ethics birth

Ethics

Couples should not be encouraged to have preimplantation genetic determination (PGD). PGD is a technique that involves "removing cells from the early embryo to test for genetic mutations, which can cause disease" (Morris, 2008). Ethically, there is nothing wrong with using PGD, as it is essentially a diagnostic tool, and does not cause harm to the mother or the child (Morris, 2008). However, it is also not a medically-necessary procedure. PGD can be used for a number of purposes, but one of the most important is to evaluate for genetic mutations such as those that might cause disease or conditions like Down's Syndrome. While it is beneficial for parents to know about the potential for these things, in many cases PGD is not a 100% accurate predictor of conditions, so is not necessarily going to be used to make decisions about the pregnancy. Arguably, such diagnoses can be made after birth more easily and accurately, so for most patients that is probably the best course of action. Again, while there is benefit to PGD is not a medical necessity, and while there is limited risk associated with it, there is no reason to claim that it is necessary to recommend PGD. It can be recommended, but it is not necessary to do so.

There are exceptions, however, and certainly so for patients with specific risk factors. Sherbahn (2013) notes that mothers with advanced age of 38 years or more are at greater risk from their pregnancies; that mothers with repeated in vitro fertilization failure are at greater risk; those with inherited genetic conditions or are carriers of chromosomal translocations and those with recurrent miscarriages are all patients for whom PGD might be medically necessary or beneficial. These patients would represent an exception, and in such cases it could be argued that mothers with these characteristics should receive PGD testing, as it could reduce the risk to the mother or avoid passing along genetic abnormalities. Women over 38 face both greater risk of chromosomal abnormalities and they have higher pregnancy risk in general, so they are the most likely candidate group for PGD testing (Sherbahn, 2013).

There are some drawbacks to PGD as well that need to be taken into consideration. While a common argument against the technique relates to moral hazard, that hazard originates from subsequent decisions and is not directly related to the PGD testing decision. However, Sherbahn (2013) notes that there are legitimate concerns about the use of this technique. In particular, the 3-day embryo biopsy technique is believed to traumatize the embryo, while there is evidence to suggest that other types of PGD testing do not place the embryo at additional risk.

Another negative aspect of PGD that must be taken into consideration is the risk of a false positive. It is known that mosaic embryos can self-repair, and this aspect of neonatal child development is not yet developed as a science. Thus, while a PGD test might detect an abnormality, that abnormality might not make its way, in that form, to the child at birth. Additionally, there is also the risk of the false negative. At the current quality level of testing, it is understood that some babies will still be born with chromosomal abnormalities. Additionally, PGD testing is expensive, and therefore remains prohibitive for many patients.