Why Shouldn't IVF Couples Pick Embryos with Tarot Cards?
Why Shouldn't IVF Couples Pick Embryos with Tarot Cards?
Where I stand on this method
Tarot is a particular type of playing card that was initially used for games but is now more popular for reflection and guidance in personal decision-making. Believers in this form of fortune-telling typically think that the cards provide some insight through spiritual forces. With the help of an interpreter, the cards can communicate a message about the future. Skeptics might claim tarot card readings are somewhat unethical, seeing as they are based on false supernatural beliefs, and providing false information is wrong, especially when exchanged for money. Most people do not care enough to be concerned with this because few people make extremely important decisions on the basis of a card reading, but what would people say if someone were picking which child to have on the basis of a draw from a deck of cards?
When a couple is undergoing in vitro fertilization (IVF) and they have multiple embryos, they face the “embryo choice problem.” They must select which embryo to transfer to be their eventual child. Many couples elect to screen embryos for the possibility of an abnormal number of chromosomes. Among the remaining embryos, the one with the best morphology is typically used. Imagine that an IVF clinic began offering a special free option in which a card reader used tarot to attempt to pick the healthiest embryo. It is not hard to imagine a strong backlash from bioethicists even if this additional service had no additional cost. What could some of these hypothetical criticisms of embryo selection using tarot (EST) look like? Probably something like the following:
EST is unproven: There is no scientific evidence to support the use of tarot cards for the selection of embryos. Even if future outcomes were determined among adults, as many tarot believers claim, the application to embryos is questionable. Prior to commercial use, embryos should be selected via tarot and have their adult health evaluated before concluding this method is effective.
EST is prone to error: While the use of tarot as a predictive tool could theoretically be accurate, there is still the possibility of error. This error rate may be much larger when applied to embryos than adults. Tarot readers may misinterpret certain readings without a full understanding of the environment that the future child will experience. Certain readings may be inaccurate when applied to certain populations.
EST is not straightforward: With a wide array of interpretations, selecting the best may prove challenging. What constitutes good health is somewhat subjective, and attempting to maximize across one dimension might have unintended consequences.
Using these arguments, it would be unsurprising that someone, perhaps even a tarot believer, could come to the conclusion that this practice would be unethical and unproven. They may come away with the impression that this practice would be harmful and dangerous to IVF babies and society. They might conclude that this sort of thing should be prohibited or that clinics offering this service are ethical.
The purpose of the hypothetical is not to demonstrate that these arguments are worthless or silly despite them sounding strange in this context. The point is that one can construct many reasons for being a skeptic while overlooking a key point. From the perspective of someone who wholly rejects tarot, consider how much harm is done to an embryo if it is selected with tarot cards. Zero. If the parents had used a different method, then a different embryo would have been selected, and a different child would have been born. But that does not necessarily mean it is morally okay. It is worth asking a similar question: how different would we expect the health of a baby selected via tarot compared to one randomly selected? Once again, the answer is zero.
Tarot cards are as effective as rolling dice. The cards will not lead to choices that differ from randomness. Almost no one thinks it is unethical to let nature decide through what amounts to randomness by conceiving naturally. Despite growing adoption, a large number of IVF couples do not even make use of aneuploidy screening before embryo transfer. If the morally acceptable method of randomness and the morally unacceptable method of tarot produce equal results, this should tell us something is wrong with the original argument.
The most critical variable is whether or not the method produces the healthiest babies compared to all relevant comparisons. It would be wise to follow the guideline that we should have babies that will live the best life possible among the available embryos, an idea that Julian Savulescu termed “procreative beneficence.” While embryo selection using tarot will probably not catch on anytime soon, people are using preimplantation genetic testing for polygenic diseases (PGT-P) to select healthier babies, and the hypothetical skeptical arguments presented above mirror those used against PGT-P. Using arguments along these lines, Forzano et al. (2022) call PGT-P “unethical” and “unproven,” while Polyakov et al. (2022) say PGT-P is “not ready for prime time” and that it “should not be offered outside of the research setting at present.”
While the appropriate qualifications are necessary, and some of the critics’ concerns are legitimate to some degree, those who claim that PGT-P is unethical go way too far. PGT-P is more effective than randomness. It is more plausible to think an IVF couple purposely not using PGT-P is unethical, provided it is available and affordable. For a couple who is already performing an embryo biopsy to check for aneuploidy, there are strong reasons to want to use PGT-P with a broad index of health and wellness. If PGT-P were totally ineffective and unproven, it would produce outcomes comparable to the tarot cards. It would be useless. If skeptics are concerned about a test equivalent to randomness, their focus is mistargeted.
They would have a legitimate concern if using a broad index of health and wellness during PGT-P was worse than useless and actively harmful in expectation. If that were the case, one could improve the expected well-being of their child by using a company like Genomic Prediction to get an embryo health score and then intentionally pick the least healthy embryo. I do not anticipate many people doing that. Hopefully, the skeptics are not willing to prove me wrong.
Ethical critiques that prioritize concerns about the nature of the method over concerns about outcomes are misguided. I think this is well illustrated with the following hypothetical, which I will pose as a legitimate question to PGT-P skeptics: Imagine that a couple believed that PGT-P was unproven, unethical, and dangerous, and so they decided to roll a die to determine which embryo to transfer, and they end up picking embryo #1. Now imagine the IVF clinic makes an error and accidentally hands them the results of a comprehensive polygenic screening for health and wellness, and they read it before recognizing the mistake. If the embryo expected to be the healthiest and happiest was #1, would it be unethical for the couple to choose this one? Imagine they decided to reroll the die and ended up with #1 again. What about now? If you believe PGT-P leads to outcomes so bad it is unethical, it would be odd to find choosing #1 acceptable.
In my view, there are strong moral reasons to want healthy children over less healthy children. Using tarot is particularly bad because there are alternatives available that produce better outcomes, namely PGT-P. For an IVF couple that is already using aneuploidy screening and can afford polygenic screening, it is not only permissible but their ethical duty to use PGT-P.