This page includes an essay topic proposal for the essay as well as the Expository Essay which explores the subject “Should Preimplantation Genetic Diagnosis (PGD) be regulated?”
Expository Essay Proposal
“The ethical use of Pre-implantation Genetic Diagnosis (PGD) in conjunction with In Vitro Fertilization (IVF) offers several benefits to prospective parents.”
Pre-implantation Genetic Diagnosis (PGD) is reproductive technology that genetically tests the chromosomal makeup of an embryo through cells removed from the embryo and is typically “used in conjunction with IVF (In vitro fertility). “PGD helps to select the best embryo(s) to achieve pregnancy or to avoid the risk of a genetic disease being passed down from the parents” (Genetics and IVF Institute). Examples of such conditions include Cystic Fibrosis and Sickle Cell Anemia. PGD is commonly used to detect and eliminate these “specific single- gene conditions and structural changes/ abnormalities of a parent’s chromosome that can be passed to potential offspring” (UCSF Health, 2020). PGD in conjunction with IVF can be used to determine the sex of the offspring which offers parents the ability to choose the sex of their child. In addition, this is beneficial to parents who are interested in “family balancing”, which as the name suggests gives parents the opportunity to balance the number of males or females in their family if they so desire. Additionally, PGD and IVF can offer individuals of an advanced maternal age increased fertility owing to the processes of IVF. Ultimately, Preimplantation Genetic Diagnosis in conjunction with In Vitro Fertilization offers several benefits to prospective parents due to its many beneficial qualities and provides an ethical alternative to disease prevention.
Expository Essay
David Lalchand
Prof. Jack Wernick
Writing for the Sciences
March 16, 2023.
Should Preimplantation Genetic Diagnosis be regulated?“
Pre-implantation Genetic Diagnosis (PGD) is reproductive technology that genetically tests the chromosomal makeup of an embryo through cells removed from the embryo and is typically used in conjunction with IVF (In vitro fertility). “PGD helps to select the best embryo(s) to achieve pregnancy or to avoid the risk of a genetic disease being passed down from the parents” (Genetics and IVF Institute). Examples of such conditions include Cystic Fibrosis and Sickle Cell Anemia. PGD is commonly used to detect and eliminate these “specific single- gene conditions and structural changes/ abnormalities of a parent’s chromosome that can be passed to potential offspring” (UCSF Health, 2020). PGD in conjunction with IVF can be used to determine the sex of the offspring which offers parents the ability to choose the sex of their child. In addition, this is beneficial to parents who are interested in “family balancing”, which as the name suggests gives parents the opportunity to balance the number of males or females in their family if they so desire. There is no restrictive legislation surrounding Pre-implantation Genetic Diagnosis in the United States and the practice is not regulated by the government. However, Medical Association Guidelines already exist which dictate the standards by which physicians and associated bodies performing these procedures must abide. Conversely, this reality begs the question of whether there is a need for regulation surrounding Pre-implantation Genetic Diagnosis or not and whether some of the desired outcomes of this practice are ethical. Pre-Implantation Genetic Diagnosis in the United States should undergo some form of regulation either by the Government or a similar regulatory body to ensure the beneficial outcomes of this procedure remain ethical.
Michelle Bayefsky in her article ‘The Regulatory Gap for Preimplantation Genetic Diagnosis’ states: “The United States is very unusual in its lack of legal guidance on the accept able uses of PGD. Most countries where PGD is available have relevant legislation restricting the technique’s use” (Bayefsky, 2015). She goes on to explain that in the United Kingdom the “Human Fertilization and Embryology Authority (a statutory body) is charged with the task of approving a list of conditions for which PGD is permitted, based on an assessment of the seriousness of the disease. Elective sex selection is banned outright” (Bayefsky, 2015). Thus, the lack of regulation of PGD in the US is quite unusual compared to other countries where the procedure is performed and Bayefsky explains why this is. The healthcare system in the United States is private and most healthcare providers do not cover advanced fertility procedures such as PGD and IVF, therefore the government has never had to intervene, unlike other countries where “the national government plays a major role in funding, and sometimes directly providing, health care service” (Bayefsky, 2015). The views of medical professionals on the issue also affect the lack of regulation according to Bayefsky. Leading authorities on reproductive health have expressed that interference from government bodies will stagnate the development of tests like PGD, is an encroachment into medical practice and even “inappropriately interferes with patient care” (Bayefsky, 2015). Finally, Bayefsky argues that since the United States is a more culturally diverse nation with an emphasis on accommodating the view of the public, it is difficult to implement such legislation.
