The medical risk-benefit calculus changes when people choose to do IVF for the sole purpose of undergoing PGT-P (still unvalidated and of limited utility) as opposed to adding PGT-P to patients already undergoing IVF for purposes of infertility or PGT-M. Additional ethical issues include who pays for it? And if it’s the patients themselves, who would have access to the technology? I understand that this latter point is not different than the situation with IVF in general in the U.S. and many parts of the world today. Still as long as patients are counseled appropriately, they should have the autonomy to make that choice. As a physician though, I would in general not actively recommend a procedure with known potentially significant risks (IVF) for purposes of a technology with unproven benefits (PGT-P).
As far as "limited utility" goes, I think the utility gained from PGT-P will vary for each couple and some may consider it worthwhile. Some may find it very comforting to have some more positive influence over their child's health. What is your threshold in terms of life years until PGT-P is no longer "limited"? I think if a parent said a low number for their own child, it would be reasonable. If your view is that IVF + genetic testing is so harmful that it is a net negative in terms of welfare to do IVF for the sole purpose of using PGT-P, then I think that's morally defensible, but we would need to do some number crunching.
I agree with the funding being an issue, but my take on that would be that we should subsidize the technology for everyone.
As far as PGT-P being "unvalidated" and "unproven", I would want to know what exactly you mean. I *think* that you would agree that it is possible to accurately genotype embryos. But probably you mean that the children who undergo PGT-P need to grow to adulthood in order for to evaluate if they are less prone to disease--the argument being that PRS generated on the adult population now may not apply in a different environment, and so validation of PRS using adults (for example what GP group did with the UK Biobank) is insufficient.
I think that threshold is exceptionally high, and could never be achieved in a world of changing environments because all the future generations would be subject to the same critique. I think it would also classify IVF as an "unproven" technology because later life disease could develop that we don't know about as a result, and we cannot be sure. If I'm mischaracterizing what you mean by proven and validated, feel free to clarify.
At some point, we have to make a judgment about how reasonable a certain concern is and we might go forth with something that might not meet every criteria for "proven." We don't know that all IVF babies don't simply die at 50. That has not been proven. But such a concern does not seem particularly warranted. That's an extreme example, I know. But I'm concerned about probablistic/utility judgments getting translated to English terms in a way that distorts our moral judgments. Someone might freak out and be hesitant to do IVF if we say "the fact that all IVF babies will live past 50 has not been proven." Or they might not care about aneuploidy screening if you call it "inaccurate" or PGT-P if you call it "limited" or "marginal"
While gene-environment interactions could make PGT-P useless, I think that's very unlikely and the worst case scenario is probably you end up back at random selection (if the couple doesn't undergo IVF specifically for PGT-P).
If you think that genetic screening or IVF is so harmful to mother or embryo as to counteract the benefits of PGT-P, I would be interested in reading any articles you recommend. I am looking over papers about the question of how harmful embryo biopsy is now.
“...relying on novel technologies to prioritize embryo transfer is ethically acceptable, but discarding embryos based on these unproven technological advances is not.”
I'm afraid this is an argument long since made irrelevant by public policy. In most of the world abortion is legal for any reason or no reason. Abortion in this case being inflicted most often on a viable--implanted the old way--fetus of some duration, not a blastocyst (or in vitro fetus)--and for those we have the "morning after" pill or in this case, the trash can.
Science gave us the the ability of life over death (really visa versa). Politics decided the legal uses of the science. it's too late for your moral concerns now. Deal with it. It's really the parents' "moral" concern at this point. Welcome to Huxley's "Brave New World".
The medical risk-benefit calculus changes when people choose to do IVF for the sole purpose of undergoing PGT-P (still unvalidated and of limited utility) as opposed to adding PGT-P to patients already undergoing IVF for purposes of infertility or PGT-M. Additional ethical issues include who pays for it? And if it’s the patients themselves, who would have access to the technology? I understand that this latter point is not different than the situation with IVF in general in the U.S. and many parts of the world today. Still as long as patients are counseled appropriately, they should have the autonomy to make that choice. As a physician though, I would in general not actively recommend a procedure with known potentially significant risks (IVF) for purposes of a technology with unproven benefits (PGT-P).
Thank you for the thoughtful comment.
As far as "limited utility" goes, I think the utility gained from PGT-P will vary for each couple and some may consider it worthwhile. Some may find it very comforting to have some more positive influence over their child's health. What is your threshold in terms of life years until PGT-P is no longer "limited"? I think if a parent said a low number for their own child, it would be reasonable. If your view is that IVF + genetic testing is so harmful that it is a net negative in terms of welfare to do IVF for the sole purpose of using PGT-P, then I think that's morally defensible, but we would need to do some number crunching.
I agree with the funding being an issue, but my take on that would be that we should subsidize the technology for everyone.
As far as PGT-P being "unvalidated" and "unproven", I would want to know what exactly you mean. I *think* that you would agree that it is possible to accurately genotype embryos. But probably you mean that the children who undergo PGT-P need to grow to adulthood in order for to evaluate if they are less prone to disease--the argument being that PRS generated on the adult population now may not apply in a different environment, and so validation of PRS using adults (for example what GP group did with the UK Biobank) is insufficient.
I think that threshold is exceptionally high, and could never be achieved in a world of changing environments because all the future generations would be subject to the same critique. I think it would also classify IVF as an "unproven" technology because later life disease could develop that we don't know about as a result, and we cannot be sure. If I'm mischaracterizing what you mean by proven and validated, feel free to clarify.
At some point, we have to make a judgment about how reasonable a certain concern is and we might go forth with something that might not meet every criteria for "proven." We don't know that all IVF babies don't simply die at 50. That has not been proven. But such a concern does not seem particularly warranted. That's an extreme example, I know. But I'm concerned about probablistic/utility judgments getting translated to English terms in a way that distorts our moral judgments. Someone might freak out and be hesitant to do IVF if we say "the fact that all IVF babies will live past 50 has not been proven." Or they might not care about aneuploidy screening if you call it "inaccurate" or PGT-P if you call it "limited" or "marginal"
While gene-environment interactions could make PGT-P useless, I think that's very unlikely and the worst case scenario is probably you end up back at random selection (if the couple doesn't undergo IVF specifically for PGT-P).
If you think that genetic screening or IVF is so harmful to mother or embryo as to counteract the benefits of PGT-P, I would be interested in reading any articles you recommend. I am looking over papers about the question of how harmful embryo biopsy is now.
Thank you.
You might be interested in @sashagusevposts threads on this topic on Twitter/X
I'll take a look. Thank you.
“...relying on novel technologies to prioritize embryo transfer is ethically acceptable, but discarding embryos based on these unproven technological advances is not.”
I'm afraid this is an argument long since made irrelevant by public policy. In most of the world abortion is legal for any reason or no reason. Abortion in this case being inflicted most often on a viable--implanted the old way--fetus of some duration, not a blastocyst (or in vitro fetus)--and for those we have the "morning after" pill or in this case, the trash can.
Science gave us the the ability of life over death (really visa versa). Politics decided the legal uses of the science. it's too late for your moral concerns now. Deal with it. It's really the parents' "moral" concern at this point. Welcome to Huxley's "Brave New World".
The authors concern is about reducing the chance of pregnancy per cycle, not with the death of embryos.
My misinterpretation. Thanks.
Totally understandable. No worries. It is odd phrasing.