invitro fertilization (ivf) & pre-implantation genetic diagnosis (pgd)

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Invitro Fertilization (IVF) &

Pre-Implantation Genetic Diagnosis (PGD)

Engineering 124; Spring 2003

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Process of IVF


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PGD: Genetic testing performed prior to embryo transfer

“The debate [around PGD] has been building since the late 1980s, when doctors at London's Hammersmith Hospital learned how to tease a cell from a 3-day-old embryo and study its chromosomes for gender.”

(Zitner 2002)

•Adds $2000 to IVF•Reduces rate of miscarriages from 23% to 10%•Does not increase chance of pregnancy


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Commonly, more than 100 diseases can be detected through testing, including…

• Hemophilia A• Muscular dystrophy• Tay-Sachs disease• Cystic fibrosis• Down Syndrome

Removal of one cell for testing


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Viable and Desirable?

“This information is helping parents choose which embryos they want--and which to reject as unhealthy, or merely undesirable.” (Zitner 2002)


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Undesirable Embryos

Disease Free Embryos

• Frozen in storage • Donated to

infertile couples• Donated to stem

cell research/usage

Disease Carrying Embryos

• Donated to research• Discarded


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Impact (Part I)

* in cre ase in mu ltip le births* in fe rtile co up les ca n re pro du ce*surrog ate p are ntho od (wom b d on o rs, $2 8 K-$ 45 K)

IV F

*d ecrea se d ra te of sp ecific d ise ases in th e p op ulation (refer to next slide)

*d ecrea sed rate o f misca rria ge

P G D

F actua l


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“GenRich” is controversial; it could be harmful or beneficial.“[The ‘GenRich’] will use technology to ensure that their children have significantly more advantages than the random mix of the gene pool, widening the gap between the rich and poor.” (Wagner 2003)

The wealthy citizens, whose offspring will become the “GenRich” “…do us a great service. They test these technologies for us and even pay enormous sums for the privilege. In a way, they function as guinea pigs for the rest of humanity. If you had to think of who you’d like to test these technologies, what better group can you imagine? They’re well informed, highly motivated, eager, hard to coerce and they are definitely volunteers.” (Jonietz 2003)

Impact (Part II)

*p ro d uctio n m en ta lity*stem ce ll re sea rch*cha lle ng es be gin in g o f life*m arket for ga me tes

*o ccup atio n of surog ate m oth erho od*p la yin g C re ator*"Ge nR ich"

IVF

*Eu ge n ics*g e ne tics arm s ra ce*d iscrim inta ion*slipp ery slo pe

PG D

Axio log ica l

Production mentality is a problem. “Where amniocentesis usually provides information about a single fetus, embryo screening allows parents to judge and reject many potential children at once. And because it bypasses the pain of abortion, some fear it will be used too freely, coarsening attitudes toward the embryo.” Fetuses become products rather than children. (Zitner 2002)

Fukuyama defines eugenics as, “the deliberate breeding of people for certain selected heritable traits.”

“Human genetic engineering raises most directly the prospect of a new kind of eugenics, with all the moral implications with which that word is fraught, and

ultimately the ability to change human nature.” (Fukuyama 2002)

“The power to change the future of the human race is, in some ways, more frightening than the weapons of mass destruction we hear so much about today. It is a weapon of mass creation.” (Wagner 2003)

“And if scientists in one nation are genetically altering unborn children, wouldn’t it be hard for other nations to resist joining in a ‘genetic arms race’ to develop a new generation better able to compete in the global economy – or in war?” (Wagner 2003)

On the potential for discrimination, Hughes, a Wayne State doctor, said:

“I went into this to help people with disease. Last time I checked, your gender is not a disease.”

(Zitner 2002)

"Would this selection (of gender) place our society on a "slippery slope" to other kinds of unacceptable selections? Possibly, but only if we continue to use this powerful technology without a thorough analysis of its ethical justification and without a professional standard that clearly articulates a strong set of moral values." (Scannell 2001)


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Rights Ethics

Ethics: The issues at hand…

…weighing the goal of pregnancy and live birth against the medical and moral risks of multiple gestation.

…using PGD inherently makes assumptions about the quality of life, challenging basic tenets of society such as equality.

Care Ethics

Utilitarianism

…requires society to make a decision

on when life begins.

World Views


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• Address the suffering of the mother due to her inability to have a child “naturally”

• “When having children, people…often roll the genetic dice and hope for the best. With embryo sorting, "they can start their pregnancy on Day One with a commitment to continuing it."

