Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T09:47:37.677Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Issues and Practical Problems in Preimplantation Genetic Diagnosis

Published online by Cambridge University Press:  01 January 2021

Jeffrey R. Botkin
Get access Rights & Permissions [Opens in a new window]

Extract

Preimplantation genetic diagnosis (PGD) is a new method of prenatal diagnosis that is developing from a union of in vitro fertilization (IVF) technology and molecular biology. Briefly stated, PGD involves the creation of several embryos in vitro from the eggs and sperm of an interested couple. The embryos are permitted to develop to a 6-to-10-cell stage, at which point one of the embryonic cells is removed from each embryo and the cellular DNA is analyzed for chromosomal abnormalities or genetic mutations. An embryo or several embryos found to be free of genetic abnormalities are subsequently transferred to the woman's uterus for gestation. Embryos found to carry a genetic abnormality are discarded or frozen. Extra normal embryos may be frozen for future transfer or donation to another couple.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 26 , Issue 1 , Spring 1998 , pp. 17 - 28
Copyright
Copyright © American Society of Law, Medicine and Ethics 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lissens, W., Review, “Preimplantation Diagnosis of inherited Disease,” Journal of Inherited and Metabolic Disease, 19 (1996): 709–23; and Harper, J.C., “Preimplantation Diagnosis of Inherited Disease by Embryo Biopsy: An Update of the World Figures,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 90–95.Google Scholar
Soussis, I., “Pregnancies Resulting from Embryos Biopsied for Preimplantation Diagnosis of Genetic Disease: Biochemical and Ultrasonic Studies in the First Trimester of Pregnancy,” Journal of Assisted Reproduction and Genetics, 13, no. 3 (1996): At 254.CrossRefGoogle Scholar
Lissens, , supra note 1, at 719.Google Scholar
See Van Voorhis, B.J., “Cost-Effectiveness of Infertility Treatments: A Cohort Study,” Fertility and Sterility, 67 (1997): 830–36.Google Scholar
See Collins, J.A., “An Estimate of the Cost of In Vitro Fertilization Services in the United States in 1995,” Fertility and Sterility, 64 (1995): 538–45.CrossRefGoogle Scholar
See Verlinsky, Y., “Preimplantation Genetic Diagnosis,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 87–89.CrossRefGoogle Scholar
See Hsu, L.Y.F., “Prenatal Diagnosis of Chromosomal Abnormalities,” in Milunsky, A., ed., Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment (New York: Plenum, 1986): At 118.Google Scholar
See Legro, R.S., “ART in Women 40 and Over: Is the Cost Worth It?,” Journal of Reproductive Medicine, 42 (1997): 76–82.Google Scholar
See Lieu, T.A. Watson, S.E. Washington, A.E., “The Cost-Effectiveness of Prenatal Carrier Screening for Cystic Fibrosis,” Obstetrics and Gynecology, 84 (1994): 903–12.Google Scholar
See Rowley, P.T., “Prenatal Screening for Hemoglobinopathies: A Prospective Regional Trial,” American Journal of Human Genetics, 48 (1991): 439–46.Google Scholar
See Rowley, P.T., “Prenatal Diagnosis for Sickle Cell Disease: A Survey of the United States and Canada,” Annals of the New York Academy of Science, 565 (1989): 48–52.CrossRefGoogle Scholar
See Wertz, D.C., “Attitudes Toward the Prenatal Diagnosis of Cystic Fibrosis: Factors in Decision Making among Affected Families,” American Journal of Human Genetics, 50 (1992): 1077-85; and Jedlicka-Kohler, I. Gotz, M. Eichler, I., “Utilization of Prenatal Diagnosis for Cystic Fibrosis over the Past Seven Years,” Pediatrics, 94 (1994): 13–16.Google Scholar
See Simpson, J.L. Liebaers, I., “Assessing Congenital Anomalies after Preimplantation Genetic Diagnosis,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 170–76.CrossRefGoogle Scholar
Ao, A., “Clinical Experience with Preimplantation Genetic Diagnosis of Cystic Fibrosis (ΔF508),” Prenatal Diagnosis, 16 (1996): 137–42.Google Scholar
See Press, N.A. Browner, C.H., “‘Collective Fictions’: Similarities in Reasons for Accepting Maternal Serum Alpha-Fetoprotein Screening among Women of Diverse Ethnic and Social Class Backgrounds,” Fetal Diagnosis and Therapy, 8, Supp. 1 (1993): 97–106.CrossRefGoogle Scholar
See Boss, J.A., The Birth Lottery: Prenatal Diagnosis and Selective Abortion (Chicago: Loyola University Press, 1993): At 77–78.Google Scholar
See Laruelle, C. Engler, Y., “Psychological Study of In Vitro Fertilization-Embryo Transfer Participants' Attitudes Toward the Destiny of Their Supernumerary Embryos,” Fertility and Sterility, 63 (1995): 1047–50.CrossRefGoogle Scholar
See Leon, I.G., “Psychodynamics of Perinatal Loss,” Psychiatry, 49 (1986): 312–24.CrossRefGoogle Scholar
See Congregation for the Doctrine of Faith, “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation,” Origins, 16 (1987): 701.Google Scholar
See Tooley, M., Abortion and Infanticide (New York: Oxford University Press, 1983).Google Scholar
See Gillespie, N.C., “Abortion and Human Rights,” Ethics, 87 (1977): 237–43.Google Scholar
See Steinbock, B., Life Before Birth: The Moral and Legal Status of Embryos and Fetuses (New York: Oxford University Press, 1992): At 43–88; and Strong, C., Ethics in Reproductive and Perinatal Medicine: A New Framework (New Haven: Yale University Press, 1997): At 41–62.Google Scholar
