beware! preimplantation maysolvesomeoldproblemswhich pigd involves a transfer of power away...

J7ournal ofMedical Ethics 1999;25: 114-120

Beware! Preimplantation genetic diagnosismay solve some old problems but it alsoraises new onesHeather Draper and Ruth Chadwick University ofBirmingham and University of Central Lancashire,respectively

AbstractPreimplantation genetic diagnosis (PIGD) goes someway to meeting the clinical, psychological and ethicalproblems of antenatal testing. We should guard,however, against the assumption that PIGD is theanswer to all our problems. It also presents some newproblems and leaves some old problems untouched.This paper will provide an overview of how PIGDmeets some of the old problems but will concentrate ontwo new challenges for ethics (and, indeed, law). Firstwe look at whether we should always suppose that itis wrongfor a clinician to implant a geneticallyabnormal zygote. The second concern is particularlyimportant in the UK. The Human Fertilisation andEmbryology Act (1990) gives clinicians a statutoryobligation to consider the interests of the futurechildren they help to create using in vitro fertilisation(IVF) techniques. Does this mean that becausePIGD is based on IVF techniques the balance ofpowerfor determining the best interests of the futurechild shifts from the mother to the clinician?(Journal ofMedical Ethics 1999;25:114-120)Keywords: preimplantation genetic diagnosis; reproduc-tive control; new genetics; best interests of future children

Preimplantation genetic testingPreimplantation genetic diagnosis (PIGD) is theresult of combining our increasing knowledgeabout the human genome with techniques em-ployed in assisted conception. It is currentlyemployed when a couple have had one affectedchild and/or one or more termination of preg-nancy (TOP) following conventional antenataltesting. Superovulation, egg collection and in vitrofertilisation (IVF) are followed by the genetic test-ing of each ofthe resulting embryos. Non-affectedembryos are then implanted using the sameprotocols covering IVF for infertility. Preimplan-tation genetic diagnosis enables couples to foundtheir family with greater confidence that they willneither give birth to an(other) affected child norsubject themselves to a series of terminations ofpregnancy.

Advantages ofpreimplantation diagnosisThe most obvious advantage of PIGD is that itenables couples to have an unaffected child with-out also having to have a series of terminations ofpregnancy. These terminations can be particularlystressful for a woman (and her partner) becauseeach aborted fetus is potentially a wanted child.Moreover, the knowledge that each pregnancy isconditional upon a clear test result also constrainsthe usual joy with which news of a new pregnancyis greeted by those "trying for a baby". Thepotential of PIGD to reduce the physical and psy-chological wear and tear on the woman and herpartner is one advantage. Another is that the fail-ure to implant an embryo is viewed by many asmorally preferable to the killing of a more fullydeveloped fetus. This view is attractive to thosewho believe that the embryo gradually acquiresgreater moral status as it develops both physicallyand towards viability - hence the various cut-offpoints in its development which have been used todemark appropriate behaviour (the primitivestreak for embryo research or the increased abilityto exist independently which seems to mark thecut-off point for termination of pregnancy etc).'Preimplantation genetic diagnosis is also attrac-tive to those who wish to draw a distinctionbetween actively destroying life (termination ofpregnancy) and a failure to save life (the decisionnot to implant an embryo). Indeed, we speak of"allowing embryos to perish" rather than "embryokilling".There remains, however, a sizeable contingent

for whom PIGD does not resolve any ethicalproblems because for them, morally significanthuman life begins at conception. Obviously thoseholding this view may be as opposed to PIGD asthey are to IVF, unless they are prepared toendorse "embryo euthanasia". According to thisview, the human embryo has a moral status akin tothat of the fetus, infant or fully developed human.This position need not be incompatible with theview that what makes life worth living is its quality.

