Bioethics in Practice: The Baby Wears Prada: Bioethics of Designer Babies
Imagine a world where a baby’s genetic composition is no longer a product of chance; where parents can select or even alter embryos to fit their preferred specifications. With the advent of technology like in-vitro fertilization (IVF), preimplantation genetic screening (PGS) and powerful and precise gene editing tools like CRISPR, this world, once found only in science fiction novels, looms exciting and unnerving just over the medical horizon.
Colloquially referred to as “designer babies,” this concept admittedly evokes the unsettling image of vapid parents sitting in a cushy doctor’s office with indulgent requests like “make sure she has blue eyes like her mother.” However, despite its shallow connotations, the medical technology behind designer babies has the potential to revolutionize healthcare. Scientists believe that it may allow doctors to prevent and even eradicate certain incurable diseases, instead of just treating their symptoms.
This possibility is not as removed from our reality as we may think. PGS, which involves screening embryos for genetic diseases before implanting them via IVF, is already legal and has been used successfully in the United States and many European countries. And though germline genetic modification, which involves direct gene editing in developing embryos, is completely illegal in the United States and over 40 other countries, clinical trials involving the practice have been conducted in China since 2015, sparking international outrage and debate. In November 2018, MIT Technology Review reported findings of Chinese documents describing a clinical trial intending to genetically modify embryos and implant them via IVF. According to the Review, “[These scientists] planned to eliminate a gene called CCR5 in hopes of rendering the offspring resistant to HIV, smallpox and cholera.”
As with all advances in biotechnology, it is important to weigh the pros and cons, and explore the ethical implications of both sides. To evaluate this complex issue, this article will examine the parties involved:
The embryo: At the crux of this issue lies, of course, the embryo, and the person that that embryo could become. One obvious benefit for the embryo would be health-related, in which case one must weigh the health benefits and risks associated with the various methods used to create designer babies.
PGS is one method which is minimally invasive and low-risk. It involves screening embryos to make sure that they are genetically healthy before implanting them via IVF. This is especially important for children born to parents who are at a high risk for passing down genetic disorders, like many individuals within the Jewish population.
Germline genetic modification, which involves altering the embryo’s genetic code, also has tremendous potential to prevent disease. However, the procedure would be much more invasive and complex, and poses an important question: can we reach a high enough level of confidence in the safety of these procedures that we can feel comfortable trying them on actual humans? Gene mapping provides some insight into the traits associated with certain genes, but is still a developing field. Genes are highly complex, interacting in ways that are difficult to predict; at least for now, we cannot account for every consequence that would result from editing an area of genetic code. Even a single unforeseen consequence could be debilitating to the child, and, if heritable, to the child’s descendants.
Another factor to consider on the embryo’s behalf is the possibility of selecting or altering embryos in favor of certain desirable qualities unrelated to health. As gene mapping becomes more nuanced, scientists have attempted to pinpoint genes that influence intelligence, athletic ability and physical characteristics like height and weight.
A number of issues could arise from parents choosing to improve their child in this way. One potential issue lies in the subjectivity of the word “improve.” What determines whether a quality is considered positive and constitutes an improvement? In a recent case, a deaf lesbian couple elected to use a deaf sperm donor to have a child, intentionally maximizing the chances that their child would be deaf. The couple said that they were part of a deaf community and culture, and did not want their child to feel isolated and cut off from that. Their baby was not technically a designer baby, but what if it was? Should parents be allowed to bestow on their children whatever qualities they consider meritorious, if there is no objective way to evaluate these qualities? This brings us to...
The parents: Every parent wants to do what they deem best for their child. In the U.S., medically speaking, this is largely within a parent’s right. American law does not consider a child competent to make medical decisions and considers the parent responsible for the child’s health and wellbeing. For this reason, a parent is allowed to vaccinate his or her child against dangerous diseases, have their broken leg set in a cast and have their inflamed appendix removed, even if the child protests. One might apply this logic to the issue of designer babies, and say that it does not matter that an embryo obviously cannot consent to genetic modification; a parent has the right to make a decision that will save their child from a dangerous disease.
However, this logic does not apply for elective medical procedures. A parent cannot force a child to get a cosmetic surgery, even if they think it is in the child’s best interest. Therefore, one could argue that a parent should not be allowed to alter a child’s natural genetic makeup for superficial or cosmetic reasons without their consent.
Society at large: One last factor to consider is the impact that designer babies could have on the global population. Overall, the proliferation of designer babies would likely result in a greater percentage of the population being more intelligent, physically fit and free of disease. This seems like a benefit; however, there is a darker side to consider. Firstly, this could lead to a more genetically homogenous population, with parents favoring genes in line with desirable or “in vogue” traits. Genetic diversity is very important since it renders different people resistant to different types of diseases and threats, which prevents a single cause from being able to wipe out entire populations.
Additionally, treatment to select or alter embryos would likely be expensive. This could increase the disparity between wealthier and poorer classes, creating an upper class that is smarter, stronger and otherwise could be considered “genetically superior.” This would make it much more difficult for members of poorer classes to achieve upwards social mobility. Even more alarmingly, it could pave the road for a culture of eugenics, a social philosophy which favors promoting populations with genetic superiority and reducing those with genetic inferiority.
So in summation, should designer babies be legalized? Obviously, there is no simple answer. When thinking of worst case scenarios — violations of medical autonomy, debilitating heritable mutations and a whole host of societal inequities — it may be tempting to keep this Pandora’s box safely shut. But when one considers the possibility of extraordinary good — the eradication of diseases, advancement of humanity and other benefits that we, in our narrow scope of vision, can’t even begin to imagine — the prospect of leaving this area of medicine unexplored can feel, at the very least, anticlimactic.
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Photo caption: Are we entering an era of designer babies?
Photo credit: Genetic Literacy Project
