Sharpening the cutting edge: additional considerations for the UK debates on embryonic interventions for mitochondrial diseases

Erica Haimes,Ken Taylor

doi:10.1186/s40504-016-0046-2

Abstract

In October 2015 the UK enacted legislation to permit the clinical use of two cutting edge germline-altering, IVF-based embryonic techniques: pronuclear transfer and maternal spindle transfer (PNT and MST). The aim is to use these techniques to prevent the maternal transmission of serious mitochondrial diseases. Major claims have been made about the quality of the debates that preceded this legislation and the significance of those debates for UK decision-making on other biotechnologies, as well as for other countries considering similar legislation. In this article we conduct a systematic analysis of those UK debates and suggest that claims about their quality are over-stated. We identify, and analyse in detail, ten areas where greater clarity, depth and nuance would have produced sharper understandings of the contributions, limitations and wider social impacts of these mitochondrial interventions. We explore the implications of these additional considerations for (i) the protection of all parties involved, should the techniques transfer to clinical applications; (ii) the legitimacy of focussing on short-term gains for individuals over public health considerations, and (iii) the maintenance and improvement of public trust in medical biotechnologies. We conclude that a more measured evaluation of the content and quality of the UK debates is important and timely: such a critique provides a clearer understanding of the possible, but specific, contributions of these interventions, both in the UK and elsewhere; also, these additional insights can now inform the emerging processes of implementation, regulation and practice of mitochondrial interventions.

Highlights

In October 2015 the UK became the first country to enact legislation, originally agreed by Parliament in February 2015, to permit the clinical use of embryos that have been constructed using genetic material from three people
Mitochondrial interventions, hereafter referred to as pronuclear transfer (PNT)/maternal spindle transfer (MST) to better reflect the actual techniques under scrutiny, have provoked much discussion because they involve changing the genetic inheritance of any children born, in novel, untried, irreversible ways that could never occur through ‘natural’ conception
In summary, we have identified ten areas in which the UK discussions of PNT/MST initiatives would have benefitted from greater clarity, depth and nuance; in each area we have highlighted information and knowledge that could have been more prominent and contributed to a more fully rounded debate

Summary

Introduction

In October 2015 the UK became the first country to enact legislation, originally agreed by Parliament in February 2015, to permit the clinical use of embryos that have been constructed using genetic material from three people. Haimes and Taylor Life Sciences, Society and Policy (2017) 13:1 been developed: (i) pronuclear transfer (PNT) and (ii) maternal spindle transfer (MST), both often erroneously referred to as ‘mitochondrial donation’ (Haimes and Taylor 2015).1 In both techniques the intending parents’ DNA is transferred into an egg (containing healthy mitochondria) provided by another woman, from which the nuclear DNA has been removed. Mitochondrial interventions, hereafter referred to as PNT/MST to better reflect the actual techniques under scrutiny, have provoked much discussion because they involve changing the genetic inheritance of any children born, in novel, untried, irreversible ways that could never occur through ‘natural’ conception. It is estimated that there are around 21,000 genes in the nuclear DNA (Pennisi 2012)

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