on August 27, 2021 by guest. P

rotected by copyright.http://jm

e.bmj.com

/J M

ed Ethics: first published as 10.1136/jm

e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/

Draper, Chadwick 115

Thus, it could both be held that the embryo hasmoral significance and that it is in the bestinterests of the embryo that it is not implanted,provided that its life is not worth living. Such aview might also justify termination of a pregnancy(feticide) or non-voluntary euthanasia (of bothsmall infants and incompetent adults).Another perceived advantage of preimplanta-

tion diagnosis is that it gives greater choice tocouples because it gives them the scope to make adecision about which of the embryos to implant,whereas TOP simply presents the choice ofwhether or not to terminate a pregnancy. Thischoice is, as we will show, somewhat of a mixedblessing. On the positive side it enables couples tomaximise the advantages for their future child butwithin the limits of what nature provides (ie thenumber of embryos they have to choose between).So, whilst not actually manipulating the genes oftheir offspring, they are able to choose not toimplant, for instance, not just those embryoswhich will be directly affected by some geneticdisorder, but also any embryo which carries reces-sive genes for some disorder. Thus, parents areable to protect their future children not just fromthe direct burdens of genetic disorder, but also theworries which they have themselves experiencedto ensure that their own children will not suffer. Intime couples may even be able to select accordingto other genetic traits just as they can now selectthe sex of their future progeny.Of course, even as these perceived advantages

are listed, old problems begin to emerge. It is onething to accept, as some people do, that no injus-tice is done to the embryo if it is not implanted. Itis quite another to endorse the policies and justifi-cations which motivate the decision not toimplant. For instance, what counts as a life notworth living? Is sex selection permissible? Whatmakes a particular genetic formation a disorderrather than a difference? Is it permissible to max-imise advantage as well as to minimise disadvan-tage? Should we be eradicating difference orintolerance to difference? These larger questionscut across the debate even if we are prepared toaccept that no one ofmoral significance is affectedby our decision not to implant any one of theembryos in question. We do not intend to dwell onthese old problems, but intend instead to exploresome of the new problems which PIGD has intro-duced, concerning whether it is always wrong toimplant an affected embryo; and the extent towhich PIGD involves a transfer of power awayfrom women. There is also a third problem, con-cerning the greater potential for eugenic implica-tions in PIGD because of the possibility thatembryos might be selected on the basis of carrier

status for recessive conditions, but this will not bediscussed here for reasons of space.

First new problem: is it always wrong toimplant an affected embryo?It would be easy to assume that the purpose ofPIGD is to ensure that only unaffected childrenare born, and that since the rationale for desiringthis end is to avoid the life of suffering whichaffected children are perceived to have, in theabsence of available and effective treatment for thecondition in question, it must be wrong todeliberately or knowingly implant an affectedembryo. It is one thing, it could be argued, forcouples to refuse to undertake PIGD, but quiteanother for them to request that an affectedembryo be implanted. The assumption that it iswrong knowingly to implant an affected embryoseems to be a shift away from the rhetoric ofchoice which dominates when the context iscounselling concerning termination of pregnancy.Yet if it is so obviously wrong to implant anaffected embryo, why is it not equally obviouslywrong to continue to term under similar circum-stances? One answer is that embryos have lessmoral worth than fetuses. Another is thattermination is wrapped up with the autonomy ofwomen whereas the ex-utero embryo is theresponsibility of the clinician. We will return tothis point later. The assumption that it isobviously wrong to implant affected embryos alsoignores at least two other issues in the widerdebate about reproductive technologies. The firstis the extent to which parents can expect - wherepossible - to be genetically related to theiroffspring. The second is the extent to which we areprepared to entertain debate about what makes alife worth living, what constitutes a disadvantagedlife, and under what circumstances, if any, anindividual could be said to be harmed by beingbrought into existence.

Let's put this into the context of someexamples.

