Genetic Testing and Ethics

Just a brief post here on a particularly interesting article prominently featured in today’s NYT.   It’s about preimplantation genetic diagnosis–also called PIGD.  This is a topic I have written about before.

The idea with PIGD is simple, though the issues raised are anything but.  When one does IVF the pre-embryos grow to something around an 8-cell stage in a petri dish.   Without causing any harm to the developing embryo you can take one of those cells and do all kinds of genetic testing on it.   It is that ability to do genetic testing that presents ethical quandaries.

Of course, some people will say that all IVF is bad/immoral

Access to Free Contraceptives Lowers Pregnancy, Abortion Rates

For this they needed a study?  Apparently the answer is “yes.”   You’ll find news reports scattered over the media today reporting on it, but they are mostly quite similar.   Researchers provided women with free contraceptives for three years.  They gave women a choice of methods.   The result?

women experienced far fewer unintended pregnancies than expected: there were 4.4  to 7.5 abortions per 1,000 women in the study, after adjusting for age and race — much fewer than the national rate of 19.6 abortions per 1,000 women and lower  also than the rate in the St. Louis area of 13.4 to 17 abortions per 1,000  women.

Surely the causation here is pretty obvious–if women use contraceptives they do not get pregnant they do not need abortions.

A Right To Genetic Testing?

I’m going to pull away from that extremely lively discussion of surrogacy (always a fascinating topic) to talk a bit about another story that caught my eye a while back.    At the end of August the European Court of Human Rights found that Italy violated the rights of a couple carrying cystic fibrosis when it refused to allow them to do PIGD.   (We’ve talked about PIGD before on the blog.   It is pre-implantation genetic diagnosis and it allows you those doing IVF to screen pre-embryos before they are transferred into a woman’s uterus.)   To put this slightly differently–the court ruled that the couple had a right to screen the pre-embryos before transfer.

Italy is one of three European countries (the others are Austria and Switzerland) that ban use PGID. 

Why You Want A Surrogacy Contract (Even If There’s No Chance You Can Enforce It)

Two recent stories about surrogacy can be tied together here to offer an important lesson:  People who contemplate surrogacy should, at a minimum, work out a detailed agreement that describes what it is they think they’ve agreed to.   (Of course, people really ought to do a great deal more than that.  In particular, they ought to have serious counselling and engage in extensive reflection about whether surrogacy is really for them.  This, as I’ve said before, is really the key to having surrogacy work for you.)  But at the same time, you should keep in mind that what you write in the terms may not be enforcable.

First we have this story of what might be surrogacy gone awry.   Except, of course, that it may not be surrogacy at all.   

Is Being A Grown-Up All About Facing Regret?

Once again I have fallen way behind in the comments.   It’s the nature of summer, I fear.   As before, I will return to them and do my best to get caught up shortly.  Many of the topics cycle round regularly so if there are particular points I miss I trust they will be raised again and I’ll have another chance.   To the extent this is avoidance (and I know it is) it’s general (all comments) rather than specific (your comment) so please do not take it personally.

At the same time, it is important to me, too, to add new content and continue the trains of thought that wander through my mind even when I’m on vacation.   I’ve been thinking about the sorts of major decisions that are often discussed here.  Giving a child up for adoption is for me an obvious and enormous one.   Or choosing to adopt a child.   Related decisions like deciding not to have children (which might include having an abortion). 

If A Fertilized Egg Is A Person, Where Does That Lead?

There’s an article in today’s NYT about a proposal to amend the Mississippi state constitution to declare that  fertilized human egg is a person.   While the drive is primarily fueled by those opposed to abortion, the implications of the amendment are obviously broader and touch on some of the topics I often address here.

One obvious impact would be on IVF.   In IVF, embryos are created in a laboratory and then transferred into a woman’s uterus.    (Do keep in mind that some heterosexual couples do this with their very own gametes, so there’s no necessary connection to all the commodification issues that we’ve been talking about with regard to sale/purchase of sperm and eggs.)   

Genetic Testing and Sex Selection: The Messenger and the Message

This story was on the front page of the NYTimes (and doubtless a lot of other places a couple of days ago.   There’s a new over-the-counter genetic test that allows you to determine fetal sex at seven weeks.  It’s part of the general march of technology that makes a lot of people (sometimes me included) nervous.

What people worry about with this particular technological advance is the use of abortion for sex selection.   Women have a right to elect abortion at seven weeks.   (And if you’re wondering, I’m committed to that right.  I know other people disagree, of course.)   I’m prepared to assume that for some women it is easier to elect abortion early on in the process. 

Parents and The Right To Change Your Mind

My last post was about a surrogacy arrangment gone badly wrong.   A woman who had agreed to serve as a surrogate changed her mind, which lead to a struggle between her and the (unmarried) woman she’d made the agreement with.    At the very end I cited some statistics that show that it’s quite infrequent for a woman whose agreed to be a surrogate to change her mind.    (This may be surprising, but I think that is because the instances where she does change her mind often engender eye-catching litigation.)    

The same statistics show that  the people commissioning the surrogacy (the intended parents, they are sometimes called) more frequently change their minds than does the surrogate.   I will confess that I’ve given very little thought to how to deal with cases where it is the commissioning individual or couple who wants to undo the deal.    And this leads me to think more broadly about the question of when you get to change your mind in matters of parentage.  This has to do with far more than surrogacy. 

Odds and Ends

I’ve got a three little notes to myself I’ve been meaning to cover here.  I think I’ll just lump them together, though they are not necessarily related.   Just things that might be of interest.

–There’s a new book out called Bad Mother by Ayelet Waldman.   I have not read the book yet (though I hope t0) but Terry Gross did a very thought-provoking interview with Waldman on Fresh Air.  It’s that interview I want to recommend.   There’s a discussion of abortion, in part about the language of abortion and generational shift, that I’m still mulling over.  If you go and look soon you can still download the podcast, I think.

–Also from the radio, but on a different note, this past Saturday Weekend Edition had a little Mother’s Day essay by Alice Furlaud.   She includes discussion of the rescue of three stranded dolphins in Wellfleet,

A slight detour to China’s emerging gender imbalance

This is really a bit tangential, but I think it’s worth a short note.   This article (curiously, though it bears a New York Times reporter’s byline, the version in the NYT is shorter than the one I’ve linked to) discusses a new study on China’s emerging gender imbalance.

Because of sex selection during pregnancy (female fetuses are aborted), there are significantly more young boys than young girls.   The preference for boys arises in part because boys are obliged to support their parents as the parents age, while girls are presumed to marry and assist their husbands in supporting the husband’s parents.   In addition to leading to wide use of sex-selective abortion, the preference for boys has also lead to the creation of a market for stolen boys.   I touched on that last week.

What interests me is this passage, present in the Seattle Times version of the article but not that of the New York Times:

The gender imbalance could trigger a slew of social problems, including a possible spike in crime by young men unable to find female partners, said an author of the report.

“If you’ve got highly sexed young men, there is a concern that they will all get together and, with high levels of testosterone, there may be a real risk that they will go out and commit crimes,” said Therese Hesketh, a lecturer at the Centre for International Health and Development at University College London. She did not specify what kinds of crimes.