Preimplantation genetic diagnosis (PGD)—the screening of human embryos created in vitro for disease-related genetic mutations—was once an exceptional test performed by only a small number of patients undergoing IVF. Today, it is no longer a rarity, but a common step within the IVF process. According to the American Society of Reproductive Medicine, the proportion of IVF cycles using PGD increased from 14 percent in 2014 to 44 percent in 2018. Certain types of PGD tests have become especially common, including screening for aneuploidy, or chromosomal conditions like Down Syndrome.
Rising rates of PGD may reflect a belief that genetic screening of embryos is part of responsible procreation. After all, if you have the ability to test your IVF embryos for serious medical conditions and prevent your child from having a life of chronic illness or disability, why wouldn’t you? But if we accept this view, it is not clear why we should stop at disease traits and not also screen for desirable, non-disease traits. Should we, for example, select for traits that place new human beings above a statistical average of human ability or appearance?
These questions have acquired greater immediacy as reproductive medicine expands into screening to select for desirable, non-disease traits like enhanced mental and physical abilities. Biotech startups are emerging offering parents the chance to select against disease but also to choose embryos with advantageous traits like height, athleticism, and intelligence. Controversial US startup Heliospect Genomics has been offering wealthy couples undergoing IVF the ability to screen embryos for predicted IQ and other traits, charging up to $50,000 for screening 100 embryos. The company claims its methods can increase IQ by more than six points and uses data from the UK’s taxpayer-funded Biobank to analyze genetic markers for intelligence, height, and risk of obesity and mental illness. The company’s CEO, Michael Christensen, envisions expanding these capabilities to include screening for personality traits, and claims they have already worked with more than a dozen couples with “babies on the way.”
This kind of genetic testing is called polygenic embryo screening, and it allows scientists to screen for clusters of genetic traits that are positively correlated with life outcomes like educational attainment or personality traits. Polygenic embryo screening appears to have wide public support and is likely to become more common in the coming years despite being notoriously inaccurate and incapable of predicting the various lifestyle factors that influence expressed characteristics. We are, it seems, moving closer to an era of so-called “designer babies.”
Given this, there is reason to worry about a creeping form of eugenics that is becoming increasingly entrenched in fertility medicine. Eugenics—an ideology that advocates public campaigns to ensure our children are well-bred and to eliminate undesirable genes from a population—was once a widely influential ideology in America and Europe. It led to widespread forced sterilization of people with disabilities across America in the first half of the twentieth century and the mass extermination of people with physical and mental disabilities in Nazi Germany. In the infamous Buck v. Bell Supreme Court decision, which upheld a Virginia statute instituting compulsory sterilization of the “unfit,” Justice Oliver Wendell Holmes advocated for preventing “those who are manifestly unfit from continuing their kind.” Terrifyingly, US sterilization regimes were an inspiration for Nazi sterilization programs, and Nazi doctors at the Nuremberg Trial attempted to justify the mass sterilizations of people with disabilities and ethnic minorities by quoting Holmes’ opinion in Buck v. Bell as well as the work of other American eugenicists.
In the aftermath of the Holocaust, eugenic practices like forced sterilization were widely condemned and the genetic theories peddled by prominent eugenicists were discredited as pseudo-science. A eugenic mindset has, however, been latent in medicine in recent decades in practices such as the genetic screening of embryos and abortion on the grounds of disability. We should not be naive about the fact that PGD typically leads to the destruction or indefinite storage of embryos that possess genetic mutations for disease and disability. PGD thus reinforces problematic assumptions about human genetics, particularly genes associated with disabilities like Down Syndrome, and is arguably a form of eugenic genetic selection in human reproduction.
Recent years have witnessed an emboldened defense of eugenic practices in embryo screening notwithstanding the dark history of forced sterilizations and systematic elimination of people with disabilities. The philosopher Nicholas Agar argues in the 2004 book Liberal Eugenics: In Defense of Human Enhancement that parents should be allowed to enhance their children’s characteristics. “Hitler and GATTACA have made eugenics an unpopular idea,” Agar suggests. He is referring to the 1997 film GATTACA, which depicts a future society where genetic engineering has created a class system between “valid” (genetically enhanced) and “invalid” (naturally conceived) humans. “However, being unpopular is not the same as being wrong,” Agar writes. In an ideal world, prospective parents would be able to use assisted reproduction to select for desirable traits based on their own personal conception of the good. Crucially, this would not deny reproductive choices to individuals looking to parent children, nor would it create social classes of superior and inferior children. Rather, it would give enhanced choice while ultimately respecting people’s right to choose whether they will become parents and to decide what kind of child they will bring into the world.