1. Simon and Claire are both in their mid-40s.They have been referred for PIGD because tenyears ago they had a child with Fragile X who diedsix months ago. Since the birth of this child, Clairehas had two TOPs following positive antenataltests for Fragile X. Following the death of theirfirst child, they are more than ever determined toextend their family, but acknowledge that time isrunning out for them. Claire is superovulated buteven so only five gametes are collected. Only twoof these become fertilised when mixed withSimon's sperm. Both embryos are affected byFragile X. Simon and Claire decide that they are



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/

116 Beware! Preimplantation genetic diagnosis may solve some old problems but it also raises new ones

getting too old to wait any longer for a child andask the clinician to implant the embryos. As analternative, he offers them a place on his IVFwaiting list, arguing that they should try IVF withdonor gametes. They refuse because they want achild which is genetically related to both of them.He offers further PIGD, they refuse again,concerned that next time they may not even man-age to produce a single embryo and that there isno guarantee that even if they do, it will be unaf-fected by Fragile X. They prefer instead to takethe chance that this second child - if a pregnancyis established - will be less badly affected than wastheir first.

2. Judith and Paul are carriers for cystic fibrosis.They have both had experience of living with suf-ferers and want to avoid having an affected child.Following PIGD they are informed that they havesix viable embryos, but one is affected withDown's syndrome. They ask for four of theembryos to be frozen for later use and for two ofthem to be implanted. They are not in the leastconcerned about Down's syndrome, saying thatthey believe that it is possible to have Down's andstill have a good quality of life. They want theaffected embryo to be implanted/frozen withoutdiscrimination and at random.

3. Philip and Linda are both deaf. Linda isinfertile and the couple have been accepted forIVF. Once on the programme they were offeredPIGD by a well-meaning clinician who assumedthat they would not want any of their children tobe deaf. He is shocked when they steadfastly insistthat out of their nine embryos the one withcongenital deafness be implanted first - along withany one of the other unaffected embryos. Theremaining embryos should be frozen for later use.They justify their decision by arguing that theirquality of life is better than that of the hearing. Asfar as they are concerned, giving preference to theaffected embryo is giving preference to the onewhich will have the best quality of life. They arevery concerned that any hearing child they havewill be an "outsider" - part neither of the deaf norof the hearing community at least for the first fiveor so years of his/her life.

CASE NUMBER 1: SIMON AND CLAIREThis case challenges us to determine whether it ispermissible for a couple to put the desire for achild which is genetically related to them abovethe interests of the child, once born; and also,whether it is acceptable to offset the risk that theywill not manage to have another successfulattempt against the risk that the child may have avery disadvantaged life. To address these issues,

we have to look at reproductive freedoms andparental responsibility.There has been systematic and unresolved dis-

cussion over what makes an individual a parent,even more debate about what makes a woman amother. This discussion has been provoked bywhat is perceived as the division of motherhoodinto, for instance, the social, the bearer and thegenetic. Although most people agree that it is nota necessary criterion of parenting that one has agenetic relationship with a child, it is usually con-sidered a sufficient qualification. The strength ofthis assumption has been revealed in a variety ofcontexts: the "father" distressed because a womanis going to abort "his" child; the reluctance ofsome to donate genetic material or frozenembryos; mothers who only reluctantly handedover children for adoption; men who discover thatunbeknown to them, they have a child in the worldwhom they have never met. Likewise, as many ofthose experiencing the discomfort and expense ofinfertility treatment attest, the desire to have agenetically related child is an enormously strongone. From this perspective, it is not difficult tohave sympathy with what Simon and Claire areproposing to do.

Their claim does, however, highlight the weak-ness of considering the conceptual issue ofparenting in isolation from the responsibilitieswhich flow from parenting. Simon and Claire areasserting a right to be parents of a particular kind- genetic parents. Whether such a right exists andif so what its content might be is contested.2 Yet ifsuch a right exists, it stands to protect the goodswhich flow from parenting.3 These goods arearguably of two kinds - the fundamental and theincidental. Incidental goods include goods whichone obtains as a known side effect of having chil-dren; for instance, securing council housing, pro-ducing a football team, or having company andsecurity in one's old age. Fundamental goods, onthe other hand, are the moral goods of parenting,the goods which parenting represent and which,without parenting, might never be achieved.These goods include the care and nurture of achild, the sense of affection and community foundin loving families and the moral good of beingresponsible for the wellbeing of another. It is thesekinds of goods which the concept of a right toparent seems to protect.The question which Simon and Claire's case

raises is whether being genetically related to thechild is an incidental or fundamental good ofparenting. Or, put another way, does the right tofound a family include the right to be geneticallyrelated to one's child? On balance, the answer tothis question is no. Being genetically related to



