Genetic modification of preimplantation embryos: toward adequate human research policies

Crowdsourcing the Moral Limits of Human Gene Editing?

In 2015, a flourish of "alarums and excursions" by the scientific community propelled CRISPR/Cas9 and other new gene-editing techniques into public attention. At issue were two kinds of potential gene-editing experiments in humans: those making inheritable germ-line modifications and those designed to enhance human traits beyond what is necessary for health and healing. The scientific consensus seemed to be that while research to develop safe and effective human gene editing should continue, society's moral uncertainties about these two kinds of experiments needed to be better resolved before clinical trials of either type should be attempted. In the United States, the National Academies of Science, Engineering and Medicine (NASEM) convened the Committee on Human Gene Editing: Scientific, Medical and Ethical Considerations to pursue that resolution. The committee's 2017 consensus report has been widely interpreted as "opening the door" to inheritable human genetic modification and holding a line against enhancement interventions. But on a close reading it does neither. There are two reasons for this eccentric conclusion, both of which depend upon the strength of the committee's commitment to engaging diverse public voices in the gene-editing policy-making process.

Genetic testing of embryos: practices and perspectives of US in vitro fertilization clinics

OBJECTIVE

To better understand the current practices of IVF clinics regarding preimplantation genetic diagnosis (PGD) and explore the attitudes and opinions of clinic directors toward PGD.

DESIGN

On-line Survey of 415 assisted reproductive technology (ART) clinics in the United States. The Survey had a valid response rate of 45% (186 clinics).

SETTING

Not applicable.

PATIENT(S)

Respondents were medical directors, laboratory directors, IVF directors, or directors' designees of ART clinics offering IVF.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

Practices and beliefs of IVF clinic directors with respect to PGD.

RESULT(S)

Preimplantation genetic diagnosis is widely provided for a variety of indications, and clinic directors support professional guidelines to guide PGD in the future.

CONCLUSION(S)

Preimplantation genetic diagnosis is an established technology and medical procedure offered by a majority of US IVF clinics. Many clinics currently provide PGD for controversial indications such as sex selection. Although there is little support for government regulation of PGD, there is significant support among IVF clinics for strong professional guidelines for PGD practice. Ongoing collection of data on PGD practice and outcomes would help patients make informed decisions and aid professionals in developing appropriate guidelines and standards.

Preimplantation genetic diagnosis: public policy and public attitudes

This paper summarizes the regulatory framework surrounding preimplantation genetic diagnosis (PGD) in the United States. In addition, the author reports results of surveys that reveal conflicting popular opinions about the moral acceptability of manipulating embryos during PGD. For example, some people who feel that an embryo has as much moral status as a born baby nonetheless feel that using PGD to screen embryos for certain diseases is morally acceptable. The national debate about technologies like PGD is stunted because it is currently cast in the same terms as the debate over abortion rights. If national leaders begin discussions about regulation of PGD and similar technologies, it could help depolarize the debate to more accurately consider the nuanced views of the public.

Preimplantation genetic diagnosis as medical innovation: reflections from The President’s Council on Bioethics

In its 2004 report, "Reproduction and Responsibility: The Regulation of New Biotechnologies", The President's Council on Bioethics analyzed ethical issues raised by preimplantation genetic diagnosis (PGD) and made recommendations for improvements.

Procreative liberty and harm to offspring in assisted reproduction

Assisted reproductive technologies (“ARTs”) have enabled many infertile couples to have children but have long been controversial. Opposition initially focused on the “unnaturalness” of laboratory conception and the doubts that healthy children would result. Once children were born, ethical debate shifted to the status and ownership of embryos and the novel forms of family that could result.

The new century has brought forth both new and old ethical concerns. The growing capacity to screen the genomes of embryos has sparked fears of eugenic selection and alteration. In addition, concerns about safety have reasserted themselves. Several studies suggest that in vitro fertilization (“IVF”) may be associated with lower birth weights and major malformations. Ethical attention has also focused on whether all persons seeking ARTs should be granted access to them, regardless of their child-rearing ability, age, disability, health status, marital status, or sexual orientation.