Ethical Issues and Practical Problems in Preimplantation Genetic Diagnosis

Lissens W. , Review, “Preimplantation Diagnosis of inherited Disease,” Journal of Inherited and Metabolic Disease, 19 (1996): 709–23; and Harper J.C. , “Preimplantation Diagnosis of Inherited Disease by Embryo Biopsy: An Update of the World Figures,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 90–95.

Soussis I. , “Pregnancies Resulting from Embryos Biopsied for Preimplantation Diagnosis of Genetic Disease: Biochemical and Ultrasonic Studies in the First Trimester of Pregnancy,” Journal of Assisted Reproduction and Genetics, 13, no. 3 (1996): At 254.

Lissens , supra note 1, at 719.

See Van Voorhis B.J. , “Cost-Effectiveness of Infertility Treatments: A Cohort Study,” Fertility and Sterility, 67 (1997): 830–36.

See Collins J.A. , “An Estimate of the Cost of In Vitro Fertilization Services in the United States in 1995,” Fertility and Sterility, 64 (1995): 538–45.

See Verlinsky Y. , “Preimplantation Genetic Diagnosis,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 87–89.

See Hsu L.Y.F. , “Prenatal Diagnosis of Chromosomal Abnormalities,” in Milunsky A. , ed., Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment (New York: Plenum, 1986): At 118.

See Legro R.S. , “ART in Women 40 and Over: Is the Cost Worth It?,” Journal of Reproductive Medicine, 42 (1997): 76–82.

See Lieu T.A. Watson S.E. Washington A.E. , “The Cost-Effectiveness of Prenatal Carrier Screening for Cystic Fibrosis,” Obstetrics and Gynecology, 84 (1994): 903–12.

See Rowley P.T. , “Prenatal Screening for Hemoglobinopathies: A Prospective Regional Trial,” American Journal of Human Genetics, 48 (1991): 439–46.

See Rowley P.T. , “Prenatal Diagnosis for Sickle Cell Disease: A Survey of the United States and Canada,” Annals of the New York Academy of Science, 565 (1989): 48–52.

See Wertz D.C. , “Attitudes Toward the Prenatal Diagnosis of Cystic Fibrosis: Factors in Decision Making among Affected Families,” American Journal of Human Genetics, 50 (1992): 1077–85; and Jedlicka-Kohler I. Gotz M. Eichler I. , “Utilization of Prenatal Diagnosis for Cystic Fibrosis over the Past Seven Years,” Pediatrics, 94 (1994): 13–16.

See Simpson J.L. Liebaers I. , “Assessing Congenital Anomalies after Preimplantation Genetic Diagnosis,” Journal of Assisted Reproduction and Genetics, 13, no. 2 (1996): 170–76.

Ao A. , “Clinical Experience with Preimplantation Genetic Diagnosis of Cystic Fibrosis (ΔF508),” Prenatal Diagnosis, 16 (1996): 137–42.

See Press N.A. Browner C.H. , “‘Collective Fictions’: Similarities in Reasons for Accepting Maternal Serum Alpha-Fetoprotein Screening among Women of Diverse Ethnic and Social Class Backgrounds,” Fetal Diagnosis and Therapy, 8, Supp. 1 (1993): 97–106.

See Boss J.A. , The Birth Lottery: Prenatal Diagnosis and Selective Abortion (Chicago: Loyola University Press, 1993): At 77–78.

See Laruelle C. Engler Y. , “Psychological Study of In Vitro Fertilization-Embryo Transfer Participants' Attitudes Toward the Destiny of Their Supernumerary Embryos,” Fertility and Sterility, 63 (1995): 1047–50.

See Leon I.G. , “Psychodynamics of Perinatal Loss,” Psychiatry, 49 (1986): 312–24.

See Congregation for the Doctrine of Faith, “Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation,” Origins, 16 (1987): 701.

See Tooley M. , Abortion and Infanticide (New York: Oxford University Press, 1983).

See Gillespie N.C. , “Abortion and Human Rights,” Ethics, 87 (1977): 237–43.

See Steinbock B. , Life Before Birth: The Moral and Legal Status of Embryos and Fetuses (New York: Oxford University Press, 1992): At 43–88; and Strong C. , Ethics in Reproductive and Perinatal Medicine: A New Framework (New Haven: Yale University Press, 1997): At 41–62.

See Strong , id.

See Ad Hoc Group of Consultants to the Advisory Committee to the Director, National Institutes of Health, Report of the Human Embryo Research Panel (Bethesda: National Institutes of Health, 1994): At 38.

Id. at 30.

See Ao , supra note 14.

