? This becomes a “quality of life” issue. Tay-Sachs is an autosomal recessive genetic disorder typically resulting in death before the age of four. I understand a parent’s concern in wanting to use PGD for therapeutic reasons as an effective way to screen against diseases such as Tay-Sachs. Tay-Sachs disease is both deadly and has an extremely early onset with debilitating symptoms. But should PGD be used for diseases that have a later onset of symptoms? For example, individuals don’t develop symptoms of Huntington’s Disease (HD) until their forties. Thus should PGD be used to screen for HD even though patients with the disease live a “quality life” into their forties? Where should the line be drawn? And how do individuals, institutions, and society define “quality of life”? I personally feel that it is ethically appropriate to offer PGD to couples who have a chance of having a child with an onset of a genetic disease which is both untreatable and the newborn baby WILL CERTAINLY develop in the future. I do not feel it would be appropriate at this time for couples to use PGD as a means to “screen out” against risk factor genetic diseases.

  10. Maija Swanson says:

    1. No. Although I do believe that PGD can be appropriate in cases where the procedure is preventing the child from having a disease that will severely impair his or her quality of life, I do not believe that is acceptable to use this technology to screen for the sex of the child. PGD should only be used when there is a high risk of a life-threatening disease, not because a couple wishes to have a boy or a girl. Even in the case where the family is trying to prevent a sex-linked trait, the screening should be for whichever embryos do not have the disease, not whether the child will be a boy or a girl.
    2. I understand the view that preventing the birth of more children with disabilities will greatly shrink the disabled population and perhaps make them seem even more rare and unique, but no parents want to give birth to a disabled child when they have the option not to. I have a friend who suffers from Tourette Syndrome and although he has an extremely mild case of it, he has absolutely no desire to have children unless he can ensure that they will not inherit the disease. I believe that if we can prevent more children from suffering from these diseases, it is a good thing, even if the population of people with that ailment shrinks. I also believe that the disabled community will not be discriminated against more than they already are. As their diseases become rarer, they will be admired as the strong few who have fought through their disease to lead as normal a life as possible.
    3. I disagree with Dr. Steinberg. His idea of the basis of medicine seems to be to offer to his patients whatever procedures technology is capable of even if it has nothing to do with their health or quality of life. As a person who wishes to eventually become a doctor, I understand the purpose medicine a bit differently. Medicine is meant to help those with an ailment and cure their disease or illness. Medicine can also be preventive in some cases, but “preventive” does not include providing people with the option to choose the sex or eye color of their baby. There is nothing about having blue eyes that will make them any healthier than if they had brown, nothing about being a boy that is better health-wise than being a girl. Medical procedures should be used for medical purposes only.

  11. Sarah Ghanbari says:

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

    Preimplantation genetic diagnosis is a powerful tool and should not be abused. It should be used for medical purposes and not to select the sex of the child or other cosmetic features. By allowing parents the opportunity to select the genetic traits of their children, parents will build certain expectations and if the child fails to meet those expectations, strained relationships within families can easily be created. It is fair for parents to try to provide their children with the best health opportunities, but designing children based simply on preferences for a certain trait should not be encouraged. Instead, parents should celebrate whatever sex or qualities their children are blessed with.

    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”?

    I believe the argument about PGD negatively affecting the disabled is accurate. In today’s society, the disabled are not seen in the highest regard, although it may be better than before, but it is still very likely with this technology that the situation could worsen. However, I also believe everyone wants their child to have the best opportunity for success in the future. No matter how accommodating a society may be, no one would really want their child to have serious disabilities. Consequently, if it is possible to avoid that, parents shouldn’t be denied that access. Of course, it will remain important to increase efforts to protect the existing disabled population from discrimination, but I do not believe it is fair to deny future generations the chance to avoid the complications.

    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?

    Just because the technology is available does not mean it is ok to use. A doctor’s responsibility is not just simply to follow whatever the patient requests, but to always ensure that the best possible decisions are made. This is not only in regards to the patient’s health, but also the family’s health and society’s health. This means that the ethical implications of each treatment must be assessed as well. Allowing parents to design their children puts great and potentially false expectations for their children to look and behave a certain way. Such tensions should not be given the opportunity to form when there are little benefits to be gained.