(Zitner 2002)

• PGD can save parents massive heartbreak and financial strain

ethics

• Address the view of the potential child

– Will the child have adequate support and a stable home?

– If there are multiple fetuses, will the children receive adequate care/attention?

• “[PGD has] the laudable goal of stopping deadly genetic diseases such as Tay-Sachs and Huntington’s. This research has growing support because it can save children from enormous suffering and early death.”

(Wagner 2003)

Some ethicists would be in favor of IVF and PGD as long as the decision is loving and promotes positive relationships.


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Definition of Moral Community for Rights Based Ethics

Before one can decide to whom rights apply, one must determine the moral community.

“As individuality is a sine qua non for personhood, it seems safe to consider 14 days of normal embryonic development to be the minimum requirement before a human being can emerge. Other criteria might place the earliest time point at a later stage, for example, 28 days, when the neural tube closes and the development of the central nervous system necessary for rationality begins. Or, with Aristotle and St. Thomas Aquinas, one might consider 40-90 days of development to be necessary to allow a human soul to be present; or as the Roman Catholic Church taught for centuries, one might require body-form and movement to be present before full human status was recognized.” (J.E.S.Hansen)

Therefore, embryos lack rights as individuals because they are not part of the moral community.


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Rights Based Ethics

Based on John Locke’s principles, all people have the right (in America) to “life, liberty and the pursuit of happiness.”

•What becomes of the idea that everyone is created equal if you start designing children?

•Loss of autonomy because of a necessity to be competitive in society

•Inherently discriminatory; makes assumptions about quality of life

"Most people with disabilities rate their quality of life as much higher than other people think. People make the decision [to reject embryos] based on a prejudice that having a disability means having a low quality of life.“ (Zitner 2002)

Embryos are mass-produced, screened, discarded and used in experiments: are they products or people with rights?

According to Hansen (see previous slide), the treatment of embryos is not an issue.


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Utilitarianism

• The alleviation of suffering for many is important. – IVF helps many infertile couples

achieve a life-long dream of having a child.

– PGD helps those same couples reach their goal of a disease free child.

• A disease free society is preferable for all members.

The greatest good for the greatest number suggests that…


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What does religion have to say about Embryo

technology?

• The Christian view:

• Life is sacred• Only God should

create life and take it away.

• God knows you even when you are in the womb...


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• You created every part of me; you put me together in my mother’s womb... When my bones were being formed... when I was growing there in secret, you knew that I was there.

• Psalm 139: 13-16


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Do all Christians have the same opinion about Embryo

technology?

• Roman Catholic Church: thinks embryo technology is wrong. This is because you are a person from the moment of conception.

• Church of Scotland:does think that life is sacred but agrees with using embryos until the 14th day of development.

• Both churches disagree with the idea of designer babies


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….Christian View• The Church of Scotland teaches

that life must be protected from the moment of conception. Genetic engineering for cosmetic purposes is rejected because it is ’playing God’ to decide which people are to be valued and which are not. Medical research up to 14 days is accepted.


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The Muslim View

• Life is a gift from Allah.• He breathes life into the

embryo, this when you become a person.

• Some Muslims think this happens on the 42nd day of development. Others say it is on the 120th day.


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Muslim View

• Life is sacred and a gift from Allah – Surah 17:33, 40:70

• How we treat other living things throughout life will form our judgement by Allah

• There is disagreement about when Allah breathes life into the foetus so some accept research up to a certain stage.


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• Some Muslims agree with embryo research.

• Some say that Allah has given humans intelligence. We should use this to make life better: if you can make someone’s life better by using embryo research then you should.

• Some argue therefore, that using pre-embryo's or embryos for research is acceptable if the possible benefits are great enough.


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Embryo research and UK law

• Licenses for embryo research must be provided by the HFEA (Human Fertilization and Embryology Authority)

• Research is allowed up to 14 days of development

• Frozen embryos can only be stored for up to 5 years.


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Why are human embryo’s used for research?

• Gives more accurate picture of how the illness/treatment might affect a person.

• The research could help to eliminate diseases such as Parkinson’s and Alzheimer’s.

• The embryo is not a human being , just a collection of cells, so it is acceptable to extract genetic material form it and use it to benefit others.


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Do human embryo’s have rights?

•No: it is only a cluster of cells, not a person. Only a person has rights. It has no awareness or feelings.

