Ethical Issues of Reproductive Technologies: Designer Babies, Sex ...

Ethical Issues of Reproductive Technologies:
Designer Babies, Sex Selection and Donor Babies
Rachael Caffrey, 5 th Year Medical Student, Queen’s University
Belfast
Address for Correspondence: School of Medicine, Dentistry and Biomedical
Sciences, Queen’s University Belfast, 71-73 University Road, Belfast BT7 1NN. Email:
rcaffrey01@qub.ac.uk
The technology of assisted reproduction has progressed rapidly in recent
years, enabling infertile couples to have the children they long for.
However, with these advances come numerous ethical dilemmas .This
essay looks at three important areas of reproductive technologies;
‘designer babies’, sex selection and ‘donor babies’, which all raise their
own ethical issues; ethical arguments for and against each are
discussed. ‘Designer babies’ describes the use of several technologies,
particularly Pre-implantation Genetic Diagnosis, which give parents an
element of control over their offspring’s characteristics. The dilemma is
whether it is ethical to design babies by selecting an embryo in this way.
The main argument for these techniques is that they can help prevent
certain genetic diseases. The main argument against is that of the
‘slippery slope’ towards designing babies for physical or psychological
traits. Sex selection for medical reasons is largely accepted as ethical,
but when carried out for non-medical reasons, is met with objections.
The case for permitting sex selection for non-medical reasons is that it
serves the desires of couples who have strong preferences regarding the
gender of their offspring. However, this raises worries regarding gender
discrimination and inappropriate use of medical resources. ‘Donor
babies’ refers to the use of donated gametes by infertile couples. There
is much debate on the acceptability of gamete donation in circumstances
where infertility is due to psychosocial factors e.g. in lesbian couples or
post-menopausal women. A major argument against oocyte donation to
older women is that there is a ‘natural’ limit to reproductive capacity and
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to transcend this would be ‘unnatural’, balanced against an argument of
‘reproductive freedom’. New reproductive technologies are helping
infertile couples have the children they yearn for, and additionally, are
saving lives and preventing disease. However, there are clearly many
ethical issues and contrasting viewpoints to consider with regards to
these technologies, and it must be remembered, that regulation is
important to avoid the use of these powerful technologies for
inappropriate purposes. J NI Ethics Forum 2008, 5: 87-96
Introduction
The technology of assisted reproduction has progressed at a rapid pace
in recent years, enabling many otherwise infertile couples to have the
children they long for. [1],[2] Conception, pregnancy and childbirth, formerly
an indivisible process, can now be considered as separable stages of
reproduction. [3] With these advances however, come numerous ethical
dilemmas. In this essay I will look at three areas of reproductive
technologies; ‘designer babies’, sex selection and ‘donor babies’, and
discuss the ethical arguments for and against each one.
Designer Babies
‘Designer babies’ is a term that has become part of everyday language,
though it was a term initiated by journalists rather than scientists. [4],[5] It
describes the use of several reproductive technologies, all with one thing
in common; they give parents an element of control over the
characteristics of their offspring. [5] The technique at the centre of the
debate about designer babies is Pre-implantation Genetic Diagnosis
(PGD), which brings together two technologies: in vitro fertilisation (IVF)
and genetic testing. [4] The dilemma is whether it is ethical to design
babies by selecting an embryo in this way. [5] The main argument for
these techniques is that they can help prevent certain genetic diseases
e.g. single gene disorders such as cystic fibrosis, and chromosomal
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abnormalities such as Down’s Syndrome. [6],[7] In this way they can save
children from debilitation and suffering and reduce the financial and
emotional strain on the parents. [6] Furthermore, Verlinsky [5] tells us these
techniques are used only by those requiring the help of a fertility clinic to
have children, and therefore argues that since these people have
invested so much time, energy and money in their effort to have a baby,
shouldn’t they be able to ensure they have a healthy child? Another point
to be noted is that many naturally conceived embryos are rejected from
the womb due to disordered growth, and so it can be argued by
screening embryos we are simply doing what nature would normally
do. [5],[6]
However, one argument against using PGD to prevent disease is that of
the ‘slippery slope’ argument. The worry is that we could get carried
away ‘correcting’ babies. [6] The Human Fertilisation and Embryo
Authority (HFEA), who regulate the use of PGD, state that it should only
be used for detecting “very serious, life threatening conditions” and not
for minor abnormalities, but ‘serious’ is difficult to define in this context. [7]
Where do we draw the line? Furthermore, from a disability equality
perspective, every life is of value and our diversity as a species has
innate value. Therefore, to discriminate against an embryo, which could
go on to become a person with a disability or disorder would be
considered wrong. [8] Moreover, once on this slippery slope what is to stop
us choosing babies for their physical or psychological traits? [5] The path
from therapy to enhancement is a continuum rather than a clear and
obvious dividing line. [9] It is argued this could be the first step towards
allowing parents to choose other characteristics of their baby such as
eye or hair colour. [10] There is always the looming shadow of eugenics
and ‘improving’ the gene pool by the elimination of ‘undesirables’, in this
case, undesirable embryos. [5]
On the other hand, opposing this argument is the fact that merely
asserting that this is the first step towards allowing parents to choose
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other characteristics is inadequate. [10] Through the use of careful
regulations PGD could be used for some reasons and not for others,
thereby avoiding a ‘slide down the slope’. [10] One form of ‘designing
babies’ I have not yet considered is that of using PGD in conjunction with
tissue typing to select an embryo for implantation that will go on to
become a ‘saviour sibling’; a brother or sister capable of donating lifesaving
tissue to an existing child. [10] An argument particular to this
technique is that saviour siblings would be treated as mere commodities,
not wanted for their own sake, but for some other purpose. [10] In the
words of Kant’s famous dictum, “Never use people as means but always
treat them as a end”. [7] However, in reality many children are born for a
purpose: as a companion to a sibling, to ‘pass on the family name’, or
bring happiness to the parents. Therefore, providing parents love their
child, it is argued there is no harm in that child benefiting another. [7]
Having discussed these issues I feel that using PGD is something that
should not be done without careful consideration on behalf of the parents
involved. Choosing which embryo to implant and which to discard is not
an easy choice, nor should it ever be. [11] Nonetheless, in my opinion any
technology that can reduce pain and suffering is one to be considered,
be that by preventing a life of suffering or by easing the anguish of an
existing child. By the implementation of regulations I believe this
technology could be used for good, and any trivialisation of the technique
to ‘design babies’ for cosmetic traits could be prevented.
Sex Selection
Another issue to consider is that of sex selection. The two main
techniques used for this are, again, PGD or alternatively, sperm sorting.
The HFEA’s recommendation is that sex selection should only be
available “in cases in which there is a clear and overriding medical
justification”, referring to the avoidance of sex-linked genetic conditions
such as Tay-Sachs. [12] The British Medical Association is concurrent with
this. [13] The main focus of ethical objections to this technique are linked
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with sex selection for non-medical reasons, with there being less debate
over the ethical validity of sex selection when its aim is to prevent the
transmission of sex-linked disease. [14] Taking this into account, and as I
have already discussed the use of PGD to avoid genetic diseases, we
are presented with questions such as: if a couple have two sons and
desire a daughter, should they be allowed to employ this technology? [15]
The case for permitting sex selection for non-medical reasons is that it
serves the desires of couples who have strong preferences regarding the
gender of their offspring, some of whom feel so strongly they may resort
to abortion or choose not to procreate unless the gender of their future
baby can be determined. [16] Then again, one can question whether
desire alone justifies acceptance of their preference, especially when it is
a preference which is often self-imposed. [16] One suggested argument
against the use of this technology in this way is that it constitutes an
inappropriate use of medical resources. However, according to the
American Society for Reproductive Medicine (ASRM) preconception
gender selection (i.e. sperm separation followed by artificial
insemination) is unlikely to drain substantial resources from the medical
system. [15] Another ethical issue surrounding sex selection is that of
gender discrimination and, furthermore, that offspring produced will be
expected to act in certain gender specific ways. [15] Some argue that
although the motivations for desiring a child of a particular sex vary, other
than in the case of preventing a sex-linked disease, there are no nonsexist
reasons for pre-selecting sex. [15] Furthermore, there is the worry
that sex-selection will lead to adverse social consequences due to an
unbalanced sex ratio. It is likely though that only a small percentage of
the population would request sex selection, therefore the impact on the
sex ratio would be minimal. [1] Alternatively, if sex selection were to
become very popular, laws could be introduced requiring providers to
select both genders in equal numbers thereby avoiding a shift in the sex
ratio. Although it could then be argued that the institution of laws in this
way would result in a decrease in procreative liberty and defy the
purpose of the procedure! [15] An alternative argument against sex
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selection is based on the parental virtue of acceptance. When an
individual becomes a parent society expects him or her to maintain that
role regardless of the specific characteristics of their child. [12]
McDougall [12] proposes that it is an intrinsic feature of a child that his or
her characteristics will be unpredictable. Even if their entire genetic
make-up were known, the complexity of the child’s environment makes
their characteristics, to some extent, unpredictable. Therefore, it follows,
since a child’s characteristics are unpredictable, acceptance of those
characteristics is a parental virtue. [12] A child’s sex would fall within the
scope of this parental virtue of acceptance and on this basis sex
selection would be regarded as wrong. McDougall [12] does acknowledge
however, that acceptance is only one in a range of parental values and
others, such as concern for a child’s opportunities, can conflict with this.
