The commentary is about choosing to have a child with Down Syndrome and it left me with a lot to think about. A critical piece of the background here is that now one does have this choice–or at least, some people do and theoretically most can. What I mean is that (according to the article) there are now simple and very low-risk tests that can be done early in a pregnancy to tell you if the developing fetus has Down Syndrome.
The earlier post is about pre-conception genetic screening. It’s now possible to do quite a lot of genetic screening on the people whose gametes will be used to create a child. Now this is obvious importance to those using third-party gametes, where what we’re talking about is screening people who provide eggs and sperm. But why should it only matter there?
Suppose you and your husband were planning to have a child. You knew your husband’s family medical history and it revealed a tendency towards some serious condition. I suspect in this circumstance it might already be fairly common to have the husband tested to see if he carries the gene for the condition. If he does, then that gives you information about the odds that the child you create will have that condition–maybe it leads you to think about third-party sperm.
Or maybe instead it means you create embryos in vitro and have them screened (that’s PIGD) to find the embryos that do not carry the risk. (Obviously this depends on what sort of thing we’re talking about and I’m not being remotely specific enough to be concrete.) You don’t use the embryos that carry the risk but pick the ones that do not to transfer.
For many (but not all) people, this sort of preconception (or at least pre-transfer) testing and screening will be less problematic than the sort that is done during a pregnancy. I think many people would find it easier to choose among embryos than they would to have an abortion.
But it does set up similar choices. What kind of a child are you willing to have? What kinds of risks and commitments are you willing to take/make. Knowledge is power, of course, but knowledge also brings with it responsiblity for choosing. What was once left to chance is now within your control. Choosing not to test–choosing not to know–is still choosing.
I think for the moment heterosexual couples who wish to have a child together are probably unlikely to do screening or PGID unless there’s something fairly serious at stake–some risk of a seriously impairing or life threatening problem. Perhaps this is actually a virtue of our attachment to genetic connections–you are unlikely to choose to use third-party sperm in order to avoid a near-sighted child or a short child.
But once you start with PGID, it’s not hard for me to imagine the choices and challenges multiplying. If they could tell you which embryos would develop into taller children vs. which shorter, some people might take that into account. I mean, you have to choose somehow. And if they could tell you, you’d have to decide that you didn’t need to know.
I don’t mean to go all brave new world here, really. There are limits to what we can do right now. But the pace of change in this field has been incredibly rapid and it doesn’t hurt to think about what might be lurking round the corner.
For the moment the most obvious implications are for sperm and egg providers. There extensive genetic testing is far more common than it was (although reliance on family history remains important.) If consumers insist on genetic perfection than the pool of providers will grow smaller and smaller (because so few of us are genetically perfect). It will be interesting to see if some genetic imperfections (say eyesight) turn out to be acceptable after all.