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ss nucleus - summer 2007,  Thinking through... pre-implantation genetic diagnosis

Thinking through... pre-implantation genetic diagnosis

Not content with 'textbook' answers, Paul Barker explored it for himself

To be quite honest, I began looking at this topic of the genetic testing of embryos in a biased way. I hoped to find a way in which these amazing developments in biotechnology could fit in with my Christian faith.

I previously heard Christians saying that pre-implantation genetic diagnosis (PGD) was just earlier prenatal eugenics or an early form of abortion, but I felt this was harsh and probably unfair. I could see the benefit of a firm standpoint, but I felt that it lacked compassion for those who believed they needed the technology.

what is PGD used for?

Testing of embryos with PGD is a major scientific development. It allows analysis of the genetic makeup of an embryo, created in the laboratory by in vitro fertilisation (IVF), to show whether or not it is likely to develop certain diseases. This technology is used for research and in selecting embryos for implantation.

In the UK, the use of PGD is limited to certain genetic conditions such as Huntington's chorea and cystic fibrosis. But as we discover more about the human genome, the list of conditions that can be tested for is increasing.

Several embryos are formed in vitro, and these are then tested for genetic conditions. In each IVF cycle, two or three of those which are believed to be healthy and free from the conditions are implanted. The remaining genetically 'OK' embryos are frozen for a finite amount of time. They may be implanted at a later date or used for research if parental consent is obtained.[1] Those deemed genetically 'imperfect' are destroyed or, more gently put, left to 'succumb'.

turning a blind eye

The more I looked at this topic the more questions I found, many of which our society is ignoring. Perhaps this is because the questions are difficult and many of the answers that they present are rather unpalatable.

Facing these issues head on takes courage and it is undoubtedly difficult. However, if you believe in absolute truth as I do, then only one option can be absolutely right. It is a duty of Christians to keep seeking to answer that sometimes difficult but always crucial question, 'what would Jesus do in this situation?'

If Jesus was a GP, would he send an infertile couple for IVF? Or would he tell them that it was not his will for them to have children? Perhaps they should consider adoption? Either way, I am sure he would spend time counselling them and meeting them in their time of hurt and disappointment, with an empathy we cannot comprehend.

the status of the embryo

It is fundamental to decide when human life begins in order to form consistent opinions on ethical issues in early life such as abortion, cloning, IVF, prenatal diagnosis (PND) and PGD. In all of these, it is the status of the human embryo that is really at stake. This is an area that many people disagree on, Christians included.

As far as I can see, there are only two options that make sense. Either an embryo has the same value and rights as a human being from the point of conception, or it is a genetically identical person seedling of a lower status. Until some latter point in its development when it becomes a human, the two are not the same. The exact point could be birth, 'quickening', development of a primordial streak or another event, which we may not be able to detect.

The problem with the second option is that there is no consensus or obvious answer as to when this point of change occurs. My view is that we ought to work our way backwards to be safe. Even if we believe human life does not actually begin at conception, but at a later point that we cannot define, the only morally acceptable view may be to err on the side of caution. This gives the embryo the benefit of doubt.

The Bible does not speak explicitly of the status of the embryo. However, it does tell us that God knew us and had a plan for our lives before we came into being and that he has a relationship with us during our time in the womb.[2]

The beginning of life cannot be explained by our limited human perspective. Professor John Wyatt said, 'the human embryo is on a journey of becoming what it already is.'[3] This may seem nonsensical to secular thinkers, but it is not so difficult for me to comprehend. After all, when a person becomes a Christian they are granted an immediate status of righteousness before God, even though they have a long way to grow in wisdom and spiritual maturity.

the cost of eliminating disease

Disease was not part of God's original design. Rather, it is a consequence of the fall of man.[4] God does not want people to suffer unduly, but I don't believe that this God would eliminate disease at all costs. Eliminating a disease, or its burden, by vaccination or treatment is a very different proposal to killing everybody who will develop that condition. If this took place at a point after birth, we would not even entertain the notion.

Was it not partly the world's disgust at Nazi eugenics that led to the largest war our planet has known? As I believe that both prenatal and postnatal eugenics are equally and absolutely wrong, I am alarmed and deeply worried by the direction in which the UK government is allowing the application of this technology to go.

To use this technology for a given condition, not only must we look a person with that condition in the eye and tell them that 'it would be better if you did not have that condition', we must also be prepared to say, 'it would be better if you had not been born'. Somebody else would have to decide whether they should be allowed to exist. I could not do that, nor do I envy anyone who thinks that they can.

Good disabled access, public facilities and care for those with congenital disability or disease is wholly reasonable, appropriate and proper. But to claim the right to control their entry to society is inconsistent; I consider it uncaring and cowardly.

an 'economics' approach

PND leading to abortion can be compared with PGD leading to the destruction of an embryo. Many would say that PGD is the lesser of two evils when patients adamantly believe they require one of the two options. Firstly, a fetus can feel more pain at later stages of development.[5] Secondly, few would deny that the mother, father, the supporting community and the team performing the procedure, would suffer more as the gestational age increases. The absolute consequences are equal in that a human life is terminated, but the suffering caused to the fetus or embryo and the parents are clearly greater with PND and abortion.

However, I am deeply uncomfortable as a Christian with using the 'lesser of two evils' argument to justify any action. Surely there can be a third, better way, be it better care of those with congenital diseases or more support for the families of such children? Do we not learn more about humanity, and the heart of God, from the weak than we do from the strong?

a surprising conclusion

After exploring this topic, I did not arrive at the destination that I had hoped for. In many ways I was disappointed. But looking at this issue in depth altered my views on other ethical issues relating to the beginning of life. It led me to believe that IVF, as practised in the UK, is at odds with my beliefs about the sanctity of life and when life begins. Currently, too many embryos are produced, so those that cannot be implanted are discarded.

To be a witness for my faith, it is crucial that my ethical viewpoint is consistent. This is both a challenge and a responsibility when looking at medical ethics. The issues are not going to go away and it is the duty of our generation of Christian medics to stand firm. It is the duty of Christian communities to speak up with the voice of reason. We need to remind the scientific community that, as history warns us, being able do something does not necessarily mean that we should do it. I think the continued use of this technology is opening up Pandora's Box.

I do not think I could personally advocate PGD and maintain my moral integrity as a Christian medical student or doctor. I humbly concede that I am by no means an expert and my research in this topic has been limited. But I do ask one thing, that those who are working with this technology make the effort to think through the issues. What sort of society will result from its continued use?

Useful resources

  • Wyatt J. What is a Person? Nucleus 2004; January:10-15
  • Wenham J. Ethical Enigma 15. Nucleus 2006; April:36,37
  • Misselbrook D. Speciesism. CMF File 26. London: CMF, 2004
  • Saunders P. Submission to the HFEA on PGD. Available from www.tinyurl.com/yuppev
  • Gattaca – Columbia Pictures, 1997 – a film depicting a future society where PGD is widely used.
References
  1. www.hfea.gov.uk/codeofpractice
  2. Ps 139:13
  3. Wyatt J, Yu V. Selective non-treatment of newborn babies and the role of embryonic stem cells (seminar). ICMDA World Congress 2006
  4. Gn 3:1-24
  5. Lee S et al. Fetal Pain: a systematic multidisciplinary review of the evidence. JAMA 2005;294:947-954
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