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/


one's child seems more appropriately located asan incidental good of parenting because it lackssufficient weight to count as a fundamental good.This way of looking at the dilemma faced bySimon and Claire yields a quite different resultfrom that which concentrates solely on future per-sons. In conclusion then, it would seem thatSimon and Claire cannot insist upon having eitherof the embryos implanted on the grounds thatthey have a right to a child genetically related tothem.

CASES 2 AND 3 JUDITH AND PAUL, PHILIP AND LINDAIn some respects both of these cases raise the sameissue - that there is no definitive view either aboutwhat makes a life worth living, or about what con-stitutes quality of life. These are not new issues.The new dimension in PIGD is the possibility ofactively choosing to have an affected child; inJudith and Paul's case because they do not seeDown's as a condition incompatible with qualityof life; and in Philip and Linda's case, becausethey think that being deaf is positively life-enhancing.Of course, making an assessment of an

individual's quality of life is a moral decisionbecause other morally important decisions will bebased upon the answer reached. In this respect,one has to look at the context in which thedecision is being made to gain a full appreciationof the morality of the decision itself. So, forinstance, if a quality-of-life decision is being usedto allocate scarce resources, we want to locate thisdecision in the context of debate about justice.The context for our two couples is that they areclaiming the parental authority to make decisionsabout the welfare of their children. The context inwhich their decision has to be discussed is that ofwhether they are making a responsible orirresponsible parental judgment. The moral basisfor respecting the judgment of parents is the pre-sumption that parents have the best interests oftheir children at heart, that they of all people canbe trusted to do what is best for their children.This is the basis upon which parental judgmentscommand moral authority. Sometimes parents donot seem to exercise good judgment when itcomes to protecting their children's best interests.When this happens, we may consider them to bebad or even unfit parents, or sometimes no kind ofparent at all! These kinds of judgments reinforcethe view expressed above that it is almost impossi-ble to look at what being a parent means withoutalso considering parental responsibility. In thissense, not only might it be argued that the termparent is actually a moral term (as opposed to aterm related to bearing, genetics or social roles),

but also that it is perhaps inappropriate to separateour understanding of good parents from ourunderstanding of what it means to be a parent.3Whilst attractive, this leaves us in danger of deny-ing that parents can make mistakes without losing,as it were, the right to parent. We have, therefore,to accept that parents can make misguidedjudgments as well as bad judgments. Also, becausethere is an acceptably wide understanding ofwhatconstitutes a child's best interests, differentparents may arrive at different decisions for theirchildren without being either misguided orirresponsible in their judgment.Now we need to apply these observations to the

decisions made by Judith and Paul, Linda andPhilip. We will then be in a better position todetermine whether it is wrong for them to want tohave affected embryos implanted.

JUDITH AND PAUL

To assess the strength of Judith and Paul's claim,we may actually need to know more about theirviews about the status of the embryo. If they aremaking an embryo euthanasia decision (ie at-tempting to make a decision about the futurequality of life for what they consider to be anexisting child) and if they believe that Down's iscompatible with a quality of life worth having,then we will have to accept that they are making aresponsible parental judgment - whether or not itis the one which we would be prepared to make forour own child.But what if they are making a more political

statement - perhaps one about the wrongness of apolicy of testing for Down's? This is a much moredifficult issue to resolve because the couple aremuch more vulnerable to the criticism of harmingthe future child, particularly if they believe thatthe embryo itself has no moral status. Judith andPaul cast as proponents of embryo euthanasia arebalancing the harm of ceasing to exist against theharm of existing with Down's. Judith and Paulcast as a couple who believe that the embryo doesnot have moral worth (because it does not yet havea life at all) seem rather to be choosing to create aperson with Down's. We need to be aware thatthere are different points coming together here.First there is the issue unique to PIGD - that ofthe active choice to implant a particular embryo.Second is the old dilemma of the extent to whichparents can allow their own political views toaffect the decisions they take about reproduction,rather than being motivated by considerations ofthe interests of their future children.

