Preimplantation Genetic Diagnosis: Ethical Aspects

Abstract

Abstract Preimplantation genetic diagnosis is a procedure, which allows for the selection between embryos before the initiation of pregnancy. Although considered morally controversial, for example, depending on views regarding the moral status of embryos, this procedure seemingly reduces ethical problems in prenatal diagnosis by offering the possibility of selecting offspring without the need to consider abortion. However, counselling of patients becomes more complicated. Also, there are controversies regarding who should be the primary beneficiary, for instance when an embryo is chosen partly to be a suitable tissue donor to a sibling, as well as regarding when benefits outweighs downsides. Moreover, preimplantation genetic diagnosis raises concerns about the connection between the pre‐selection of children on genetic grounds and the discrimination of disabled people. It also raises the ethical problem of whether the selection of future children on the basis of less serious or even nonpathological traits is an acceptable practice. Key Concepts: Preimplantation genetic diagnosis (PGD), selecting embryos based on genetic analysis before pregnancy by in vitro fertilisation (IVF), gives rise to ethical issues on the basic, clinical and societal level. The acceptability of PGD depends on how one views parental responsibilities towards future children and the moral status of embryos. Prospective parents may consider PGD to be preferable to prenatal genetic diagnosis, since in PGD selection can be made without subsequent abortion. Drawbacks of PGD may outweigh benefits if the procedure of IVF is considered too burdensome, if the pattern of heredity is considered too complex to yield unambiguous genetic information, or if the condition is not considered serious enough. PGD may also be used to select embryos that can become suitable bone marrow donors to seriously ill siblings, which has aroused controversies regarding the instrumentalisation and future well‐being of these children. PGD makes genetic counselling more complex and possibly harder to comply with the ideal of nondirectiveness. The question of which uses of PGD should be allowed can only be answered against the background of the basic ethical issue of what goal PGD should be taken to serve. The goal of promoting reproductive autonomy gives rise to ethical issues of using PGD for less serious conditions or nonpathological traits, which may lead to backdoor eugenics. The goal of preventing (the birth of individuals with) certain serious diseases gives rise to ethical questions of which diseases should be considered serious enough, as well as concerns of a subsequent reinforcement of discrimination and stigmatisation of disabled people. The idea of a list of pre‐defined conditions serious enough for PGD sends the message that people affected by these conditions are more undesirable than others, which may push the situation closer to morally problematic forms of eugenics.