Similarly, Frances A. Flinter in her article “Preimplantation Genetic Diagnosis: Needs To Be Tightly Regulated” from the British Medical Journal, expressed related views based on the state of PGD in the United Kingdom. She also urges that lack of regulation of the technique in other countries where it used for purposes such as “sex selection for ‘family balancing’ and HLA typing “risks bringing the whole technique in disrepute” (Flinter, 2001). Additionally, she brings into consideration a study conducted on 886 families that underwent 1318 cycles of PGD that were monitored and tested for a period of seven years. “Fewer than 25% of parents had healthy children, over a quarter had one or more child affected by a genetic condition, a similar amount had spontaneous abortion and underwent termination after prenatal diagnosis…and the reported pregnancy rate was 17%” (Flinter, 2001). Although dated, this data is very concerning since the success rates are below the acceptable percentile. While this study was conducted in the United Kingdom and success rates have risen since, there is still need for regulation since new advancements in technology accompany greater possibilities for the misuse or even abuse of this reproductive technology. Furthermore, Flinter reiterates that “to offer a safe effective service, a multidisciplinary team needs to be established,” as well as encourages that establishing a degree of regulation similar to the UK “will depend on the motivation of individual governments and clinicians” (Flinter, 2001).
While widespread regulation from the Government over a procedure like PGD would be ideal, alternatives exist and function effectively for the most part. In her essay from the AMA Journal of Ethics, Michelle Byefsky states “Self-regulation of PGD by professionals applying society guidelines is a viable alternative to government regulation that avoids the potential pitfalls” (Bayefsky, 2018). She also states that “health professionals are more likely to prioritize the needs of patients when deciding which uses of PGD are ethically permissible” (Bayefsky, 2018). At present, extensive research and studies have been conducted to investigate the long and short-term effects of PGD on both the children born with the help of the procedure, as well as mothers and the results conclude that there was little to no detrimental effects to suggest major disadvantages of the procedure. This suggests that the current alternatives to widespread regulation of PGD are effective for the most part. Although, the current obligations mandated by Medical Association Guidelines and preventative acts such as the Clinical Laboratory Improvement Amendment are sufficient in ensuring ethical practices, there remains cases of the misuse and even abuse of an otherwise lifesaving and disease preventing treatment.
While alternatives to widespread regulation of Preimplantation Genetic Diagnosis exist, legislative intervention on the part of the Government is required to ensure the numerous benefits of PGD remain ethical. Ultimately, the decision to undergo PGD in conjunction with IVF remains in the hands of the parents, especially in the case of preventing potentially life-threatening conditions. However, special emphasis should be placed on regulating the misuse of PGD since it will prevent practices that may potentially perpetuate discrimination as well support the efforts made to raise awareness around the fact that one can live a happy and fulfilling life regardless of medical conditions.
Works Cited
Bayefsky, Michelle. “Policy and Politics: The Regulatory Gap for Preimplantation Genetic Diagnosis.” The Hastings Center Report, vol. 45, no. 1, 2015, pp. 7–8. JSTOR, http://www.jstor.org/stable/44159127. Accessed 17 Mar. 2023. (This article explores what PGD is, its lack of regulation in the United States as well as explanations as to why that is.)
Bayefsky, Michelle. “Who Should Regulate Preimplantation Genetic Diagnosis in the United States?” Journal of Ethics | American Medical Association, 1 Dec. 2018, journalofethics.ama-assn.org/article/who-should-regulate-preimplantation-genetic-diagnosis-united-states/2018-12. (In this article Michelle Bayefsky considers whether the government should regulate PGD or if it should be left largely to the decision of potential parents and their physicians. She also compares regulation in the US to other medically advanced countries.)
Flinter, Frances A. “Preimplantation Genetic Diagnosis: Needs To Be Tightly Regulated.” BMJ: British Medical Journal, vol. 322, no. 7293, 2001, pp. 1008–09. JSTOR, http://www.jstor.org/stable/25466858. Accessed 17 Mar. 2023. (Frances Flinter discusses a particular study conducted to compare and contrast the effectiveness of PGD in the UK and urges that other countries consider imposing heavier regulation towards the practice.)
UCSF Health. “Pre-Implantation Genetic Diagnosis.” ucsfhealth.org, 7 Oct. 2020, www.ucsfhealth.org/treatments/pre-implantation-genetic-diagnosis.
What Is PGD? www.givf.com/geneticservices/whatispgd.shtml.
(This article and the one above it both explain PGD and suggests some of its benefits.)
