Misconceptions: Ethics and the Rejection of Reproductive Roulette

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By Leonard Fleck, Ph.D.

In a recent story in the New York Times, Gina Kolata reports the story of Amanda Kalinsky, age 30, who had been told four years ago that she had the gene for Gerstmann-Straussler-Scheinker [GSS] disease. This is a very rare neurological disorder that will result in a slow and terrible death, likely before she is fifty years old. Her father was dying of this disorder at that time. She very much wanted to have children but she could not bear the thought of passing on GSS to them. She had then learned of the option of pre-implantation genetic diagnosis [PGD]. This involved her being given a drug causing her to hyperovulate. Multiple ova would be surgically removed from her, inseminated by her husband, and result in the creation of 12 embryos. Over two days those embryos would grow to the eight-cell stage, at which point a cell would be removed from each and genetically analyzed for the GSS mutation. Six of her embryos had the GSS mutation. Those embryos were discarded. She successfully bore twins free of GSS and another child, also free of GSS. She and her husband paid over $20,000 for PGD.

Ethically speaking, how should individuals who wish to be just and caring and genetically responsible think about this procedure? How should citizens in a liberal, pluralistic society think about PGD? Should this be a covered benefit under the Affordable Care Act, at least for couples who know they are at risk of having a child with a serious genetic disorder that could very adversely affect the length or quality of life of a future possible child?

Advocates for a Right to Life position would surely object because the procedure necessarily involves the destruction of genetically flawed or excess embryos. They would further object to paying taxes to support access to the procedure for couples like the Kalinskys because this deeply violated their conscientious beliefs. The same is true for many advocates for persons with disabilities who regard this procedure as necessarily diminishing the value of persons with disabilities. Should we have a public policy that would ban this procedure, period?

Let me suggest two responses to the objections that have been raised. And let me also suggest why we should have a policy that would publicly subsidize the cost of the procedure for couples like the Kalinskys. First, what is being disvalued is the disability itself, not persons with disabilities. This can be understood more clearly with a brief thought experiment. Imagine that in the future regenerative medicine is able to use modified embryonic stem cells to restore mobility to individuals who have suffered severe spinal cord injuries. The cost of the procedure might be $100,000. I would argue that a just and caring society ought to underwrite that cost. Some persons with quadriplegia might refuse the procedure. Many others might gratefully accept it. There would be fewer immobile individuals in the world, but it surely seems that would be a good thing from the point of view of those newly mobile patients.

Advocates for a Right to Life position might argue that if a couple knows they are at risk for having a child with, say, cystic fibrosis, they ought either forego having children or accept having a child with cystic fibrosis. A child with cystic fibrosis may have lifetime medical costs in excess of $1 million, not to mention diminished length and quality of life. Those costs will largely be socially borne, as opposed to being borne by the parents. I would argue that the social acceptance of these costs is what a just and caring and liberally respectful society ought to do. However, others might see this a bit differently.

Others might regard such a couple as being thoughtless and irresponsible, both because of the preventable harm they are imposing on that child and the costs that are imposed on society. I would argue that such thoughts are illiberal. Those choices ought to be respected. But if that is true, then a liberal society is nothing if not mutually respectful. In other words, an advocate of a Right to Life position as well as advocates for persons with disabilities ought to respect the Kalinsky’s right to make their choice not to have children with GSS. Further, such advocates should also accept a democratically-legitimated policy that would pay the costs of PGD for couples like the Kalinskys, especially those not as economically well off as the Kalinskys. In both cases advocates for either point of view are paying taxes to support services they judge to be conscientiously troubling. But this is what mutual respect and fair treatment often means in a liberal pluralistic democratic society.

Perhaps I am wrong in my judgments here; perhaps advocates for a Right to Life position are wrong. If we both righteously insist on our rightness, then the practical consequence will be unnecessary suffering and premature death for many future possible children. Perhaps the better choice would be mutual respect and continued efforts at mutual understanding.

References:

Kolata, Gina. “Ethics Questions Arise as Genetic Testing of Embryos Increases.” New York Times 03 Feb 2014. Retrieved from http://www.nytimes.com/2014/02/04/health/ethics-questions-arise-as-genetic-testing-of-embryos-increases.html?hp&_r=3

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Fleck smallLeonard Fleck, Ph.D., is a Professor in the Center for Ethics and Humanities in the Life Sciences at Michigan State University and the author of Just Caring: Health Care Rationing and Democratic Deliberation.

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