See Andrew L.B. , Committee on Assessing Genetic Risks, Division of Health Sciences Policy, Institute of Medicine, eds., Assessing Genetic Risks: Implications for Health and Social Policy (Washington, D.C.: National Academy Press, 1994): At 105; and Council on Ethical and Judicial Affairs, American Medical Association, “Ethical Issues Related to Prenatal Genetic Testing,” Archives of Family Medicine, 3 (1994): 633–42; and Wertz D.C. Fletcher J.C. , “Fatal Knowledge? Prenatal Diagnosis and Sex Selection,” Hastings Center Report, 19, no. 3 (1989): 21–27.

See, for example, Robertson J.A. , Children of Choice: Freedom and the New Reproductive Technologies (Princeton: Princeton University Press, 1996).

See Wertz Fletcher , supra note 27.

See Strohman R.C. , “The Coming Kuhnian Revolution in Biology,” Nature Biotechnology, 15 (1997): 194–200.

See Robertson J.A. , “Genetic Selection of Offspring Characteristics,” Boston University Law Review, 76 (1996): At 421.

See Strong , supra note 22, at 133–58.

See Post S.G. Botkin J.R. Whitehouse P. , “Selective Abortion for Familial Alzheimer Disease?,” Obstetrics and Gynecology, 79 (1992): 794–98; and Botkin J. , “Fetal Privacy and Confidentiality,” Hastings Center Report, 25, no. 5 (1995): 32–40.

Clarke A. , “Is Non-Directive Counseling Possible?,” Lancet, 338 (1991): 998–1001.

See Asch A. , “Reproductive Technology and Disability,” in Cohen S. Taub N. , eds., Reproductive Laws for the 1990's (Clifton: Humana Press, 1998): 69–124.

See Andrews , supra note 27.

See Ross D.W. , “DNA on a Chip,” Archives of Pathology and Laboratory Medicine, 120 (1996): 604–05; Eng C. Vijg J. , “Genetic Testing: The Problems and the Promise,” Nature Biotechnology, 15 (1997): 422–26; and Marshall A. Hodgson J. , “DNA Chips: An Array of Possibilities,” Nature Biotechnology, 16 (1998): 27–31.

Americans with Disabilities Act of 1990, 42. U.S.C. §§ 12101–12113 (1994).

See Anonymous , “Fetal Gender Testing,” Nature Biotechnology, 15 (1997): 700.

See McGee G. , “Parenting in an Era of Genetics,” Hastings Center Report, 27, no. 2 (1997): 16–22.

See Davis D.S. , “Genetic Dilemmas and the Child's Right to an Open Future,” Hastings Center Report, 27, no. 2 (1997): 7–15.

See NIH Workshop on Population Screening for Cystic Fibrosis Gene, “Statement from the National Institutes of Health Workshop on Population Screening for Cystic Fibrosis Gene,” N. Engl. J. Med., 323 (1990): 70–71; Committee on Obstetrics, Fetal and Maternal Medicine, American College of Obstetricians and Gynecologists, “American College of Obstetricians and Gynecologists Committee Opinion: Current Status of Cystic Fibrosis Carrier Screening” (Washington, D.C.: American College of Obstetricians and Gynecologists, 1991); and Biesecker L. , “General Population Screening for Cystic Fibrosis Is Premature,” American Journal of Human Genetics, 50 (1992): 438–39.

Murray T.H. , The Worth of a Child (Berkeley: University of California Press, 1996): At 136.

See Ao , supra note 14.

See Raeburn J.A. , Commentary, “Preimplantation Diagnosis Raises a Philosophical Dilemma,” British Medical Journal, 311 (1995): 540–41.

See Mehlman M.J. Botkin J.R. , Access to the Genome: The Challenge to Equality (Washington, D.C.: Georgetown University Press, 1998).

See Lauritzen P. , “What Price Parenthood?,” Hastings Center Report, 20, no. 2 (1990): 38–46.

See Advisory Committee on Human Radiation Experiments, Final Report: The Advisory Committee on Human Radiation Experiments (Washington, D.C.: U.S. Government Printing Office, 1995): At 825, Recommendation 13.

See Walters L. Palmer J.G. , The Ethics of Human Gene Therapy (New York: Oxford University Press, 1997).

The technical difficulties of inserting functional genetic material into in vivo eggs and sperm are significant. Primary oocytes are produced from cell division while the woman is still a fetus herself and the meiotic divisions occur near the time of ovulation and fertilization. Because the insertion of genetic material generally requires an actively dividing cell, primary oocytes are a difficult target in their dormant state. The challenge with sperm is to insert successfully the genetic material into virtually 100 percent of billions on billions of sperm stem cells. Further, the insertion must be in a stable fashion that leaves the sperm functional and otherwise unimpaired. Given the limited success to date with any gene therapy, prospects for such success in humans are not on the horizon.

See Juengst E.T. , “Can Enhancement Be Distinguished from Prevention in Genetic Medicine?,” Journal of Medicine and Philosophy, 22, no. 2 (1997): 125–42.