A Mutation of Genetics
More and more couples pursuing IVF are also using genetic tests to determine which embryos to transfer into the womb. Most commonly, preimplantation genetic diagnosis (PGD) is done, to identify serious diseases when one or both parents are carriers. Preimplantation genetic screening (PGS) is an exploration, not looking for a particular disease, but to see if any worrisome disease shows up. Recent advances in technology opened the door to even broader screening. Meanwhile, embryos can be frozen pending results of the tests and discussion with the couple.1 Thanks to such technologies, the ethical stakes are being raised, and not necessarily in the direction one might expect.
In late 2011, a group of geneticists, fertility specialists, and ethicists met in the Netherlands ("the Netherlands group") to wrestle with the challenges of comprehensive genetic testing in the context of assisted reproduction; the results were published last year.2 Some of the issues are familiar, but new ethical ground is being broken as well.
Since PGS can identify a range of unsuspected genetic mutations, the Netherlands group raised the issue of "the minimum criteria that should be satisfied to allow the transfer of any embryo."3 Where IVF is publicly funded, "some objective selection criteria may be used regardless of the preferences of the couple."4 The technology puts a presumed moral right in potential conflict with a presumed moral obligation: reproductive autonomy may be overridden by "procreative beneficence."
Ethicist-provocateur Julian Savulescu argues for the principle of "procreative beneficence," which would obligate parents to select the embryo most likely to have the best life. What criteria would be used? Predictions based on inconclusive tests. Genetic tests can indicate obvious chromosomal anomalies (such as Trisomy 21) but are less useful for genetic mutations. Tests do not reveal the age of onset, the severity of the disease, or even the probability the disease will erupt. Nor can they predict that a car accident, not heart disease, will take that child's life. We all carry gene mutations that are never expressed. Yet an embryo can be excluded based on an adult onset disease marker.
If Savulescu's "procreative beneficence" proposal takes root, current understandings of reproductive autonomy will be undermined. Once a woman is pregnant, she cannot be forced to undergo prenatal testing or an abortion. But the Netherlands group argues that once she goes down the IVF path, the fertility doctor becomes an active participant with responsibilities and rights of his own. He "shares a direct responsibility for the welfare of future children," and may use test results to make decisions contrary to the couple's wishes—including refusing to transfer embryos deemed "unfit" into the woman's womb.5
Although genetics has not yet linked genes with traits such as memory or musical ability, the Netherlands group decided that non-health-related criteria were worthy of consideration. After all, the parents are aiming not just for a healthy child, but for the child's wellbeing.
This option, too, may become not quite so optional. If non-health-related information becomes available, then the question (in the eyes of the Netherlands group) will be "whether it is morally acceptable for parents and professionals to ignore information about traits that may be important for the wellbeing of the child."6
Here's my take on the proceedings: If genetics research + genetic screening technology + information = parental option, then parental decision to test + public funding of IVF = obligation of parents and doctors to choose only embryos who can have "a good life." The answer = an ethical disaster.
Paige Comstock Cunninghamis the Executive Director of The Center for Bioethics & Human Dignity in Deerfield, Illinois.
Get Salvo in your inbox! This article originally appeared in Salvo, Issue #31, Winter 2014 Copyright © 2026 Salvo | www.salvomag.com https://salvomag.com/article/salvo31/unnatural-selection