  12. Lauren Simas says:

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

    It is ethical to select the sex of your child when trying to avoid x-linked diseases in male offspring. I think this option is much more ethical than aborting a male fetus that is confirmed to have the disease. I definitely think that it is unethical to choose the sex of your child based on personal preference. On a large scale it could throw the global sex ratio off balance. On a small scale, the scope of human perceptions within a culture could shrink. For example, if the stereotype of an older brother protecting a younger sister became overwhelmingly desirable, eventually the experience of being an older sibling would be lost to women. Also, the patriarchal idea of men taking care of women would be strongly reinforced.

    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”?

    I think that depending on one’s personal experience and viewpoint, these arguments could offend a disabled person or a person familiar with disabled persons. However, the way I understand it, PGD to prevent disease/disability is presented as a way to reduce human suffering overall. I believe that a person’s view about the disabled in general and the ability to save a child from a lifetime of suffering are two different issues. Choosing to abort a disabled fetus for the simple reason of not wanting to raise a child with a mild disability is unethical, but preventing a genetic disease that would end in childhood death or only surviving long enough to experience pain is ethical in my opinion.

    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 do not agree with Dr. Steinberg for many reasons. First, this technology would be limited to rich patients and further the socio-economic gap. Second, choosing “appealing” traits is merely reflecting the “perfect” image provided by society and media; in essence, the image media is portraying at the time would be reflected in the incoming generations. Third, choosing a hair/eye color implies that the parents would love a child with these traits more than a child with traits generated by genetic recombination. Lastly, designing above average children would result in parents putting unfair pressure on them to live up to their genetic potential.

  13. AWong1 says:

    I do not believe that it is ethical to use preimplantation genetic diagnosis (PGD) to select the sex of a child unless the sex-selection is strictly used to avoid the inheritance of an X-linked disease. I think that sex-selection (for non-medically related purposes) is unethical for two main reasons. The first reason is that it values one sex over the other. In a world where there is already a lot of evidence of gender inequality, it would be unfortunate to let gender inequality influence a child’s first impression of the world. It is also concerning that placing value on one sex over the other may also place extra pressure on the child to assume the socially constructed gender that is commonly matched with the child’s biological sex, even if that is not how the child wants to identify itself. The second reason why I think that sex-selection is unethical is that it places value on one type of family dynamic over another type. I personally know many people who come from families that vary in the number of males and females, but I do not know anyone who would readily trade their family dynamic and experiences for another one, at least not for reasons related to the male to female ratio. As someone a girl who grew up with only one sister, I do not feel cheated out of having a brotherly experience at all and I definitely would not choose to change my family dynamics, even though I have friends that are happy in their 1:1 male to female ratio family. Thus, I am not really convinced by the “family balancing” argument. It places value on a standard family dynamic that cannot be proven to be better than any other family dynamic. I do, however, believe that it is morally permissible to choose a female baby if there is a risk of inheriting an X-linked disease. I make this exception with the understanding that the symptoms of the disease are very undesirable and that the child will have a lower quality of life to begin with in comparison with the other embryos that could be chosen using PGD.

  14. Nikkie Tomblin says:

    1. Personally, it depends on the situation as to why a parent would want to select the gender of their child. If two parents carry the genes for a sex-linked disease and are afraid of passing it down to their child, then of coarse it is alright to give them the opportunity to choose the sex of the child that will not inherit the disease. Again, it depends on the severity of the disease that the couple is afraid of; for example, Klienfelter’s Syndrome or Muscular Dystrophy are acceptable diseases to select against. However, if parents are afraid that their genes will produce a bald son and that is the driving force behind wanting a daughter, than that is not acceptable. Even if we allow parents to choose in acceptable circumstances, I will always be hesitant to fully come to terms with allowing the choosing of gender. Mother nature has worked in odds and chances of having boys or girls. I admit, this would be an extreme situation and would take a lot of meddling on our part, but I am afraid that people would choose too many of one sex, and soon we would be overpopulated with one sex and not the other. Life needs a balance, and that is why mother nature factored in percentages and chance. If we take that power away from her, it could be difficult to keep the balance in tact. I would hate to be the doctor telling a family that they can no longer choose their baby’s gender because too many other families choose girls, or for them to be forced to have a gender because everyone before them took advantage of the situation.

