Microinsemination and pre-implantation genetic diagnosis (PGD)
Resumé of recommendations
Ethical position on microinsemination
1. Eight members of the Danish Council of Ethics have ethical misgivings about the use of microinsemination, recommending that use of the method be either halted or restricted to a stringently controlled minimum.
2. Nine members of the Council of Ethics consider that the arguments in favour of using microinsemination to treat infertility weigh more heavily than the arguments against such use of the method.
Should microinsemination be used on an experimental basis?
3. Ten members of the Council are of the view that microinsemination should at any rate only be used on an experimental basis, as there is insufficient knowledge about the risk involved in using the method.
4. Seven members do not consider the uncertainty associated with using the method to be so great as to necessitate carrying out the treatment on an experimental basis.
Use of PGD with a view to avoiding severe illness
5. Three members of the Council feel that it is ethically unacceptable to use PGD for the purpose of preventing a child with a severe and possibly hereditary disorder from entering the world.
6. Five members of the Council take the view that it is acceptable to use PGD only in those cases where there is a known and substantially increased risk of the child having a severe hereditary disorder. In that case, four of these members feel that the examination may address only the severe hereditary disease(s) to which the increased risk relates. One member, on the other hand, finds that, if this is the case, the study must address all the severe disorders it is accepted to check for.
7. Nine members of the Council consider it acceptable to use PGD in cases where there is a known and substantially increased risk of the child having a serious hereditary disease, and to rule out major chromosomal abnormalities if the woman is already undergoing IVF treatment for other reasons. One of these members feels that examinations carried out because there is a known and substantially increased risk of the chid having a severe hereditary disorder must, in that case, address only the severe hereditary disorder(s) to which the increased risk relates. Eight members, conversely, feel that these studies must address all the severe disorders it is accepted to check for. Finally, four of the nine members consider that PGD ought only to be performed on women undergoing IVF treatment if, in the course of a normal pregnancy, the women would be entitled to have either a chorionic villus biopsy (CVB) or amniocentesis.
Regulating which predispositions it is allowed to check for with PGD
Each individual member of the Danish Council of Ethics has recommended one or more possible ways of examining which severe disorders PGD is used to check for, assuming that it is allowed.
8. Six members consider that a list should be drawn up of the predispositions which it is basically acceptable to examine for with a view to screening out embryos. The criterion for drawing up such a list should be whether the relevant disorder has an essentially adverse impact on the quality of life and life opportunities of any child to be born.
9. Ten members think that guideline examples should be drawn up for the relevant individuals or authorities to refer to. Every effort should be made to ensure that the only embryos to be screened out are those with disorders that will substantially impact on the quality of life and life opportunities of any child to be born.
10. Nine members are of the opinion that, in some or possibly even all cases, permission to carry out PGD with a view to targeting out embryos with severe disorders must be applied for from the Danish joint councils on abortion or some board with an equivalent function and structure.
PGD with concurrent examination for predispositions and tissue compatibility
11. Nine members consider it unacceptable to use PGD to simultaneously examine embryos for predisposition to disease and histocompatibility with a view to making it possible to donate to a sick sister or brother. The members mentioned are therefore able to recommend neither the use of the method in Denmark nor the involvement of the public authorities in getting Danish couples treated abroad using the method.
12. Eight Council members take the view that it is acceptable in some cases to use PGD to simultaneously check embryos for predisposition and histocompatibility with a view to making it possible to donate to a sick sister or brother. The prerequisites included are that the sick child must be suffering from a severe and possibly even life-threatening disease that cannot be treated in any other way and that the child-to-be should not be exposed to interventions which must be regarded as unacceptable in their own right.
PGD involving solely examination for histocompatibility
13. Ten members consider it unacceptable to use PGD to examine embryos for histocompatibility purely with a view to making it possible to donate to a sick sister or brother.
14. Seven members take the view that in some cases it is acceptable to use PGD to examine embryos for histocompatibility with a view to making it possible to donate to a sick sister or brother. The prerequisites included are that the sick child must be suffering from a severe and possibly even life-threatening disease that cannot be treated in any other way and that the child-to-be should not be exposed to interventions which must be regarded as unacceptable in their own right.
Sibships with compatible tissue type
15. All members of the Danish Council of Ethics consider it ethically unacceptable for PGD to be used to obtain a sibship with compatible tissue type so that the siblings can all act as donors for one another, should the need arise. This also applies on the assumption that PGD would have to be performed for other reasons anyway.
PGD and the right of at-risk persons not to know
16. All members of the Danish Council of Ethics think that PGD should not be performed for the purpose of enabling a man or woman in a group at risk of carrying a hereditary, dominant and late-onset disorder to have a healthy child without simultaneously being given to know whether they themselves are a carrier of the disorder.
PGD and sorting by common attributes
17. The members of the Danish Council of Ethics agree that PGD should not be used to sort embryos on the basis of common attributes such as sex, looks and so on. In the members’ opinion, any such form of sorting should also be banned in cases where PGD would have had to be performed anyway for different reasons.
General instructions regarding the use of PGD
18. All members of the Danish Council of Ethics recommend that it should not under any circumstances be possible to use PGD for purposes other than preventing, curing or remedying severe disease.
19. With an eye to limiting the use of PGD to altogether specific situations, all members of the Council of Ethics can endorse the view that it should not be possible to have an extra examination performed in combination with a treatment that is acceptable if the extra examination per se is unacceptable. By the same token, in the members’ view, it should not under any circumstances be possible to receive IVF treatment for the purpose of having PGD carried out in situations where PGD would otherwise not be indicated.
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