The Ethics of Having Children Today

The concept of baby-making as something inherently simple — get pregnant, wait, hope for the best — is long outdated. But this week the act is feeling downright futuristic, thanks to news of two advances in reproductive technology: the FDA’s examination of a fertility procedure that combines the genes of three people to create a defect-free baby, and a study on existing prenatal DNA testing that has the method poised to replace other less-reliable ones, bringing prospective parents more information about their child-to-be than they’d ever imagined possible. The bits of news are just part of an expanding prenatal landscape — which now regularly includes everything from in vitro fertilization to gestational surrogacy — that’s changing our approach to having kids.

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“Even 10 years ago, this would have seemed very science fiction,” Dr. Steve Joffe, a bioethicist with the University of Pennsylvania Perelman School of Medicine, tells Yahoo Shine. Joffe is referring to the study on fetal DNA testing, which has been available since 2011 and which has a fundamental purpose, to screen for abnormalities, that’s not new. Still, he says, “there’s the potential for things to get more novel.”

That’s because what it does now — using a sample of the mother's blood to sequence DNA and look for major abnormalities, like Down syndrome, mainly for high-risk pregnancies — will most likely be expanded in the near future, to look for the likelihood of a baby's carrying the BRCA cancer gene or being afflicted with muscular dystrophy or Huntington's disease, a neurological disorder, or other conditions.

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The study, by Dr. Diana Bianchi of Tufts Medical Center and published Wednesday in the New England Journal of Medicine, looked at this method of testing in the general, or low-risk, population, which had not been done before. It found a lower false-alarm rate than in more standard ultrasounds or blood tests. And, unlike tests like amniocentesis and chorionic villus sampling, DNA blood testing is noninvasive, and carries no risk of miscarriage. 

With more studies like Bianchi’s, these tests are likely to become more available and more financially accessible for women, as insurance companies start including them in their coverage.

It's why Erik Parens, a bioethicist with the Hastings Center and author of the forthcoming “Technologically Shaping Selves,” finds news of Bianchi’s study the most indicative of where reproductive technology is headed. Meanwhile, the FDA story — about a procedure involving one woman’s defective mitochondria (power producers in cells) being replaced with healthy mitochondria from another woman, either before or after an egg is fertilized — seems more like a “red herring," he says.

“It’s getting a lot of attention, and the concern is the prospect of it opening up efforts to change nuclear DNA—and that [the procedure] will go from helping women to have healthy babies to engineering designer babies,” he explains. “The fact is, that’s looking ever less likely. It’s incredibly hard to change embryos in ways that we want them to change.” With the DNA testing, he adds, “the concern is about the more plausible scenario of testing fetuses not just for major diseases but for minor ones, and even for the increased probability of desirable traits.” It’s certainly where such testing is headed, according to various reports on the topic, and it raises a tangle of thorny issues for those facing the prospect.

For some, what it comes down to is a fundamental concern over eugenics — a highly controversial social philosophy of improving the genetic quality of the population by reproducing people with desired traits and reducing reproduction of people with less-desired ones. But Jaffe doesn’t believe those worries have much merit here. “We’re talking about technology giving people choices,” he says, as opposed to what is a horrifying history of forced sterilizations. “That, to me, is a lot less threatening.” But what’s certain to play an active role in the national discourse on genetic testing, he notes, is “abortion politics,” because with more prenatal testing, it could be argued, comes more likelihood of abortion, based on what information is revealed.

Still, Bianchi counters, “I would like to make clear that in our study there were eight fetuses with abnormalities, and only one chose to terminate.” The findings could wind up saving lives, she says, since the DNA testing produces fewer false positives than more traditional tests, and carries no chance of miscarriage as more-invasive tests do.  The goal, she says, "is to develop treatment, and to separate the idea of screening from termination.”

So how can a newly pregnant woman even begin to navigate the myriad testing options and the difficult choices the results might bring? Women can start by finding out whether they are high risk or low risk, Bianchi suggests, which affects the chances of having a baby with a chromosomal abnormality. For those with financial concerns, finding out what insurance will pay for might also help with answers.

“The question is: What does the mother want to know?” she says. “Some want to know everything — including where the child will go to college. Others say, whatever it is, I will welcome the child. And there’s a big spectrum in between.”

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