Some bioethicists, however, go as far as to argue that we have a duty to maximize the well-being of our future children by selecting for certain desirable traits (such as intelligence, health, or emotional stability). Prominent Australian bioethicist Julian Savulescu, for example, asserts that exercising this choice is an ethical duty because it promotes the overall welfare of future generations. Savulescu calls this duty the principle of procreative beneficence. Savulescu’s argument is controversial, but it seems to follow logically as an implication from taking radical control of the process of human conception, as is the case in IVF. If we take what are otherwise natural biological processes of reproduction into human control, we take responsibility for the outcomes of these processes. If we are indeed responsible, then we have a duty to try to obtain the best outcome possible.
Philosopher Jonathan Anomaly, a senior staff member at Heliospect Genomics, suggests in a recently published book—Creating Future People: The Science and Ethics of Genetic Enhancement—that genetic screening and gene editing of embryos for eugenic purposes is an inevitability:
Eventually, more elites will openly use the technology, and a preference cascade will cause more people to move from reluctance and condemnation to support for embryo selection, and eventually gene editing.
The question for Anomaly is not whether we use the technology, but rather, how we use the technology and how we go about deciding what kinds of people we want to bring into the world.
The revival of eugenics in the context of assisted reproduction is deeply concerning, but it also betrays what is ultimately the fundamental moral and metaphysical problem with PGD and IVF more broadly. They represent a form of radical control of the process of conception whereby life goes from being gifted to being made. Life becomes a human creation which some argue we have a duty to craft in a perfect manner. In genetically screening IVF embryos, we take control over and alter the givenness of human life. We subject embryos to our will by not only conceiving them outside the womb but also screening them to assess their disposition to disease. Parents then choose which embryos to proceed with for pregnancy and which to discard. This is, in a very fundamental way, a contravention of the dignity of early human life.
The only way to avoid the radical eugenic obligations arising from new genetic screening technologies is to insist on the notion that embryos are human beings, not mere products, and that human life ought to be received into the world as a gift rather than subject to the technological manipulation of IVF medicine. As Christopher Tollefsen wrote recently in these pages,
in IVF, children are made, and made in the manner of a thing: at the will and desire of another. . . . But children, it bears saying despite the obviousness of the claim, are neither desks, nor cars, nor houses: they are not things at all. And the conditionality of desire that we reserve for things, discarding when they are not up to standard, improving according to our desires, is incompatible with the unconditionality of love that should accompany parenthood.
We need to treat children as human beings who are our moral equals and who, even in their embryonic stage, ought to be treated as persons and not as objects to be made and manipulated. This is not to say that we do not try to prevent and cure disease where possible. But this admirable aim should not be confused with technologies that objectify early human life and rob it of its moral standing.
To be clear, PGD does not “cure” genetic flaws in IVF-conceived embryos. Rather, it allows us to identify embryos that do not possess genetic abnormalities and to implant these embryos alone. This is an important distinction as some may be tempted to justify PGD by saying that it is a treatment for genetic disease. This is a mistake. It is not a treatment, but rather, a form of diagnosis that allows us to determine if an embryo carries a specific genetic mutation, then avoid implanting those particular embryos that are deemed defective.
The implications of genetic screening, however, extend far beyond the potential to prevent genetic diseases. By selecting embryos based on genetic information, society has found itself on a slippery slope toward a so-called “positive eugenics” that aims not only at health but also the selection of “desirable” non-disease traits.
While PGD may offer enhanced choice to prospective parents, it is not a cure, and we must consider how the line between enhancing fertility treatments and selective eugenics is being blurred. IVF and its accompanying procedures have been framed as a public good that allows people to have healthy children and prevent the transmission of genetic disease. President Donald Trump recently described IVF as “beautiful” and pledged to support the availability of IVF services available in every US state.
But this framing of IVF as an unqualified good ignores the fact that practitioners are ushering in a new age of genetic selection under the auspices of therapy. To avoid this dystopian outcome, we need to seriously reconsider the use of genetic screening as “treatment” for genetic disease. More broadly, we also need to re-embrace the joy of risk that comes as part of accepting human life as a gift that is graciously received, not tailored to our preferences and risk appetite. This, rather than the reinstatement of eugenic norms, is what true progress in our use of biomedical technologies looks like.
Image by Maria Sbytova and licensed via Adobe Stock.
