Slippery When Wet
The prestigious Journal of the American Medical Association (JAMA) is also serving this particular dish, albeit with a side order of subtlety. This week’s issue features an article encouraging the use of preimplantation genetic diagnosis (PGD) for screening out embryos genetically inclined towards developing cancer. After noting that a growing number of cancers have been associated with more than 30 gene mutations, the authors conclude
men and women at hereditary risk for cancer can take advantage of the potential of assisted reproduction, including PGD, to decrease the psychological burdens imposed by these diseases, by threat or occurrence, from one generation to the next.
PGD was initially developed to allow parents to avoid having children with early-onset diseases that are genetically determined, almost certain to occur, and dramatically diminish life expectancy. Tay-Sachs is a prime example. But this JAMA article highlights how new arguments are being put forth to expand the use of screening technologies to exclude embryos with genetic predispositions for often treatable adult-onset diseases that are not simply hereditary or sure to happen, but are complicated by environmental influences and lifestyle choices.
While understated, this article reflects an extraordinary shift in how we think about reproductive technologies’ appropriate use as well as their social impact. And rather than being an isolated incidence of biomedical overreaching, there are other prominent examples of how this approach is taking hold in the medical community.
Lowering the PGD bar seems to be, as Slate’s Will Saletan puts it, a “gentle descent towards eugenics” where medicine’s role becomes controlling the types of people born rather than helping individuals manage the medical risks we all have at some level. Even more troublesome, it’s only a small yet slippery slide down the slope to future understandings of “risk” that conflate social and medical determinants; after all, people with genes for blond hair and blue eyes seem to lead “healthier” and “better” lives. Not exactly Hippocrates’ vision of modern medicine.