See Strong, , id.Google Scholar
See Ad Hoc Group of Consultants to the Advisory Committee to the Director, National Institutes of Health, Report of the Human Embryo Research Panel (Bethesda: National Institutes of Health, 1994): At 38.Google Scholar
Id. at 30.Google Scholar
See Ao, , supra note 14.Google Scholar
See Andrew, L.B., Committee on Assessing Genetic Risks, Division of Health Sciences Policy, Institute of Medicine, eds., Assessing Genetic Risks: Implications for Health and Social Policy (Washington, D.C.: National Academy Press, 1994): At 105; and Council on Ethical and Judicial Affairs, American Medical Association, “Ethical Issues Related to Prenatal Genetic Testing,” Archives of Family Medicine, 3 (1994): 633-42; and Wertz, D.C. Fletcher, J.C., “Fatal Knowledge? Prenatal Diagnosis and Sex Selection,” Hastings Center Report, 19, no. 3 (1989): 21-27.Google Scholar
See, for example, Robertson, J.A., Children of Choice: Freedom and the New Reproductive Technologies (Princeton: Princeton University Press, 1996).Google Scholar
See Wertz, Fletcher, , supra note 27.Google Scholar
See Strohman, R.C., “The Coming Kuhnian Revolution in Biology,” Nature Biotechnology, 15 (1997): 194–200.CrossRefGoogle Scholar
See Robertson, J.A., “Genetic Selection of Offspring Characteristics,” Boston University Law Review, 76 (1996): At 421.Google Scholar
See Strong, , supra note 22, at 133–58.Google Scholar
See Post, S.G. Botkin, J.R. Whitehouse, P., “Selective Abortion for Familial Alzheimer Disease?,” Obstetrics and Gynecology, 79 (1992): 794–98; and Botkin, J., “Fetal Privacy and Confidentiality,” Hastings Center Report, 25, no. 5 (1995): 32-40.Google Scholar
Clarke, A., “Is Non-Directive Counseling Possible?,” Lancet, 338 (1991): 998–1001.Google Scholar
See Asch, A., “Reproductive Technology and Disability,” in Cohen, S. Taub, N., eds., Reproductive Laws for the 1990's (Clifton: Humana Press, 1998): 69–124.Google Scholar
See Andrews, , supra note 27.Google Scholar
See Ross, D.W., “DNA on a Chip,” Archives of Pathology and Laboratory Medicine, 120 (1996): 604–05; Eng, C. Vijg, J., “Genetic Testing: The Problems and the Promise,” Nature Biotechnology, 15 (1997): 422-26; and Marshall, A. Hodgson, J., “DNA Chips: An Array of Possibilities,” Nature Biotechnology, 16 (1998): 27–31.Google Scholar
Americans with Disabilities Act of 1990, 42. U.S.C. §§ 12101–12113 (1994).Google Scholar
See Anonymous, , “Fetal Gender Testing,” Nature Biotechnology, 15 (1997): 700.Google Scholar
See McGee, G., “Parenting in an Era of Genetics,” Hastings Center Report, 27, no. 2 (1997): 16–22.Google Scholar
See Davis, D.S., “Genetic Dilemmas and the Child's Right to an Open Future,” Hastings Center Report, 27, no. 2 (1997): 7–15.Google Scholar
See NIH Workshop on Population Screening for Cystic Fibrosis Gene, “Statement from the National Institutes of Health Workshop on Population Screening for Cystic Fibrosis Gene,” N. Engl. J. Med., 323 (1990): 70-71; Committee on Obstetrics, Fetal and Maternal Medicine, American College of Obstetricians and Gynecologists, “American College of Obstetricians and Gynecologists Committee Opinion: Current Status of Cystic Fibrosis Carrier Screening” (Washington, D.C.: American College of Obstetricians and Gynecologists, 1991); and Biesecker, L., “General Population Screening for Cystic Fibrosis Is Premature,” American Journal of Human Genetics, 50 (1992): 438-39.Google Scholar
Murray, T.H., The Worth of a Child (Berkeley: University of California Press, 1996): At 136.CrossRefGoogle Scholar
See Ao, , supra note 14.Google Scholar
See Raeburn, J.A., Commentary, “Preimplantation Diagnosis Raises a Philosophical Dilemma,” British Medical Journal, 311 (1995): 540–41.Google Scholar
See Mehlman, M.J. Botkin, J.R., Access to the Genome: The Challenge to Equality (Washington, D.C.: Georgetown University Press, 1998).Google Scholar
See Lauritzen, P., “What Price Parenthood?,” Hastings Center Report, 20, no. 2 (1990): 38–46.CrossRefGoogle Scholar
See Advisory Committee on Human Radiation Experiments, Final Report: The Advisory Committee on Human Radiation Experiments (Washington, D.C.: U.S. Government Printing Office, 1995): At 825, Recommendation 13.Google Scholar
See Walters, L. Palmer, J.G., The Ethics of Human Gene Therapy (New York: Oxford University Press, 1997).Google Scholar
The technical difficulties of inserting functional genetic material into in vivo eggs and sperm are significant. Primary oocytes are produced from cell division while the woman is still a fetus herself and the meiotic divisions occur near the time of ovulation and fertilization. Because the insertion of genetic material generally requires an actively dividing cell, primary oocytes are a difficult target in their dormant state. The challenge with sperm is to insert successfully the genetic material into virtually 100 percent of billions on billions of sperm stem cells. Further, the insertion must be in a stable fashion that leaves the sperm functional and otherwise unimpaired. Given the limited success to date with any gene therapy, prospects for such success in humans are not on the horizon.Google Scholar
See Juengst, E.T., “Can Enhancement Be Distinguished from Prevention in Genetic Medicine?,” Journal of Medicine and Philosophy, 22, no. 2 (1997): 125–42.Google Scholar