Skip to main content /HEALTH with /HEALTH

Should we be able to choose our kids?

Should we be able to choose our kids?

By Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

(CNN) -- A new type of embryo testing is being offered by a growing number of fertility clinics as a way of improving the chances of a successful pregnancy.

It involves genetic testing of chromosomes in embryos created by in vitro fertilization, or IVF, and implanting only those embryos with normal chromosomes into the mother.

The logic is that even if embryos appear normal in the lab, subtle chromosomal abnormalities can prevent a pregnancy from continuing past a certain point. Screening embryos before implantation is a way this problem can be avoided.

While such screening seems to improve the odds of having a baby, it also raises ethical and policy issues at the same time.

The testing process also identifies the gender of the embryo, which may or may not be made available to the couple to help them decide which embryos to implant.

And while the testing is being initially offered to help couples overcome infertility, it also affords the chance to perform other genetic tests on the embryo.

Is such embryo screening a good thing? And which tests should be added as they become available?

Getting used to genetic testing

There has been much discussion about the appropriate uses of genetic testing in embryos.

Sparking debate have been stories about couples trying to "create" a genetically matched cord blood donor for their sick child, and a woman screening embryos to make sure her offspring would not be afflicted with the same genetic form of early-onset Alzheimer disease that she had.

These two cases were seen as controversial uses of technology. What makes the current screening efforts different is that they propose testing only for what will give the embryo a better chance at birth.

This laudable goal will make genetic testing more regularly used in IVF -- and widely acceptable in the process -- effectively getting us used to the idea of genetic testing on embryos.

Why stop at 'successful' embryos?

But why should we stop at screening embryos only to increase their chances of birth?

As we learn more about our genetic makeup, and genetic testing becomes more sophisticated, there will be both the opportunity and the desire by some to select more of the characteristics of their future children.

Why not screen for diseases or increased risk of illness in the future? Why not test for gender, and eventually physical and behavioral traits?

The problem is that we have no mechanism to make decisions about where to stop.

There is little, if any, oversight of IVF for several reasons:

  • The U.S. federal government hasn't funded research on embryos as a matter of policy dating to the mid-1980s, and so has avoided making rules about such research in the private sector.
  • Health insurance companies generally don't pay for IVF and embryo testing, so no criteria have been established to receive approval from payers, which means we're left with "whatever the market will bear."
  • Since reproductive medicine is such a market-driven part of medicine, clinics compete to offer the latest services and have a difficult time regulating themselves.
  • What all this means is that it is time to take a hard look at oversight in both the making and testing of embryos.

    We've come to realize that IVF and embryo testing technologies are closely linked with stem cell research, since embryos for embryonic stem cell research come from these technologies and the clinics where they're practiced.

    It is becoming increasingly likely that government will step in and fill the policy void, either through an existing regulatory mechanism like the Food and Drug Administration or by Congress passing legislation.

    Before that happens, these big decisions deserve societal discussion and debate in which we ask ourselves not whether we can choose what our children will be like, but whether we should.

    Visit the
    "Ethics Matters" Archive
    where you'll find other columns from Jeffrey Kahn
    on a wide range of bioethics topics.

    "Ethics Matters" is a biweekly feature from the
    Center for Bioethics and CNN Interactive.




    Back to the top