
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 life threatening genetic disorder referred, to as spinal muscular atrophy (SMA). As the grandparents await what they expect to be happy news, the parents are receiving an awful reality that this disease will indefinitely claim the life of their first born. When the child draws its first breath, giving out its first cry, the parents sign in relief and hug each other. The parents look at one another, excited about what the future with this child will hold, but then their attention is drawn to the nurses rushing around the room. They could tell that something was wrong, as they began to try to get answers from one of the nurses. No one paid attention to them, the nurses and doctors rushed the newborn out of the room. One nurse walked over to the bed and explained that they would keep them filled in on the details of the child’s status. Fear overcomes the new parents as they sit awaiting any news about their child. It would be hours before they would get any answers from the doctors and the news they received would change their lives forever. SMA is a life threatening disease that is inherited from parent to child, that can claim the life of a child in their early hours, which is exactly what happened to the couple’s newborn.  It is an awful notion that a parent should have to bury a child and equally as awful a notion that a parent should have to risk having this tragedy repeat itself on another one of their children. With the advancements in technology, it is now possible for parents, such as those from the story, to be able to select against specific genetic markers * that indicate heritable diseases, such as SMA. 

A preimplantation genetic diagnostic (PGD) screening is a scientific test that is used to determine the genetic makeup of an embryo, that has been produced through in vitro fertilization therapy * (Penn Medicine). In vitro fertilization (IVF) has become a more commonly used reproductive therapy option for couples, who have experienced trouble conceiving a child through sexual reproduction. * As a result of the technological advances in the medical field there are more options when it comes to genetic identification/selection regarding the traits of a potential offspring. The use of a PGD screening allows for a patient to receive a full genetic write-up of a potential offspring, including genetic markers for chromosomal disorders down to * the eye color of that embryo. 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. Although most physicians would only recommend a preimplantation genetic diagnostic screening * to patients with high risk factors, such as a family history of heritable diseases or a history of recurrent miscarriages, it has come to light that requests are currently being made by patients to receive the genetic makeup of a potential offspring in order to determine aesthetic traits rather than those traits related to medical conditions.* These newer requests for information have raised certain ethical questions, such as whether it is morally right for a patient to be able to discard an embryo purely based on the knowledge of non-preferable aesthetic traits. ** If patients are given the ability to handpick an embryo with aesthetically appealing traits, then this could lead to an era of “designer babies” or a societal rejection of those offspring who were conceived * without genetic manipulation. Preimplantation genetic diagnostic screenings on embryos * has created the controversy of whether discarding embryos, due to specific genetic markers, can be considered an ethical practice. * It is not ethical for a patient to be able to discard an embryo purely based on the genetic markers for 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 was no longer 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 this * discovery was overcoming the baroness of women. By the early 2000s, IVF therapy treatments were yielding a success rate of 40% for women under the age of 35 years old (Saucer & Wang). * This scientific practice * 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 barren, the limits of science are again being tested with the potential for patients to be provided with information regarding the genetic makeup of a potential offspring. Through the use of PGD screenings, the traits of embryos, which before were considered to be a “scientific mystery”, can now be provided to patients prior to the implantation of an embryo. The original use of a PGD screening was to determine whether an embryo contained genetic markers for a hereditary disease or another chromosomal disorder. Physicians would recommend this type of intervention for patients, who were considered to be at risk (Penn Medicine), * which included those with a family line of disease, recurrent miscarriages, loss of a previous child to an early onset disease * , or any other reason that could cause a physician to believe that the offspring could be at risk for an offspring to inherit a genetic disorder and/or death. Even in the early days of PGD interventions, * ethical questions were being raised regarding this particular practice, such as whether or not these screenings would lead to a “slippery slope” in regards to what can be considered a major medical issue that needs to be addressed versus * a minor one that doesn’t need 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, * 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 have 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 were requesting that the physicians provide * the sex of embryos before implanting those embryos. In these situations, the patients were not only requesting to know the sex, but furthermore requesting to have the option to discard those embryos if they were not of the patient’s desired sex. As a result of these family balancing requests, physicians now face the ethical question of whether or not discarding embryos purely based on sex is morally right. *** 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 particular sex. According to Saucer and Wang, physicians * discard millions of embryos per year * in attempts to select embryos for a particular sex.  The process of creating a genome is not done through the manipulation of a physician, * the chromosome organization is still left up to chance, 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 a preferred sex, will not be part of the overall process. Overall the practice of using PGD screenings in order to select for a specific sex calls for the discarding of a large number of healthy embryos for no medical reason. This practice further raises the question of whether it is ethical to allow for patients to discard healthy embryos purely based on the sex of the embryo.  

