From genetic and genomic testing to new techniques in human assisted reproduction, various technologies are providing parents with more of a say about the children they have and “stirring the pot of designer baby concerns,” writes Thomas H. Murray, President Emeritus of The Hastings Center, in a commentary in Science.

Murray calls for a national conversation about how much discretion would-be parents should have. “Preventing a lethal disease is one thing; choosing the traits we desire is quite another,” he writes.

He discusses public hearings two weeks ago by the FDA to consider whether to permit human testing of a new method of assisted reproduction — mitochondrial manipulation — that would prevent the transmission of certain rare diseases and perhaps address some causes of female infertility. At issue is the safety of the technology, as well as its ethical implications.

Mitochondrial manipulation creates an embryo with the nuclear DNA from the prospective mother and father (which contains most of the genetic material) and the mitochondrial DNA (containing 37 genes) from a donor without mitochondrial defects. Among the ethical concerns is that daughters produced by this procedure could pass down the mitochondrial DNA to their children. “Up to now, the United States has not allowed such genetic changes across generations,” Murray writes.

A simmering controversy

He says that the FDA’s discussion is the latest development that “tapped into a simmering controversy over what it means to have a child in an era of increasing convergence among genetic, genomic, and reproductive technologies.” Those technologies include preimplantation genetic diagnosis (genetic analysis of embryos before implantation via in vitro fertilization) and prenatal screening to detect health problems in the fetus, including the prospects of a blood test of a pregnant woman to screen fetal DNA in her blood.

“Of all the possible choices prospective parents might make, sex selection for non-medical purposes has prompted the strongest policy response, “Murray writes. “It is prohibited in at least 36 countries, but not in the United States.” He notes that “conflicts over the legal and moral status of embryos and fetuses have discouraged American legislators from proposing sensible regulations, lest they be drawn in to the abortion debate.”

The absence of federal legislation has left the regulation of sex selection up to professional societies. But they have different guidelines, reflecting “clashing ethical frameworks for thinking about parenthood in the genomic era.”

Murray calls for a national conversation about current and emerging technologies shaping the choices that parents have, beginning with an examination by the U.S. Presidential Commission for the Study of Bioethical Issues.

“It will not be easy to avoid the quicksand of the abortion debate,” he writes, “but it would be a great public service to provide a sober assessment of the choices that would-be parents increasingly face, and to encourage a respectful dialogue about the meaning of parenthood and the worth of a child so that parents and children can flourish together.”

Abstract of Science paper

In February 2014, the U.S. Food and Drug Administration’s (FDA’s) Cellular, Tissue, and Gene Therapies Advisory Committee met to consider the possibility of future clinical trials that would test mitochondrial manipulation technologies for two purposes: to treat infertility and to prevent the transmission of mitochondrial disease from women to their future children. This meeting focused on scientific, technological, and clinical issues. The FDA acknowledged “ethical and social policy issues related to genetic modification of eggs and embryos” but chose not to engage with them, at least not yet (1). Good ethics begins with good facts, but the effort by the FDA to get the facts straight is just the beginning, not the end, of the conversation we must have on the wisdom of mitochondrial manipulation and other reproductive technologies that potentially provide parents with more of a say about the children they have. Preventing a lethal disease is one thing; choosing the traits we desire is quite another.