Whilst I recognize that sex selection would satisfy the desires of couples
to ‘balance’ their families, I feel that other than in exceptional
circumstances, sex selection should only be available for medical
reasons. I believe concern with gender, be that male or female, is not
something to be encouraged. [16] Gender is not a medical condition, but
rather, a characteristic to be accepted by parents. Therefore, I see no
compelling argument to justify the use of this technology for social
reasons.
Donor Babies
A final area to look at is that of ‘donor babies’ or the use of donated
gametes. For infertile couples who lack sperm or oocytes this may be
the only solution to enable the accomplishment of a parental offspring. [17]
Gamete donation was introduced to address various medical problems,
and is indicated where there is no possibility of pregnancy without the
technique, or when other treatments have a minimal chance of
success. [1],[17] Such circumstances include the use of donated oocytes
where a woman has suffered premature ovarian failure or because
treatment such as chemotherapy has rendered her infertile. [18] It can
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also be used to evade transmission of a genetic disease to the
offspring. [17] These uses all fall into the realm of medical treatment and
pose no unique ethical problems. Major ethical issues arise however,
when the practise is used for non-medical reasons. There is much
debate on the acceptability of gamete donation in circumstances where
the infertility is due to psychosocial factors such as, in, lesbian couples or
post-menopausal women. [19],[17] It is this use for older, post-menopausal
women that is often debated and the area that I will focus on. Oocyte
donation has been used for infertile women over the age of forty when
IVF with their own oocytes has been unsuccessful and there is no
explanation other than age for their infertility. The use of younger
women’s donated eggs proved highly successful and paved the way for
their use in postmenopausal women. [1] In this way a woman’s
reproductive age has been artificially extended. [19] A major argument
against oocyte donation to older women is that there is a ‘natural’ limit to
reproductive capacity and to transcend this would be ‘unnatural’. [19]
Furthermore, parenting can be a physically demanding, energyconsuming
task and it is thought that older parents may be unable to
meet the needs of a growing child. [1],[19] However, it can be pointed out
that it is not unusual for children to be raised by grandparents and it is
therefore put that older people are capable of fulfilling parental roles. [1]
Arguments in favour are based on gender equality and reproductive
freedom. It is argued that since older men may father children naturally,
denying woman an alternative to reproduction at the equivalent age is
sexist, especially since women generally live longer than men. [19],[20]
However, there are real concerns regarding the health of the recipients.
In a postmenopausal pregnancy the woman faces increased risk of
complications such as hypertension, diabetes, and preterm labour. [19]
There are also concerns surrounding the interests of the child who, some
feel, may be adversely affected psychologically and socially, and may
resent having a mother old enough to be their grandmother. [19] In
addition, there is the concern that there is increased likelihood that one
or both parents will die before the child is raised. [1] Nonetheless, it
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should be noted that individuals with life-limiting illnesses are not
prohibited from reproduction because of their shortened life
expectancy. [19] In addition, Strong [1] makes the point that if a couple
were to have a child at the age of 60, on average the life expectancy for
the woman would be another 23 years, and for the man, another 19
years. Thus, on average the child would be a young adult before its
parents died. Having considered the above arguments I feel we cannot
say absolutely that oocyte donation to older post-menopausal women is
‘right’ or ‘wrong’. Whilst it can be argued that infertility should remain the
natural characteristic of the menopause, I do not consider this reason
persuasive enough to deem the practice unethical in every case. [19]
There are many factors we have to take into account, such as the
woman’s age, health, and personal circumstances. The specifics of each
case should be carefully considered by the prospective parents and
physician involved before choosing oocyte donation. [19]
Conclusion
There are clearly many ethical issues to consider with regards to
reproductive technologies and many viewpoints to be looked at, all of
which cannot be included in the constraints of this essay. New
reproductive technologies are helping infertile couples have the children
they yearn for, and additionally, are saving lives and preventing disease.
The good it will bring about is the moral motive for intervening in the
natural lottery of life. [21] It must be remembered however, that
regulations must be set in place to avoid the use of these powerful
technologies for inappropriate purposes.
Rachael undertook the 2 nd Year Student Selected Component ‘Reproductive
Technology” co-ordinated by Professor Sheena Lewis, School of Medicine, Dentistry
and Biomedical Sciences, QUB in spring 2006 and was joint runner-up in the Forum’s
2006 Essay Competition.
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References
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[5] Verlinsky Y. Designing Babies: what the future holds. Ethics, Law
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