Picking the Best Baby
As harsh as the language is, we must ask ourselves: "Are we on a search-and-destroy mission to wipe out certain groups of people?"...
[A]re we implementing a new eugenics and, if so, what are its dangers? To respond we need to take heed of history....
Whether or not we like it, the message we will be delivering at the societal level is: "We don't want you in our society unless you measure up to a certain genetic standard. You are only a potential member, until you've passed the admission test that we are willing to pay for with our tax dollars and implement."
The unavoidable collective impact of these decisions is the implementation of negative eugenics with respect to disabled people and it's disingenuous to deny that.
Negative eugenic practices have historically taken various forms, from infanticide, on to prenatal testing and selective abortion, and then to preimplantation genetic diagnosis (PGD) in the last two decades. With the price of genetic sequencing plummeting, the next step becomes apparent. The technology behind the wide genetic scans offered by companies such as 23andMe could feasibly be used on an entire batch of blastocysts in a fertility treatment, enabling prospective parents and clinicians to pick the genetically "best." Such a process was just described by the assisted reproduction and stem cell company Reprogenetics, at a recent meeting of the American Society for Reproductive Medicine.
What might be the cost of a wide-scanning PGD? Traditional PGD presently costs a few thousand dollars over the price of basic in vitro fertilization, and has been used to select against a single gene at a time, generally one related to a serious disease that is known to be carried by one or both of the parents. As a baseline for some "back of the envelope" calculations, the service of 23andMe, which tests for 91 genetic variations, currently costs $400. At this price, applying it to an entire cohort of a dozen blastocysts, even with additional costs for extracting a single cell from each and amplifying their DNA, may become competitive.
If the additional cost of such a procedure were just a few thousand dollars, then prospective parents who already are using IVF may find it hard to resist. But could this become even more widespread? I would not rule out the future use of wide genetic scans for natural pregnancies. This would sometimes be followed by selective abortion, just as it now sometimes is for sex selection. In fact, there's a good chance genetic testing could be done using a pregnant woman's blood at just five or six weeks gestation, as is currently done with prenatal sex determination and possibly soon for monogenetic diseases such as cystic fibrosis.
But wide adoption may hinge on the cost-benefit analyses of insurance providers. In jurisdictions where a new baby is likely to have the same insurer for much of its life, such as nations with single payer health care, some may argue that the cost of a wide genetic scan plus IVF would warrant coverage in order to ensure a "genetically healthy" baby, even if there is no indication of genetically-related disease in the parents.
Of course, IVF remains a physically unpleasant process, and many parents would decline the service, even if free. At what point, though, might they face pressure from their insurer, government, or society at large to be sure their child will be the healthiest possible?
Previously on Biopolitical Times: