A set of grandparents sit in the lobby of a hospital awaiting the exciting news regarding the birth of their first grandchild. The pair sit with such anxiety and excitement, not yet knowing that their grandchild would be born with a genetic disorder referred to as spinal muscular atrophy (SMA). As the grandparents await the happy news, the parents are receiving the awful reality that this disease will indefinitely claim the life of their first born. It is an awful notion that a parent should have to bury a child, and equally as awful a notation that a parent should have to risk having this tragedy repeat itself on another one of their children. With advancements in technology it is now possible for parents, such as those from the story, to be able to select against specific genetic markers for particular heritable diseases such as SMA. A preimplantation genetic diagnostic (PGD) screening is scientific test that is used to determine the genetic makeup of an embryo, that was produced through in vitro fertilization therapy treatments (Penn Medicine). In vitro fertilization (IVF) has become a more commonly used scientific therapy options for couple, who have experienced trouble conceiving a child through sexual reproduction. With the technological advances in the medical field there are more options for couples when it comes to making choices regarding a potential offspring. The use of a PGD screening allows for a patient to receive the full genetic makeup of a potential offspring including genetic markers for chromosomal disorders down to even the eye color of that embryo. Although most physicians only recommend a preimplantation genetic diagnostic screening in high risk cases, such as a family history of heritable diseases or a history of recurrent miscarriages, it has come to light that requests are being made, by patients, to receive the genetic makeup of a potential offspring in order to determine aesthetic traits, rather than those related to medical conditions. The new requests for this information about a potential offspring, certain ethical questions have been raised, such as whether it is right for a patient to be able to discard an embryo purely based on the knowledge of non-preferable aesthetic traits. By using a PGD screening, patients are able to identify embryos that contain genetic markers for late onset diseases, susceptibility to cancer, disabilities that would financially burden the patient, and other medically-related issues. This use of the PGD screening has been accepted as an ethical use of this practice. But if patients are given the ability to handpick an embryo with aesthetically appealing traits, this could lead to an era of “designer babies” or a societal rejection of those offspring who were conceived naturally, without genetic manipulation. Preimplantation genetic diagnostic screenings on the embryos of patients undergoing in vitro fertilization, has created a controversy of whether discarding embryos due to specific genetic markers can be considered an ethical practice. Based on the research and information surrounding this practice, it can be determined that it is not ethical for a patient to be able to discard an embryo purely based on an aesthetic trait or traits, that are considered to not be preferred by the patient, but it is ethical for a patient to discard an embryo that has the genetic markers for diseases or medical disorders that could potentially burden or end the life of an offspring. 

In the earlier days of in vitro fertilization treatments, the main goal of this scientific intervention was to allow for patients to have children, in cases where natural conception seemed to no longer be a viable option. Beginning in the early 1980s, IVF had an average success rate of about 23.5%, which was deemed a great success considering that this was a scientific discovery that was overcoming the baroness of women. By the early 2000s, IVF therapy was yielding a success rate of 40% for women under the age of 35 years old (Saucer & Wang). As far as this scientific practice goes, it has continued to produce better rates of success as the years have progressed. Now that scientists have found a way to make women fertile, in a situation where the patient was deemed baron, the limits of science are again being tested with the potential for patients to know the genetic makeup of a potential offspring. Through the process of preimplantation genetic diagnostic screenings, the traits of embryos, which before were considered to be a “scientific mystery”, can now be known prior to the implantation of an embryo. The original uses of PGD screening was to determine whether an embryo contained genetic markers for a hereditary disease or any other chromosomal disorder. Physicians would recommend this type of intervention for patients, who were considered to be at risk (Penn Medicine). “At risk” patients could include those with a family line of disease, recurrent miscarriages, loss of a previous child to an early onset disease, mothers whose age put them at risk during a pregnancy, or any other reason that could cause a physician to believe that the offspring could be at risk for a genetic disorder and/or death. Even in the early days of PGD interventions there were ethical questions regarding these practices, such as whether or not these screenings would lead to a “slippery slope” in regards to what is considered a major medical issue that need to be addressed versus what is considered a minor one that shouldn’t be addressed (Harper). It wasn’t until technological advances allowed it, that patients began to request a PGD for reasons other than the medical risks, such as an embryo’s genetic makeup and its compatibility with a patient’s current child’s genetic makeup, or the aesthetic traits of the potential offspring.          

