Why Genetic Screening Should Be Mandatory

Fertility clinics can now identify and prevent the implantation of embryos with known genetic defects. For the first time we have the technical ability to determine whether or not certain babies will be born and what characteristics they’ll be born with. 

This idea was suggested by Big Think Delphi Fellow Jacob M. Appel.

What's the Big Idea?

Since the late 1980’s, advances in genetic engineering have been so rapid–the Human Genome project famously wrapped a full three years early—that fertility clinics can now identify and prevent the implantation of embryos with known genetic defects. “For the first time we have the technical ability to determine whether or not certain babies will be born and what characteristics they’ll be born with,” says Jacob M. Appel, a bioethicist who spends days at New York's Mt. Sinai counseling patients on reproductive choices and nights teaching medical students to navigate the hot-button issues that are an increasingly important part of the doctor’s role.

Traditionally, research has focused on conditions (like Tay Sachs) that arise from the mutation of one specific gene, rather than on characteristics such as height or weight, which involve complex and variable interactions among multiple genes. But Appel estimates that major breakthroughs in “enhancement technology”--actively seeking out desirable traits--are just a decade away, and that the dream of “designer babies” could soon be reality. 

The goal of bioethics is to give people the technical and emotional tools to make their own decisions as rationally as possible in a complicated and sometimes tenuous scientific landscape. Appel believes that because there's no physical need to undergo IVF, those who do so are morally obligated to have their embryos screened for genetic defects prior to implantation, and such screening can legitimately be made mandatory. (Current policy tends to be more conservative: in Britain, for example, special permission is required to screen for a particular disorder.) 

In contrast, the decision of whether to opt for enhancements--as the technology to select a child’s hair color, eye color, or even aptitude for certain skills becomes available--should be left to prospective parents, who Appel says make the same choices (albeit more subtly) outside the test tube. “We allow people to date tall, handsome men; we allow people to raise their children in all sorts of ways. The idea that everyone is going to want a child with blue eyes and blond hair, that diversity will decrease as a result of this is wrong. My strong guess is that people will not want to have that kind of ‘ideal’ child, but to have children who look and act like them.”

And while public sentiment about genetic engineering tends to fall somewhere between alarmist dystopian scenarios and a valid critique of the indefensible history of eugenics, Appel argues that the benefits far outweigh the risks: “I realize that I’m in some sense embracing a genetic free-for-all. There’s no guarantee we’re going to get what we want to get, and even when we’ve isolated traits, there may be other traits that come along with those traits that we don’t know about.” However, relying on Mother Nature can be just as precarious. “When people are approaching these issues, they need to think about what is desirable, not just what is natural. Infectious diseases are natural.”

What's the Significance?

Technological advances don’t have to be anti-egalitarian. In fact, if executed fairly, genetic engineering could be a social equalizer. "Right, now only very wealthy people can afford to provide resources like full-time tutors and tennis instructors for their children," says Appel. Universal access to genetic enhancements might even the playing field. Equally important is access to bioethics education, which should start as early as high school. "The idea that patients are asked to make these decisions about reproductive issues with no experience--which is sort of how things work now--is not a very effective model."

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