  15. Shilpa Narayan says:

    1. Although PGD can be very useful for detecting and avoiding life threatening diseases I think it is morally wrong to use it for sex selection. I believe that despite the reason an individual or family has for choosing the sex of their child the problems it can cause outweigh the benefits. Once people are giving the ability to choose the sex of their child the are automatically putting a value on gender. By making a chose the parents are saying that one is better than the other. Like Prof. Nelson stated gender is not only determined by biological but by the environment as well, so having a gender of your choice may not guarantee you the characters you wish your child to have. By choosing the sex of your child you are already passing judgment on that child and taking away their freedom to be whomever they wish to be and that is morally wrong.
    2.I find the arguments the disabled are giving against PGD very interesting because I do believe that in society there are traits which are considered “normal” or “desirable” and people tend to discriminate against people who do not carry these so called “desired” traits. PGD now gives us the ability to potentially rid society of certain unwanted traits which in turn will slowly lessen the disabled population if not one day totally wipe them out. The less disabled there are, the more they will be outcast and ridiculed. So I understand where the arguments of the disabled are coming from however I do believe most parents are looking at the health of their child rather than how they will fit into society.
    3. I somewhat agree with Dr. Steinberg’s reasoning. I agree that as a physician he should want to go to all necessary means and provide the best opportunities that science and medicine has to offer to his patients however I feel that there should be limit on what he gives to his patients.Just because everyone wants everything and wants to give as much as they can doesn’t mean they all should. There are ethical and moral limitations on what should be given out, especially when it comes to something so important as health care. Not all advancements and scientific inventions created should be offered and used, there are moral/ethical implications with everything and these should be taken into account first before being dealt with patients.

  16. betsy2021 says:

    I think the widespread use of PGD is something that deserves a much closer look before it is introduced as a normal, routine process. Being able to sequence the genome and identify the location of certain genetic diseases is an incredibly valuable discovery, however, it seems as though we have lost sight of its potential as it has given the opportunity to avoid disease altogether. Sequencing the human genome gives the opportunity for more in depth understanding of certain diseases and development of successful treatments as a result of that understanding. The use of PGD for gender selection is just one more example of how PGD is used to play god. Just because we have the technology doesn’t mean we have the right to use it. While it could help prevent the birth of children with sex-linked diseases, but many people will most likely use it to pick which sex they would rather have. This has the potential to change the population ratios of gender, which could lead to many more problems down the road, including social injustice and gender inequality.
    Using this technology to avoid genetic diseases sound like a romantic idea, however, the potential for social issues is enormous. By finding out before your child is even in the womb whether or not it will develop a disease may prevent suffering, but at what expense? Avoiding conceiving children with disease shows that there is obviously something wrong with people with disease or disability. If we avoid having children soley because they are sick, are we saying that a disabled life is one that isn’t worth living? Are people who have CF not worth while because they could die at a younger age and have more medical needs? What about people who can’t afford the technology and have kids with disease, does that make them a “lower class.” I think that offering widespread use of PGD has an enormous potential to create divides and conflict in society that would be greater than having people with disease, and using the genetic information to develop more successful treatments.

  17. mynakamoto says:

    1.I don’t believe that it is ethical to use PGD to select a child’s sex, unless it’s for medical purposes. I agree, like many others, that it is ethical to use it to prevent bearing a child that will have a serious fatal disease – for it would be in the best interest of the child – but I don’t think that parents having the ability to pick whether or not they want a boy or a girl just so they can balance their family is ethical. As the blog stated above, it could allow for the active selection for (and possibly result in the discrimination against) one sex over the other; in a society that heavily prefers one sex over the other, this could be disastrous. Besides, shouldn’t we love our kids unconditionally regardless of what sex they are? It just makes me uneasy to think that we can decide these things about our children now, granted that we have the money. I think that the people who are seriously considering sex based selection of their child should in the least be counseled and educated on the issues surrounding the matter.