New discoveries related to 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 more of public knowledge, there have been an increasing number of requests to be provided with the information about an embryo’s genetic markers for specific aesthetic traits. Taking the sexual selection, of a potential offspring a step further, patients have begun to make requests to know not only the genetic * markers for medical conditions, but also any genetic markers identifying appealing aesthetic phenotypes. These requests raise the question of whether * the knowledge of specific genetic markers should be considered proper grounds for a patient to choose to discard an embryo. This ethical dilemma further proves Harper’s theory that the use of these screening would eventually cause a slippery slope to form causing more requests for genetic manipulation of embryos to arise. By giving patients the right to select * embryos with preferable traits, it is thereby giving the patient the ability to handpick a potential offspring, with specific desired traits, that would meet the standards * set by * particular patients (Sterckx). In Dr. Robertson’s article regarding the ethical debate of extending PGD, it states that, “Dr. Leon Kass has articulated [a] view, as has the President’s Bioethics Council in the United States, [of] 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.” * Those in the field of bioethics have laid the ground work for this practice of genetic selection to be deemed unethical, due to the potential production of a population in which the members would have been manufacture by patients rather than by the laws of nature. The bioethics council has evaluated the practice of using the preimplantation genetic diagnostic screenings to select embryos for preferable traits pertaining to the phenotypes of an embryo and came to the conclusion that this practice cannot be considered an ethical practice (Robertson). Robertson further analyzes the potential of this practice as a whole and proposes that if made possible, the population could transition to having been manufacture by man, which ultimately could result in more divides within society.

** With the way that technology is currently progressing, the developments in reproductive therapy treatments has the potential further expand. The idea that patients could eventually have the choice and/or ability to handpick aesthetic traits of potential offspring opens the door to questioning * the effects that this practice could have on society as a whole. In many different aspects of society, the members of a population compete *, whether that be in physical , intellectual, or artistic abilities the competition exists in most, if not all, aspects of society. By allowing patients to select for or against traits *, this will allow for the selection of potential advantages that would be desirable in today’s society. As science allows for increased specificity among the identification of traits, more ethical questions will begin to arise and new standards will need to be enforced in order to protect not only those who were born through genetic manipulation, but also those who were born without genetic manipulation. Robertson questions 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 * be possible to measure up to their genetically modified counterparts. Allowing for patients to select embryos with aesthetically appealing traits * leaves room for a divide to be created in society between the genetically modified and the “normally conceived” children. 

 Although many believe that the use of a preimplantation genetic diagnostic screening to identify traits could lead to a manufactured population, with divides among the modified and unmodified, this argument really 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, * 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 those patients believe to be desirable raises the question of the ethical grounds of this practice. But Harper argues 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 specific aesthetic traits, such as muscle mass, which could be correlated to other abilities, in this case the athletic ability of that potential offspring. The argument * being made 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 still aspects of genetic selection that * remain feasible. Although it isn’t possible with today’s technology to select specific genes and place them into an embryo, the process currently being questioned is done by through a process of selecting an embryo with preferable traits, not the selection of a specific gene to be placed into an embryo. This is an important distinction because at this point in time it is not scientifically possible for a patient to select genes, then have a physician take those selections and place them into an embryo. But it is possible for patients to look at the genetic markers of an embryo, which could indicate aesthetic traits, then make the decision to discard that particular embryo based on the lack or presence of those aesthetic trait. 

