Friday, February 7th, 2014
Earlier this week, the media was again abuzz with the long-debated question of ethics when it comes to genetics and babies. The spark? 30-year-old Amanda Kalinsky—a woman diagnosed with Gerstmann-Straussler-Scheinker disease, a rare genetic neurological disorder that will lead to a slow, painful (and by all predictions) premature death. Though immediately after her diagnosis four years ago she vowed never to have children in order to cut off the head of the GSS snake, The New York Times reported that Amanda and her husband Bradley now have three children thanks to genetic testing and in-vitro fertilization.
The Kalinsky’s doctors created 18 embryos, tested all of them for the GSS gene, and implanted only the 12 without it. My first reaction is that this is an amazing breakthrough. A woman who wanted very badly to be a mother without passing on a terrible fate is now Mommy to three kids. Thanks to the availability of testing, she didn’t have to play Russian roulette and hope that a naturally-conceived child would be born without the gene —or have to debate aborting a fetus who tested positive for GSS during prenatal tests. She also didn’t have to forego motherhood (and her husband didn’t have to forego fatherhood). Not to mention, if doctors were able to do this for GSS—a rare disease—this could mean that we may be able to avoid passing along so many other diseases to future generations.
At the same time, this is not an equal-opportunity solution. The procedure cost the Kalinksys $20,000 for the first round—which they paid out of pocket because many insurers don’t cover this. So are we saying that only wealthy folk get to eliminate their diseases? What about people who can’t afford this? Are they subjected to the choice of taking their chances versus no children, at all?
But questions of who can take advantage of this aside, there is one huge question we need to ask ourselves: Should we be doing this at all? Will we continue to use this technology to prevent disease, or will it evolve into so much more? I am all for giving every child the best shot we can at a healthy, happy life. But is that really what’s going on? As of a recent international survey, 2 percent of over 27,000 uses of preimplantation diagnosis were actually to choose a child’s sex. Clearly, not a life and death matter.
(If you want to try and predict if you’re having a boy or a girl—sans science—check out our Chinese Gender Predictor.)
I have a hard time believing that we will be able to keep the uses of this technology limited to “the right reasons.” And even if we do manage to pass laws and regulations about this technology (to keep it preventing diseases rather than brunettes), something tells me we may be drunk with power—believing that eliminating embryos of one gene means there are no unknown or other harmful genes lurking inside. But I have to say that in my opinion, if we have to put up with some people choosing girls over boys or blue-eyed kids over brown-eyed kids so that others can (to the best of their knowledge) choose healthy kids, then that’s the bullet we bite.
Yet, all this talk of genetic diagnosis reminds me of the other side of the genetics debate: genetic engineering. Last year Intelligence Squared sponsored a debate about whether or not we should prohibit the genetic engineering of babies. The most striking point was that genes do not occur in a vacuum. Genes interact with each other to create traits such as brown hair, fair skin, genius intelligence, or disease. By removing or altering a disease-causing gene, scientists cannot automatically declare victory. Disrupting the natural order could invent a new disease. It could cause the original gene to mutate and become alteration-resistant. Bottom line: We do not yet know the consequences of this.
When it comes down to it, here’s where I fall (for now): Genetic testing, yes. Genetic engineering, no.
What do you think about this hot-button issue? Sound off in the comments below!
Image via Shutterstock
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Tuesday, August 13th, 2013
Genetic testing, and prenatal screening more broadly, have become a fact of modern pregnancy. As an Ashkenazi Jewish couple, my wife and I have been tested for a staggering array of disorders, a number that has expanded with each of her three pregnancies. From well-known illnesses like Down syndrome to virtually unknown ones, many of which are specific to certain ethnic groups such as ours, these tests offer a degree of knowledge about your growing baby that previous generations would have considered unimaginable or the stuff of science fiction.
Parents.com recently published a series of articles on prenatal genetic testing, which explain the “whats” and “whys” of the process, but it was one article on the emotional side of genetic testing that caught my eye. This is a part of the process that I find is rarely discussed. In our data-driven, Google-at-our-fingertips culture, we are hungry for more information. But what do we do with that information once we have it? That’s where prenatal testing gets difficult–and, for some, is a reason to avoid it altogether.
Doctors often perform these prenatal screening tests as a matter of course, and just assume that that knowledge is essential. However, the implicit–and sometimes explicit–assumption of testing seems to be that a woman will abort her pregnancy if a serious problem is discovered. And that’s obviously not a choice everyone is willing to make, regardless of the consequences.
My wife and I struggled with this issue with every pregnancy and even before we started trying to conceive the first time. Would we bring a child into the world knowing he or she will suffer greatly or live a tragically short life? Where is the line between loving every life and having compassion on a suffering being? What diseases would we consider too horrible for a child to suffer from and which ones might be manageable?
The issue is more than theoretical to us. Our sweet, resilient, and amazingly positive 15-year-old nephew has a rare disorder called Familial Dysautonomia, a neorological disease that he’s dealt with since birth. As a result, he is developmentally delayed, consumes food through a stomach tube, can be difficult to understand when he speaks, suffers from frequent pneumonias, cannot feel pain, had major back surgery recently, and deals with countless other health problems. In addition, a dear friend of ours died several years ago in her early 30s from Cystic Fibrosis. Today, both of these disorders are among the many diseases tested for as a matter of course in prenatal testing. (Showing just how effective screening has become, some diseases typical of Jews are mostly affecting non-Jews these days, having been, in effect, “screened out” of the Jewish population.)
In contemplating this blog post, I turned to the best source I know of for advice on prenatal testing, Amy Julia Becker, an occasional Parents.com contributor and author of What Every Woman Needs to Know About Prenatal Testing: Insights from a Mom who has Been There (a book I offered an endorsement to). Amy Julia has written movingly about her daughter Penny, who has Down syndrome, and the challenges and joys Penny has brought to their family–and what her experiences have taught her about navigating the world of prenatal testing.
Amy Julia emailed me these bits of advice for people considering whether to have prenatal testing and concerned about what to do with the results:
- Because every pregnant woman will be offered prenatal testing for genetic conditions, every pregnant woman should spend some time thinking about what genetic information she wants about her baby and why she wants that information. Information is not neutral.
- Doctors can provide a medical context for genetic conditions, but they are not trained to offer a social, educational, or familial context. As a result, many pregnant women receive a prenatal diagnosis with lots of medical information that seems partial or less significant than a fuller picture of life with the genetic condition might offer. Women need to seek out counsel and information that goes beyond the medical realm.
- Spending time with a family or two who have children with that condition can be a helpful way to begin to imagine a different life, full of new possibilities even as it is also full of new challenges.
In the end, my wife and I decided to have most of the tests–not because we knew what we’d do in every instance and eventuality, but because we felt that knowledge is power. Knowledge would allow us to learn, prepare, speak with others, assemble our support network, and steel ourselves for what is to come. We are planners. And these tests would have allowed us to plan. Thankfully, we’ve never had to face these questions beyond the theoretical realm, a conclusion that we are extremely grateful for.
Ultrasound image via Shutterstock.
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