    2. I personally don’t feel that PGD reinforces a message that negatively affects existing disabled people and fosters an increase in the oppression and prejudice that they already suffer. In general, I think it’s pretty safe to say that if given a choice, people would rather have their kids (and would rather themselves also) be not disabled rather than disabled. It’s a simple matter of being able to live a normal life. That, however, is not to say that the lives of the disabled are any less valuable or worth any less than the lives of the non-disabled. Each person, disabled or not, has many things to offer the world. I don’t feel like choosing for non disabilities in children has anything to do with people who are already disabled.

    3. I don’t agree with his reasoning in the way he put it. I do, however, agree with Dr. Caplan that if people are given those options to genetically engineer their children, then they must be counseled and exposed to all the matters of the situation (as well as both sides of it) so that they can make an informed decision. I honestly don’t know exactly how i feel yet towards scientific progress and offering the latest of it (regardless of whether or not it passes the ethics test yet) to the general public; i stand torn as an economics major. I do understand though how powerful these new technologies are, and how a series of uninformed bad decisions can lead to something catastrophic.

  18. Gaby says:

    I don’t really agree with the use of PGD. The more I learn about PGD, the more I ask myself – where is our humility? I know that many people disagree with me because PGD can not only be used to design children (physical traits), but it can also be used to prevent having a child with specific diseases. In addition, PGD can also prevent many parents from experiencing emotional pain and suffering. However, by adopting such technologies, who are we really trying to keep from pain and suffering – the children or the parents? We all know that people with disabilities have greater struggles to face in life, but we also know that it takes extra care, extra love, and extra patience from parents to raise children with disabilities or diseases. My question is – what are we really trying to prevent? I think that PGD is just another way for parents to save themselves the trouble of having to take extra care of their children. I mean who are we to decide who lives and who dies? How can we just discard embryos without stopping to think that they have the potential to be autonomous human beings? I just don’t think it’s fair for us to judge what it means to have a good quality of life, and we definitely do not have the right to choose physical characteristics for children (why do we even prefer certain physical traits over others anyway if we are all uniquely beautiful?). I think we do not have the right to choose what’s best or perfect in this world because we are all different, and each difference has its own value. We have heard so many inspiring stories about people with disabilities conquering things that normal people don’t have the courage to even try, and we’re still trying to use PGD to choose against such strong people? I know a child that has Down syndrome, and I cannot ever think that his life is of less quality or worthless. On the contrary, he is able to brighten anyone’s day with a smile – he’s adorable. It would have been a tragedy if his parents had chosen a normal child over him! I think we need to become more ethical human beings; we need to be courageous and accept what life brings us despite the consequences.

  19. Victoria Rossetti says:

    1. I think that the only situation in which this is ethical is if the diagnosis is used to prevent a seriously harmful or deadly sex-linked disease. For example, I think that using PrGD to prevent the birth of someone with a severe immune deficiency is both fair and ethical. The couple may not necessarily even terminate the pregnancy; they may just use PrGD to better prepare for raising a child with the disease. However, I do not think less serious disorders such as color-blindness should be a reason to select the sex of your child. In contrast, I think it is absolutely unethical to use PrGD to select the sex of your child solely for the purpose of what gender you “prefer.” The cases of wanting to achieve gender balance in a family or a preferred birth order are not preventing disease but are superficial reasons for PrGD.

    2. I do see some validity in this point; using PGD to prevent the birth of people with certain disabilities does imply that they are less desirable. However, regardless, I think that people have the individual right to choose whether or not they have a child with a disability. Again, I think it is fair to prevent bringing a child into the world that will undoubtedly face serious health problems, pain and suffering, or even a shortened lifespan. I think preventing this suffering is of more value than protecting the disabled from degrading or negative messages, especially when there is no solid evidence that this even occurs.