It might be argued that since Down's syndromeis not deemed to be incompatible with a life worthliving, Judith and Paul do not wrong a child by



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/


bringing it into existence with Down's. Buthowever much value is attached to the lives ofthose who have Down's, it nevertheless remainsthe case that is it not good to have the disabilitieswhich those who have Down's have to suffer. It isone thing to say that those who have Down's arevaluable and quite another to say that the choicebetween choosing to implant an affected or anunaffected embryo has no moral significance.Whether a condition is so severe as to make lifenot worth living is one question. Whether it ispermissible to implant an embryo with a condi-tion that will result in disability, but a disabilitythat is not so severe that it makes life not worthliving, is another. If the answer is not clear thenthere is a case for leaving it to parental choice.There remains an issue, however, about the sortsof considerations that are relevant to that choice.What if, however, they argue that for them the

moral significance in having the affected embryoimplanted lies precisely in making a politicalstatement about the value of those with Down's, asymbol of their belief that a life with Down's isnevertheless a valuable life? We cannot do justiceto the wider issue here, so we will simply describeit rather than discussing it at length. In its broad-est sense this question asks us to decide whichtakes precedence, our obligations as citizens orour obligations as parents.The extent to which we can impose the effects of

our political beliefs on our children is raised inmany different contexts. The conscientious objec-tor in an oppressive regime knows that herobjections place not just herself but her children atrisk ofphysical harm and death. Those who believein public education for children have to decidewhether or not to send their children to privateschools when their children have special needs orhappen to live in the catchment areas of substand-ard state schools. We might be happy to concludethat making these decisions is one of those areaswhere, once again, the boundary for responsibleparental decision making is quite a wide one.Nevertheless, we also conclude that once parentscite their moral authority as parents as the reasonto allow them to make such decisions for theirchildren, the interests of the children do have tofigure to a significant degree in the calculations,whatever the final decision which is reached.

LINDA AND PHILIP

Linda and Philip also want to implant an affectedembryo, but in their case what they believe them-selves to be doing is maximising the advantagesfor their future child. This decision is a difficultone to challenge. By offering a choice betweenpossible future persons, PIGD provides not only

the opportunity to avoid avoidable harms, but alsothe possibility of maximising advantage or en-hancing quality of life.Why are Linda and Philip able to argue that

deafness is life-enhancing? One answer is that theyare themselves deaf and are therefore in a goodposition to judge, whereas we who can hear arenot. Equally, however, it could be argued thatLinda and Philip because of their deafness are notin a position to appreciate what they are missing.In one sense this argument is intractable; it isimpossible to claim that one form of life is betterthan another unless one has experienced both andeven then one's preference could be said to besubjective. One could, of course, refuse to givetheir claim any credibility at all by arguing that itis harming a child to engineer that she is bornwithout the capacity to enjoy all of her senses ordo all that it is possible for humans to do.4 This issurely the kind of judgment to which we appealwhen we observe that whatever value attaches tothe life of the person with Down's, neverthelesshaving Down's is a disadvantage. But Linda andPhilip's claim is more difficult to dismiss than this.Few if any of us claim that the pressure of intellec-tual capacity is so great that we wish we'd beenborn without it. We might claim that the pressuresof responsibilities we have as a result are so greatthat we'd like to give them up in favour of a moresimple life, but in considering the possibilities forthis more simple life, irreversible brain damagerarely, if ever, features. Many of us have, however,found noise to be obtrusive. Too much uninvitednoise is itself a recognised medical condition (tin-nitus) but too much intellectual capacity is not.Some of us regularly resort to ear-plugs in order tosleep or work in environments we cannot control.Thus whilst we do not literally deafen ourselves,we certainly are prepared to trade hearing forpeace and quiet.The argument, however, may be less in terms of