With the technological advances of preimplantation genetic diagnostic screenings to patients, the information that can be provided to patients undergoing IVF therapy has expanded extensively. Due to this expansion, new requests for the selection of embryos with specific genetic markers has begun to arise more frequently. The earliest requests that fell outside of the original uses of PGD, were those made by patients attempting to take “family balancing” measures (Klitzman). These patients are requesting that the physicians provide information regarding the sex of embryos before those embryos were implanted. In these situations, the patients were not only requesting to know the sex, but furthermore the patients wanted to have the option to discard the embryos that were not of the preferred sex. Due to these family balancing requests, physicians face the ethical question of whether or not discarding embryos based on sex is morally right. In Dr. Klitzman’s article, “Struggles in Defining and Addressing Requests for ‘Family Balancing’”, he attempts to bring to light both the opinions of the patients and the providers. In this article, Dr. Klitzman states that discarding of embryos based on sex is considered a form of sexual discrimination, that would have negative impacts on society overall. Focusing not only on countries where no regulations exist regarding the number of children one household can have, and reorienting the view to countries such as China, where those regulations do exist, there is a great risk for one sex to outnumber the other, if patients are given the option to select an embryo with a preferred sex. The request to discard embryos based on an undesired sex is inherently discriminatory toward the sex that is being selected against. In situations where patients would purely prefer a male child over a female child or vice versa, it could take multiple in vitro fertilization cycles in order for a physician to be able to produce that sex. According to Saucer and Wang, physicians have to discard millions of embryos per year when selecting embryos, for patients, based on their sex.  The process of creating a genome is not done through the manipulation of a physician it is still left up to chance, regarding what sex an embryo will be, in the IVF process, which in turn means that physicians are not able to guarantee that the act of discarding an embryo or multiple embryos, in order to obtain the preferred sex, will not be part of the overall process.

Taking the sexual selection of a potential offspring a step further, patients have begun to make requests to know not only the genetic make-up of an embryo, as it pertains to medical conditions, but also any genetic markers for particular aesthetic traits. New discoveries in genetic screenings have revealed that there are genetic markers for traits such as, endurance, muscle mass, height, eye color, hair color, etc (Saletan). Since these new discoveries have become public knowledge there have been more requests by patients to be given information about an embryo’s genetic markers for aesthetic traits. These requests raise the question of whether that genetic information should be considered proper grounds for a patient to discard an embryo. This dilemma further proves Harper’s theory that the use of these screening would eventually cause a slippery slope to form and more requests for genetic manipulation of embryos to arise. By giving patients the right to select the embryos with preferable traits, it is thereby giving the patient the ability to design a potential offspring that would meet the standards that have been set by that particular patient (Sterckx). In Dr. Robertson’s article regarding the ethical debate of extending PGD, he states that, “Dr. Leon Kass has articulated [a] view, as has the President’s Bioethics Council in the United States, which he chairs. [He and the council] argue that human reproduction is a ‘gift’ and that any form of selection or manipulation turns the child into a ‘manufacture’ and thus impairs human flourishing.” By examining this view, it can be seen that those in the field of bioethics have laid the ground work for this practice of genetic selection to be considered unethical, due to the potential production of a population in which the members would have been manufacture by parents rather than by the laws of nature. A population that has been manufacture by man, could lead to more divides within society. The bioethics council has evaluated the practice of using the preimplantation genetic diagnostic screenings to select embryos for preferable traits pertaining to the aesthetic traits of an embryo and came to the conclusion that this practice cannot be considered an ethical practice.

Although it has been found that the potentials for a manufactured population cause this practice to be deemed unethical, this stance only holds water if the use of these practices do in fact allow for patients to select the traits of potential offspring. According to Dr. Harper, a Professor of Human Genetics and Embryology at the Institution for Women’s Health, University College London, the idea that “PGD will eventually allow prospective parents to design what they consider to be the ‘perfect’ child” by selecting for the traits that they believe to be desirable raises an ethical question, but this author states that “[t]he feasibility of this type of selection is strongly exaggerated in the media and in science fiction: in reality, the preferred characteristics are rather complex, determine by many different genes and environmental factors” making it difficult to select for or against (Harper). Even though Dr. Harper makes the case that genetic selection is over exaggerated in the media, it is a fact that scientists have found genetic markers for aesthetic traits. The traits that Dr. Harper refers to in this argument are in fact exaggerated in the media. Currently it is not possible for genetic markers to predict characteristics such as athleticism or intelligence, but there are genetic markers for aesthetic traits such as muscle mass, which could be correlated to the athletic ability of a potential offspring. The argument, that Dr. Harper is attempting to make, is based purely on the idea that everything the media displays is exaggerated, which in fact is not true. “In October 2007, scientists from deCode Genetics of Iceland published a paper in Nature Genetics pinpointing various [genes] that influence skin, eye and hair color” (Saletan), which further proves that although the media has exaggerated some aspects, there are aspects of genetic selection that still remain feasible. Although it isn’t feasible to select specific genes and place them into an embryo, the process at question is done by through a process of selecting an embryo with preferable traits, not a specific gene to be placed into an embryo. This distinction is important to the argument as a whole because at this point in time it is not scientifically possible for a patient to select genes and have a physician take those selections and place them into an embryo. 