    3. No, I do not agree with Dr. Steinberg’s reasoning that because something is available in science, he should provide it to his patients. The sciences of performing abortions and euthanasia are available, and these are highly controversial issues in our society. I do not believe that doctors are just meant for the service they provide but should impart some judgment on if what they are doing is ethical. Of course, doctors should not try to sway a patient’s opinion or encourage any type of procedure. But a doctor should be aware of when a new technology or science has ethical implications.

  20. Lilliana Gonzales says:

    1. The use of preimplantation genetic diagnosis to select the sex of your child is ultimately unethical. Generally speaking, the population of the world is equal. However, in some countries the goal to have one gendered child over another is highly desirable. If PGD gave parents the right to chose which gender their children will have, then women and men populations would begin to become unequal. This leads to problems with furthering human populations past a certain number of people. Moreover, by being able to select the gender of children, parents are essentially saying that one gender is more important than the other. This seems to be backwards because in American society we are very focused on projecting the importance of equality and celebrating differences. Ultimately, gender selection via PGD is hypocritical of what we teach our children about equality.

    2. I feel that by being able to determine at the fetal stage of life using PrGD for disease and disabilities can reinforce prejudice/oppression that affects disabled people today. By not having children that have been proven by PrGD to be positive for disease, we are saying to society that it is not acceptable to have disabled children. Additionally, we do not have the right to determine if one’s life–even if it will be harder because of disability–is theoretically worth not being born and given a chance.
    3. I disagree with Dr. Steinberg’s statement that because we have a technology, it must be put to use. I feel that medicine should be used to cure aliments and provide people who suffer with disease a sense of comfort. Dr. Steinberg’s statement sounds as if he will play god for patients who have the means to pay for desirable genetic traits. When doctors begin to provide this sort of treatment for patients who do not a have a direct reason for concern that their children will be born with a genetic disease, we begin to move into the idea of a GenRich society. It is important that we focus on helping people with debilitating genetic aliments before we being to change our children into something that we feel is perfect.

  21. Allie Hart says:

    1. I think it is wrong to use PGD to determine the sex of potential children. I believe this technology should only be used when parents are at risk for passing on a life threatening disease or for generic prenatal screening and testing. The only exception to my statement may be for X-linked diseases, but as far as I am concerned, if these diseases aren’t fatal, then we have no business in trying to control what sex we want our children to be. Science sometimes gets in the way of natural processes and I can’t believe it was ever intended for us to create designer children-that’s missing the point of part of the joy of pregnancy.
    2. I don’t think PGD is discriminating against or having a negative impact on handicapped/disabled people. I believe all of the people who had a certain disease or disability would jump at the chance to be able to fix whatever was wrong if they could. We aren’t saying anything negative about those in our society who do suffer from diseases we are now trying to fix, we are merely saying there’s a way to stop it and we want to prevent that suffering if at all possible. It is for the common good of everyone.
    3. I agree with Dr. S’s reasoning. As a physician, I believe it is his duty to provide and explain all of the technologies available to his patients even though I may not agree with certain uses of the technology. I think it’s up to us to stop PGD or to at least rise enough questions before it gets out of hand in regards to designer children. That’s when, as far as I am concerned, things have gone too far.

  22. Brenda Everling says:

    I think that the use of PGD to select a child’s sex is ethically acceptable when it can prevent the inheritance of a sex-linked genetic disease just as it could be used to prevent other serious diseases. However, I don’t think that the child’s sex should be chosen simply for personal preferences since it implies that one gender is better than another. The idea that it is acceptable to use PGD to select against a disease brings into question the possibility of selecting against any disability. I don’t think that every disability should be selected against since many people with disabilities have created their own culture and lifestyle which would be devalued by elimination of embryos carrying the disability genetically. However, I believe that fatal diseases can be selected against since doing so would provide the child with a greater opportunity for a full life no matter what style or culture the parents choose to bring him or her up in. Similarly, I don’t think that the parents should be able to select for a specific disability, deafness for example, in order to bring up their child in the same cultural environment since the child would have no choice in the decision whereas with other cultural aspects, such as religion, a child may choose not to follow his or her parents’ decision. In general, I think PGD is a valuable tool to combat fatal diseases, but that it should not be made widely available as a way for parents to select personal characteristics for their child. The potential uses for any new technology need to be fully understood before they are implemented.

