The Ethical Implications of Preimplantation Genetic Diagnosis

Abstract

The development of in vitro fertilization in the 1970s has revolutionized the treatment of infertility. In the US, 126 procedures are performed per million people each year. The ability to culture embryos in vitro has allowed the development of preimplantation genetic diagnosis (PGD). PGD is similar to the prenatal diagnosis used to screen for various genetic diseases before birth, but its advantage is that it allows the selection of certain embryos before their transfer back to the uterus and avoids selective pregnancy terminations. For women of advanced maternal age or couples with known genetic mutations, the ability to screen for embryos free of certain genetic mutations is reassuring. As with many medical interventions associated with human reproduction, however, PGD raises many ethical issues. Recently, PGD has been used in new ways, including: HLA typing so that the child's HLA profile matches that of a sick sibling and is thus available for stem cell transplantation; sex selection; and selection of affected embryos so that the child has the same minor disability as the parents (e.g., deafness). We explore the field of PGD with the director of a PGD laboratory, a bioethicist, and an attorney to understand their views on the ethics of PGD. As the director of a PGD laboratory, do you feel laboratories need to consider the moral/ethical and societal implications before developing a new PGD test? Richard T. Scott: The practice in a PGD laboratory is no different from any other area of medicine. Thoughtful and ethical decision-making is mandatory. Any controversial case is first evaluated by all the physicians and scientists in the program. Complex issues are dealt with by the entire team, with the ultimate responsibility falling on the director. We are always mindful that PGD laboratories are unique, in that they analyze embryo biopsies and produce …