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Pure Selection: The Ethics Of Pre-Implantation Genetic Diagnosis And Choosing Children Without Abortion
  1. Lynn Gillam
  1. University of Melbourne and Murdoch Childrens Research Institute

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    Christian Munthe, Göteborg, Acta Universitatis Gothoburgensis, 1999, 310 pages, 180 Kroner.

    This book investigates the issue of “pure selection”–that is, choosing the genetic characteristics of one's children, without using abortion as the method to achieve this. Pure selection is made possible by the relatively new technology of preimplantation genetic diagnosis (PGD), in conjunction with now-routine IVF procedures for creating embryos. In PGD, a cell or cells can be extracted from an early embryo, and be subjected to genetic diagnosis of whatever kind, without damaging the embryo. So embryos with the genetic make up favoured by the parents-to-be can be identified and transferred to the uterus, whilst those with non-favoured genetic make up can be discarded. Hence choice about the genetic characteristics of children is achieved without recourse to invasive procedures for prenatal diagnosis, and without termination of pregnancy, which is not only physically invasive, but also ethically controversial.

    The author firstly presents a case study of the events involved in the introduction of PGD into clinical practice in Sweden, and then proceeds to a thorough, at times almost too thorough, examination of the ethical arguments for and against use of PGD for pure selection. From the broad ground covered in this book, I want to pick one issue which I find to be of particular interest. This is the central moral question of whether there is anything morally wrong with discarding embryos which are not selected.

    As Munthe points out, PGD is only preferable to selective abortion as a method of selection if the disposal of unwanted embryos is ethically neutral, or at least less problematic than abortion of a fetus. It is often simply assumed that this is so, but Munthe challenges the reader to seek an argument for it. Interestingly, he considers in detail not the Catholic-style objection to embryo destruction (namely, that the embryo is morally a person from the moment of conception), but possible utilitarian objections. The most significant fact about both embryos and fetuses, from a utilitarian point of view, is the consequence of destroying them, namely that a person's life has been prevented from existing. Hence, except in the case of the most severe genetic disease in which the life would consist of more suffering than happiness, a significant amount of utility has been lost. Moreover, as Munthe observes, PGD typically involves the destruction of several embryos, whereas abortion involves only one fetus–and the numbers always count for utilitarians. So are utilitarians logically required to object to pure selection using PGD?

    Munthe advances several arguments to show that this is not necessarily so, the most compelling of which is the replaceability argument–that the lost life of the discarded embryo will be replaced by the life produced by the embryo selected for, and that replacement life will have more happiness than the lost life, even if only by a relatively small margin. But he also explores the fundamental problem of the utilitarian approach to the value of future lives. The utilitarian seems left with the unpalatable choice between, on the one hand, saying there is an obligation to create more and more people whose lives will be only marginally better than no life at all (Parfit's repugnant conclusion), or on the other hand, allowing that the only harms that matter are those done to already existing people, which means there is nothing wrong with deliberately bringing into the world a child with a significant disability (since that child would otherwise never have existed at all, and is not harmed by its coming into existence). This is Parfit's non-identity problem. Munthe's preferred solution is to opt for the repugnant conclusion, although, frustratingly, he does not give an argument for this preference.

    Thi`s utilitarian approach to the moral evaluation of embryo destruction in pure selection is, in my view, a central feature of this book. My one criticism would be that Munthe does not highlight this enough, but rather presents a whole range of possible arguments for and against PGD for pure selection, apparently giving all of them equal weight, when some are clearly much more to the point than others. On the other hand, the book certainly does provide a thorough overview of the ethical issues associated with PGD, and would be an excellent starting point for anyone wishing to gain an efficient grasp of the area. The broad coverage of a range of issues means that each one cannot be pursued in as much depth as readers more familiar with the issues might like, but, in all fairness, the book cannot be expected to provide both.