  23. Sarah Mathes says:

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


    I believe that it is only ethical to use PGD to select against embryos carrying X-linked diseases that would bring undue harm to the child if he or she were to be born. I do not think it is appropriate for couples to choose PGD for any other reason—family planning, choice of physical characteristics, etc.— because it not only discriminates against those who cannot afford it (which, at this point, is a vast majority of the population) but also leads to a very scary future if universalized. If all couples were allowed and able to choose the gender of their children, the natural ratio of men to women would be upset, causing huge problems—reproductive and otherwise.

    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”?


    While I think PGD would be a great tool to reduce the prevalence of debilitating diseases, I think it does indirectly reinforce a message about the disabled that increases the oppression from which they regularly suffer. Every time a choice is allowed to be made, by nature of the choice itself, you are allowing one side to hold more value and consequently devaluing the disability. As fewer people have disabilities that are able to be selected against, the remaining individuals who do have these diseases would evidently come from families who may have been discriminated against in a different way, perhaps from an inability to pay for the procedure, as it is not covered by insurance. Furthermore, those who have diseases that are not yet able to be selected against would be “pushed down the totem pole” and further oppressed because their disease may not be prevalent enough to test and yet they have to live in a world of disappearing disabilities and growing prejudice.

    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—as well as his attitude that physicians can and should be transparent facilitators of the procedures developed by other scientists. If Dr. Steinberg sees his role as merely carrying out any and all tests that “science gives him”, then it may as well be in a direct-to-consumer format. Because technology develops at a rapid pace and is inextricable from the realm of science, every person—a stakeholder, of sorts, even if they are not directly “receiving” the treatment or procedure—has a moral obligation to ethically evaluate the technologies becoming available to the public.

  24. Tatyana Alfaro says:

    I do not believe that it is ethical to utilize PGD by means of selecting the sex of your baby. A fetus is a developing human being that does not have a moral stance or any ethical sense, so it should not give someone else the right to determine if the child will be female or male. PGD should only be used when determining whether or not the baby carries a fatal genetic disease. By doing so, it gives the individual the opportunity to live a longer life. PGD does in fact carry a negative stigma toward the disabled community however a parent will do what is in the best interest of their child. The last thing a parent wants is to see their child suffer. By no means, should we eliminate the disabled community because they are human too. Just as specific traits and races have been subject to elimination and discrimination, the disabled community should not be a part of such abuse. Disabilities provide insight and shed light on development, genetic variants, gene markers, and the human as whole. Therefore, a disability should not be seen as something negative. People tend to veer away from what is “abnormal” or “different.” But who is to say what is defined as being “normal?” Different traits, race, disabilities, culture, diversity are all components that make up society and add to how we as humans interact, function, and behave. By eliminating a component, we take away a part that makes us up as a whole. I do not agree with Dr. Steinberg because, although technology is advancing does not mean that we should use it. There are circumstances in which the technology is beneficial, but it should not be abused to accommodate a parent’s preference.