•Yes: It is a potential human being and deserves to be respected. Life begins at conception.


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Other Views on Embryo research:

• British Humanist Association• Spare embryos produced through

fertility treatment are routinely disposed of, so it is better that they are used to benefit other people.

• Embryo is fertilized egg with potential to be a person but it has no self-awareness, no ability to feel pain or emotion. Therefore it cannot suffer.


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Peter Singer (Preference Utilitarian)

• We already allow this kind of treatment. It has benefited many people.

• Individuals should be free to make their own choices on this issue as it is a private matter harming no-one else.

• Many children have been born as a result of this technology. It hasn’t harmed any of them or society so we should conclude that it is acceptable.


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Mary Warnock (Philosopher)

• Immense benefits come from using human embryos therefore it is right that they are used.

• The key stage of embryo development is the ‘primitive streak’ at 14 days.

• The ‘slippery slope’ argument is not valid as there are specific laws to stop this happening , eg the ’14 day rule’


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International Policies on PGD

•Banned PGD for ALL usages

•Used to select child’s gender only when there is medical need

•Clinics set policies; no federal or state restrictions


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What is your opinion?


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1. Name two ways in which Christians and Muslims agree about embryo research

1. When does the Catholic Church think that life begins?

Questions: answer these fully in your jotters.


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Describe UK law relating to the use of human embryos in

research.• Human cloning is not allowed.• Therapeutic cloning is allowed.• Licences must be provided by the

HFEA.• Research allowed up to 14 days of

development.• Frozen embryos can only be stored for

up to 5 years.


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Describe a secular viewpoint in relation to genetic

selection

• Peter Singer (a Utilitarian)• We already allow genetic selection by

encouraging prenatal diagnosis of conditions such as Downs Syndrome as this often leads to selective abortion.

• If humans have already developed the ability to prevent certain genetic disorders then we should use this technology to benefit people.

• Individuals should be free to make their own choices on this issue as it is a private matter harming no one else.

• However, Singer also points out that human genetic engineering may lead to a loss of diversity among human beings. This may reduce humanity's capacity to adapt to changing circumstances.


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• This may also lead to an increasing gap between rich and poor in society as the children of the rich, who can afford to genetically enhance their offspring, gain more advantages over the children of the poor.

• Singer suggests the State should control human genetic engineering so that everyone can share in the benefits.


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What arguments might scientists use to support using human embryos in

research?• A human embryo gives a more accurate

picture of how the illness/treatment may affect a person.

• The embryo is not a human being but only a collection of cells.

• It has no self-awareness, thoughts, internal organs etc. Therefore, material can be extracted to benefit others.

• The research could help to eliminate diseases such as Parkinson’s, Alzheimer’s and even cancer.


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How far does the religious viewpoint you have studied agree with using embryos

for stem cell research • Only God has the right to create life.

Whenever humans try to behave like God they mess up.

• Humans are made in God’s likeness – Genesis 1:27.

• ‘Do not commit murder’ – Exodus 20:13.• Life is sacred and should only be ended

by God – Job 1:21.• God cares for the developing foetus –

Psalm 139:13-16.


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• The Roman Catholic Church teaches that life begins at conception. Therefore life must be protected from the moment of conception. However, gene therapy is acceptable where it is of medical benefit.

• The Church of Scotland teaches that life must be protected from the moment of conception. Genetic engineering for cosmetic purposes is rejected because it is ‘playing God’ to decide which people are to be valued and which are not.


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• The Church of Scotland does accept medical research up to 14 days.

• The Bible also teaches that Christians should be compassionate towards others leading some to suggest that this includes medical research if it can provide cures for diseases or help those with fertility problems.


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• Islam• Agree• Life is sacred and a gift from Allah

– Surah 17:33, 40:70.• How we treat other living things

throughout life will form part of our judgement by Allah.


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• However• There is disagreement about when

Allah breathes life into the foetus so some accept research up to a certain stage


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How might medical scientists define an

embryo?

• A fertilised egg from 14 days to 8 weeks.

• The Human Fertilisation and Embryology Act defines an embryo as a live human embryo where fertilisation is complete.

• or• An egg in the process of

fertilisation.

invitro fertilization (ivf) & pre-implantation genetic diagnosis (pgd)

Documents

genetic testing

potential children

human genetic engineering

embryo screening

dayold embryo

human race

unborn children

genetic arms race