the quality of sound-related experience or its lack,but as indicated above, in terms of a sense ofbelonging to a community, a language and a cul-ture. It is this that marks out deafness from otherconditions. Linda and Philip are not simply mak-ing a political claim that people like them shouldnot be discriminated against through programmesto screen out deaf future persons, although thereare arguments for the view that screening fordeafness harms the deaf community. They aremotivated by the genuine belief that they are act-ing in their child's best interests. Perhaps the bestthat can be argued against them is that they shouldallow their child to decide for herself whether shethinks that their quality of life is better than hers.This choice is removed from her if she is born



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/


irreversibly deaf. But even this solution does notaddress the point which they make about being anoutsider.

This case highlights one of the disadvantages ofgiving parental decision making moral authority,namely that it can act as a trump card in thoseareas where there is no right answer, but where thedecision which parents want to make, to choose astate in which a child is born with a hearing systemwhich does not work, is one that most rationalbystanders would not take. On the other hand, ashas been suggested above, in cases where it is notthe case that the child would be so disadvantagedthat its life would not be worth living, it may beargued that parental choice is the best option,particularly where motivated by the child's bestinterests. It is precisely this that may be under-mined by PIGD, however, and this is where weturn to our second problem.

Second new problem: does PIGD shiftreproductive power from women tophysicians?To date, quality-of-life decisions have largelyrested with women because it was impossible tomake decisions over the life or death of fetuseswithout effecting these decisions on women'sbodies. Once pregnant, a woman is free to decidewhether or not to seek antenatal screening, andirrespective of this decision she is free (within legalboundaries) to determine whether or not the childis a wanted one, irrespective of any advice given tothe contrary by her clinician.5 Although womencannot be compelled to participate in PIGD, oncethey have parted with their gametes and once theresulting embryos are tested, it is possible forthem to lose control over what happens next. Cli-nicians participating in IVF have a clear statutoryobligation (and some would argue that thisreflects an absolute moral obligation) to considerthe interests of the future child. Just as theclinician cannot compel a woman to give up hergametes, or have a TOP, or be implanted, shecannot compel him to implant embryos againsthis wishes. Does this mean that in all the cases wediscussed above, we were wrong to assume thatthe decisions were the parents to make at all? Theclinician, it seems, has the final say in whether ornot to implant.6Or does he? There are several points to be made

here. The first concerns the extent to which theclinician needs to rely solely on his own judgment.He can of course take account of the arguments ofthe parents - or indeed, his own ethics committee.However, the net effect of this could be to splithairs, since although he takes account of the par-

ents' views he still has the final power to decidewhether or not to be bound by their decision.Also, the 1990 Human Fertilisation and Embryol-ogy Act was formulated on an assumption that theclinician would arrive at this judgment beforedeciding whether or not to treat. When disagree-ments arise in PIGD, treatment (if this is the cor-rect term) is already well underway. Any disputeconcerns whether or not to implant existingembryos. In deciding not to implant on the basisof disagreement about the interests of the futurechild, the clinician not only retains his consider-able power over reproductive freedom, he alsogains power over what could be described as theproperty of the couple - the embryo - which is theproduct of their own gametes, which arguably aretheir property.

But, is it fair to assume that if gametes areproperty embryos are also property? If weconsider that the embryo has an independentmoral status, the claim about ownership dimin-ishes because we readily accept that humans can-not be owned in any sense. If, however, we areworking on the assumption that the embryo hasno independent moral status it does seem reason-able to suppose that it can be owned and thereforebelongs to the couple jointly (let's leave asidetotally the issue of what to do if they disagreeamong themselves). This puts the clinician in animpossible position. He cannot implant becausehe does not think that it is in the interests of thechild to do so, equally he cannot simply freeze theembryo since the purpose of this would be toafford the couple the chance of successfully find-ing a clinician who will agree to implant and thismay result in a child whose interests he believesare best served by not coming into existence. Bothfreezing and implanting are using his skills tobring about a child. Of course, there is a precedentfor suggesting that he should freeze and refer,namely the practice of clinicians who have a con-scientious objection to abortion but who areexpected to offer to refer patients to someone whowill perform an abortion for them. The moralinconsistency of this position is obvious and needsno further explanation.