  25. Jared Lumpe says:

    1. In the case of trying to prevent serious sex-linked diseases, I’d say the answer is a very obvious yes. Barring that, things get a lot more complicated. I definitely don’t think it makes you such a bad person just to want to have a girl over a boy or vice versa. I think many people envision an “ideal” family consisting of say, two boys and a girl, or something similar. This does not necessarily mean you are some kind of sexist or enforcing stereotypes. However, I think choosing the sex of your child runs into the exact same problems as does choosing your child for any other characteristic that does not have a huge effect on their health or well-being. When having a normal child, you may hope for the best but ultimately have almost no idea how your child may turn out, hopefully the parents will still love the child no matter what. The more control we allow people to have over a child’s characteristics, the more expectations I think they will have of that child and the more they will be disappointed when it doesn’t turn out like they expected (which it never completely will). I personally don’t think that simply determining the sex would be very bad in most cases (many couples already know the sex of their baby before birth, and that gives them plenty of time to form unrealistic expectations of how their child will conform to gender stereotypes), but I think just starting with sex determination leads down a slippery slope with no clear stopping point. As I said the more control parents have the more unrealistic and potentially damaging their expectations become. I don’t think there’s a single trait you can just pick out and say that’s the farthest we should go, so we have to semi-arbitrarily draw the line somewhere. Although I said sex predetermination is probably not all that bad in most cases, I can’t think of a good reason why it’s very necessary either. It’s ok to want one sex over the other, but you should love your kid and treat them the same no matter how they turn out (unless they’re like a serial killer or something). Because of that I think we should just be consistent and not allow any selection for or against any attributes that do not significantly affect the child’s quality of life. But I guess if you think embryos are fully morally equivalent to human beings then this is all a moot point anyways.

    2. This is an argument I’m getting quite tired of. Assuming we’re at least talking about serious disabilities like deafness or mental retardation and not something like having an IQ ten points below the norm, stating that a disability has a negative on someone’s life in no way implies that people with disabilities are somehow inferior as human beings or that their lives are worth less than ours. I’m sure most people with disabilities can still go on to live completely happy and fulfilling lives despite of them. But if tomorrow we heard that one of our classmates was in a car accident and was now a paraplegic, I don’t think we’d all shrug it off and say “Oh well, I’m sure s/he’s still a human being deserving of our respect and is perfectly capable of living a fulfilling life anyway.” While that may be true, given the chance I know we all would have done anything we could have to stop that event from happening. Trying to prevent these disabilities in no way makes any judgments against the actual people who suffer from these conditions. In fact, I would go so far as to say that if the technology is readily available it would be seriously morally irresponsible not to screen for serious disabilities.

    3. I’ve been nonsensically rambling for a while because it’s 3 am and I’m still doing homework, so I’ll keep this one short. As a doctor, you have the responsibility to use all resources at your disposal to ensure your patient’s continued health and well-being. In no way does this cover things like eye or hair color. Period. In fact, it would be very irresponsible of you to waste their time and money screening dozens of embryos for such trivial attributes without at least making sure that it is absolutely important to them (which is still kinda creepy if you ask me).

  26. Dr.Mayahi. says:

    Nowadays, advances in medical technology mean that it is possible for a couple to choose the sex via preimplantation genetic diagnosis. Some people believe this technique should be made available for all couples who wish for it, so they can have a child of the sex that they want what is your opinion on this question?

    There is a current contentious argument over whether the preimplantation genetic diagnosis should be available for all parents to select their baby gender. I totally disagree with this opinion because this kind of procedure led to an imbalance in society and could be misused.

    The people who support the benefits of preimplantation diagnosis put forward some relevant points to make their stand clear. First and foremost, preimplantation diagnosis allows a couple to avoid specifically related gender diseases. This could be very beneficial to the longevity of their child. One good illustration of this is Rett Syndrome which is an inherited disorder occurs in female presented with problems with various types of brain function – from emotional and behavioural issues to cognitive challenges. Another advantage of in vitro fertilization is that it can help single women and same-sex couples to choose their dream baby girl or boy. For single women or same-sex couples who wish to have a child, IVF with PGD can provide a great opportunity for helping them to become parents. For instance, Jodie Foster and her girlfriend Cydney Bernard chose to have two boys.

    The opposing opinion highlights serious disadvantages like the difficulty to maintain social equilibrium. People believe this because life cannot continue without the effort of both genders to collaborate and produce better life opportunity. Males, for example, cannot perform and tolerate a certain job that can be done by females such as cooking, cleaning, and delicate handcraft. Another drawback is the ethical issue raised by the misuse of such a procedure. The idea of selecting certain embryo and potentially discarding others may lead to gender discrimination. Chinese, an obvious example, prefer to choose a baby male rather than female in order to carry their families’ names.

    In conclusion, the serious drawbacks of choosing certain gender can lead to a collapse of society component and gender discrimination. Therefore, the disadvantages significantly outweigh the advantages.

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