 The original use of preimplantation genetic diagnosis screenings was intended to provide patients with information about diseases or disorders that a potential offspring could * have, along with other specific and relevant 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 serve as “a sibling’s keeper”. In Pet’s article, “My Sister's Keeper and Genetic Selection”, the process by which patients create “savior siblings” is explained in detail. The article explains that patients and physicians will work together to fertilize multiple embryos, then the physician will identify specific genetic markers within those embryos, identifying the correct blood type or donation type match to the patient’s sick child, which in turn would allow for the patients to be able to save the life of that child. * Pet focuses on one particular use of donation matching referred to as human leukocyte antigen (HLA) matching, which is a form of donation match that would allow for the offspring produced from that embryo to serve as a bone marrow donor to a child, who was diagnosed with leukemia. The obvious proponents of the use of PGD to match donation types to current children * are those patients who would be able to save a child through its use *. Although saving a child’s life seems to be a noble and moral use of the information provided through PGD screenings, there are still many who believe that allowing for patients to use these practices to create a child to serve as a donor bank * is * unethical. In an article written by Do Carmo, this practice of creating “sibling’s keepers”, that can serve as donors, is further analyzed and evaluated. * Do Carmo illuminates the downsides of allowing patients to have savior children, by speaking to the effects that the conception of a child to serve as a donor could have on that child. Do Carmo argues that by using child purely to save another sick child could result in psychological issues, such as lack of purpose other than serving as a donor, for the child. Although the author illustrates that there are issues that could stem from this practice, the article further argues that there are also benefits of this practice that potentially outweigh the downsides. ** Do Carmo argues that if a couple had planned to have a child for reasons other than to serve as a donor bank, then the use of a PGD screening to ensure that the child would be a match to the sick child shouldn’t be restricted. The article continues to elaborate on the potentials to save a life through this process, which the author argues is an ethical use of the process if monitored properly. 

When preimplantation genetic diagnostic screenings are used in order to select against medical disorders, then there are many benefits of this scientific practice. The radio-show hosts of NPR, Mr. Palca and Ms. Kramer, go through a first-hand account from a couple, that used a PGD screening in order to determine whether an embryo, this couple planned to implant, would present with a genetic marker for a disease that a previous child of the couple had died from. In this particular case, the use of a preimplantation genetic diagnostic screening allowed for the 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 radio show. Physicians and researchers never imagined that the technological advances would allow for the identification of traits such as, muscle mass, endurance, etc. Which further 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, along with 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 decision to implant an embryo with * 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 * prevents, by selecting against genetic markers for unfavorable or potentially fatal medical conditions, discarding embryos for these reasons is ethical. 

Based on the information provide through scientific research, along with the first-hand accounts from patients that have used preimplantation genetic diagnostic screenings during the in vitro fertilization therapy process, * it is unethical for patients * to discard embryos based on the knowledge of undesired nonmedical traits * provided by the PGD screening. Although discarding embryos due to nonmedical genetic markers * is unethical, that determination does not correlate to the discard 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 children containing medical disorders, ** the use of the preimplantation genetic diagnostic screenings to select against medically related genetic conditions is an ethical use of this scientific intervention. ** In order to maintain the ethical backing for the use of this practice, there is a need for clearer distinctions between the identification of genetic markers indicating aesthetic traits versus those indicating medical diseases or disorders. Without the distinction between discarding an embryo based on medically unfavorable traits versus discarding them based on aesthetical unappealing traits, a slippery slope will form and this practice will lead to the creation of “designer babies”. Clear distinctions will allow for both patients and physicians to understand the ethical uses of identifying genetic markers and how the information gained through the preimplantation genetic diagnostic screening should be used. 