It seems to us highly probable that this tensionis likely to cause problems in the future. The cou-ple will, not unreasonably, assume that thedecision in the case ofPIGD will be theirs to make- because in antenatal screening it is. Likewise, theclinician cannot be blamed for assuming that hehas the final word since in infertility treatment hedoes. Moreover, it seems likely that any "contract"which the couple make with their clinician as partof their consent prior to PIGD will be impossibleto enforce - particularly in a case like that of



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/


Simon and Claire, where the embryos in questionbecame endowed with the additional status ofbeing the ONLY chance for them to have agenetically related child. It remains to be seen,then, whether PIGD should be marketed asaffording greater autonomy and reproductivefreedom to couples when, as things stand, they areeffectively putting the decision in the hands of thetreating clinician.

AcknowledgementBoth authors would like to acknowledge the sup-port of the Directorate General XII of theCommission of the European Communitiesunder its Biomedicine and Health ResearchProgramme (Biomed II). The authors gratefullyacknowledge the stimulus and support providedby the commission.

Heather Draper, BA, AIIA, PhD, is Lecturer inBiomedical Ethics at the Centre for Biomedical Ethics,University of Birmingham. Ruth Chadwick, BPhil,

MA, DPhil, LLB, FRSA, is Head of the Centre forProfessional Ethics, and Professor of Moral Philo-sophy, University of Central Lancashire.

References and notes

1 For instance in the amendment to the Abortion Act 1967 foundin the Human Fertilisation and Embryology Act 1990.

2 See for example, Chadwick RF, ed. Ethics, reproductioni anidgenetic control [2nd ed]. London: Routledge, 1992.

3 For the complete development of this argument see Draper H.Assisted conception techniques, parent selection and the inter-ests of children to adequate parents. Bioetica 1997;5:391-9.

4 For a discussion of this issue see Chadwick R, Levitt MA. Theend of deafness? Deaf people, deaf genes and deaf ethics. DeafWorlds 1997;13:2-9.

5 Granted, conditions such as extent of knowledge, subtle coer-cion, tests made available and other circumstances may erodeautonomy.

6 Steinberg DL. Bodies inl glass: genetics, eugenics, enibryo ethics.Manchester: Manchester University Press, 1997. As DeborahLynn Steinberg has argued, while preimplantation diagnosismay be debated in the gender-neutral language of genetic risks,it "obscures social inequalities between practitioners andfemale patients and between patients and their male partners,while implicitly reinforcing and relying on these powerimbalances".

News and notes

Models of Teaching Biomedical Ethics: Can There be aConsensus?A workshop on this topic is to be held at Imperial Col-lege School of Medicine, London, on 20th April 1999,from 9am to 5 pm.The workshop is the final event in a three-year

research project on European biomedical ethics educa-tion, funded by the European Commission and coordi-nated by Michael Parker and Donna Dickenson at

Imperial College School of Medicine.Samples of the workbooks will be available at the

workshop. Speakers will include: Ann Sommerville(BMA), Tony Hope (ETHOX), Gwen Adshead (Broad-moor Hospital) and Ruud ter Meulen (Institute forBioethics, Maastricht).There is no charge for the workshop but places are

limited. Lunch will be provided.For more information please contact: Michael

Parker on 0171 594 3368 or by e-mail: m.j.parker(aic.ac.uk.



e.bmj.com

/J M


e.25.2.114 on 1 April 1999. D

ownloaded from

http://jme.bmj.com/

beware! preimplantation maysolvesomeoldproblemswhich pigd involves a transfer of power away...

Documents