Continuing to evaluate preimplantation genetic diagnosis screenings with the facts in mind that genetic selection is feasible and with the way that technology is progressing the developments in this field could further expand, the idea that patients could have the choice and/or ability to handpick aesthetic traits of potential offspring opens the door to the question of what would become of the members within society who were not genetically manipulated before birth. In many different aspects of society, the population competes among itself, whether that be in physical traits, intellectual abilities, athleticism, artistic abilities, etc. the competition exists in most, if not all, aspects of life. By allowing patients to select for or against traits that an embryo presents with, this allows for the selection of potential advantages that would be preferable in today’s society. As science allows for more specificity among the identification of traits, more ethical questions will arise, and new standards will need to be set in order to protect not only those, who were born through genetic manipulation, but also those who were born without genetic manipulation. Robertson brings up the question of whether or not it would be fair to allow patients to choose to have a child with the gene for larger muscle mass, while others leave it up to chance, and then expect those who were born without genetic manipulation, to feel as though it would even be possible to measure up to their counterparts. Allowing for patients to select embryos with aesthetically appealing traits this leaves room for a divide, between the genetically modified and the “normally conceived” children, to be created in society. 

The original use of preimplantation genetic diagnosis screenings was intended to provide patients with information about diseases that a potential offspring could possibly have, along with other specific medical information. One of the largest debates over preimplantation genetic diagnosis screenings follows the movement of couples being able to conceive a child that could be “a sibling’s keeper”. In Pet’s analysis of genetically modifying embryos to be “savior siblings”, it is explained that couples will fertilize multiple embryos and choose to implant the embryo with the correct blood type, or donation type that would be needed for procedures such as, bone marrow transplants, in order to save another child of the patient. This concept became a more common practice when it was found that it was possible for physicians to identify these donation traits in embryos, which could save another child’s life. The obvious proponents of this practice being used are those who would be able to save a child by selecting donation matches within embryos, but there are many who find that allowing for patients to use in vitro fertilization to create a child that could serve as a donor bank for another child is completely unethical. In an article written by Do Carmo, the concept of having a child in order to serve as a savior sibling is evaluated and the process of allowing parents to select embryos that would be able to serve as a donation bank for another child. The author attempts to show the downsides of allowing patients to have savior children, but in the evaluation the author makes a case for the process as a whole. Although there are risks behind the uses of a savior sibling the benefits outweigh the risks. Through this process patients are able to have two children instead of losing a child to a disease. 

When preimplantation genetic diagnostic screenings are used in order to select against medical disorders, then there are many benefits that follow this scientific practice. The talk-show hosts of NPR, Mr. Palca and Ms. Kramer, go through the first-hand account from a couple, who used a PGD screening in order to determine whether the embryo being implanted would present with a genetic marker for a disease that a previous child of the couple had presented with and later died as a result of. In this particular case the use of a preimplantation genetic diagnostic screening allowed for this couple to select an embryo that wouldn’t have the genetic markers for a life threatening disease. The preimplantation genetic diagnostic screening was original invented and presented as an option for patients, for reasons similar to the couple on the NPR talk show. Physicians and researchers never imagined that the technological advances would allow for the identification of traits such as, muscle mass, endurance, etc. Which speaks to the fact that when this practice was first brought to market there were no intentions for the PGD screenings to lead to the selection against aesthetic traits. In cases such as, attempting to prevent the loss of another child to an early onset disease, the benefits of these screenings are brought to light. This practice has prevented potential deaths of offspring and psychology pain to patient, by allowing for physicians to identify potentially fatal medical conditions within an embryo and further given physicians the ability to provide patients with enough information to make an educated choice to implant an embryo with genetically and medically unfavorable genes, or to not take the risk and try with another embryo. When examining this practice with a focus on the potential harm it could prevent, by selecting against genetic markers for medical conditions, it can be seen that this is an ethical practice. 

Based on the information through scientific research, along with the first-hand accounts of patients that have used preimplantation genetic diagnostic screenings during the in vitro fertilization therapy process, it can be determined that it is unethical for patients to be able to discard embryos based on the knowledge of nonmedical traits that was provided through these practices. Although the discard of embryos due to nonmedical genetic markers can be proven as unethical, that determination does not correlate to the discarding of embryos due to the presence of genetic markers for potentially harmful or fatal medical conditions. Through further analysis of the benefits that the PGD screenings can provide, if used to identify and furthermore prevent patients from giving birth to embryos containing medical disorders, it has been determined that the use of the preimplantation genetic diagnostic screenings to select against medically related genetic conditions is an ethical use of this scientific practice. Today’s society is progressively moving toward being more accepting of any and all types of people, by allowing for patients to discard embryos based on non-preferred genetic markers pertaining to aesthetic traits are we in turn promoting society to create the ideal image of a person? 
