Editor’s Note: Robert Klitzman is a professor of psychiatry and director of the masters in bioethics program at Columbia University. He is author of “Designing Babies: How Technology is Changing the Ways We Create Children.” The opinions expressed in this commentary are solely those of the author. View more opinion articles on CNN.
Many surprises come with having a baby, including learning your child’s sex and discovering all the traits they inherited as they grow up. But what if parents could pick and choose their children’s genetic makeup instead of leaving those traits up to nature? Such arrangements are increasingly possible, posing ethical and social dilemmas that more and more people are now facing.
In November, Dr. He Jiankui announced that twin girls had been born in China from embryos whose genes he had altered using CRISPR gene-editing technology. According to the magazine Science, he hoped to build a baby-designing business.
In March, a World Health Organization committee argued for a moratorium on clinical human genome editing “until its implications have been properly considered.” But no system of global guidance exists to implement or enforce such a ban on the practice. In June, a Russian scientist declared that he plans to proceed anyway.
You can imagine what bad actors with eugenic fantasies could do with this technology. But today, many patients, with the best interest of their future children in mind, choose embryos based on the genes inside. Yet here, too, ethical questions arise.
Through preimplantation genetic diagnosis, physicians now routinely test embryos for hundreds of genes. Parents can thereby select embryos with certain genes to avoid particular diseases – or to pick the sex of their future child. Since 1978, when the first child, Louise Brown, was born using in-vitro fertilization, this and other assisted reproductive technologies have expanded immensely, creating over a million babies.
About 12% of all couples experience infertility. Increasingly, women who delay childbirth to pursue careers, single men and women, and gay and lesbian couples are also using assisted reproductive technologies, which account for about 10% of all births in Denmark.
Yet the European Union nations and other industrialized countries closely regulate this industry far more than the United States does. Here, many observers call the IVF industry “the Wild West.”
Laws regarding these assisted reproductive technologies vary from country to country, if they exist at all.
Several countries allow women to provide their eggs to other prospective parents and to receive relatively small amounts of compensation to cover basic expenses: generally less than about $1,200 in all.
The underlying idea is that the would-be parents are not buying the eggs themselves – and treating them as commodities – but rather just covering the donor’s basic expenses. In contrast, the United States allows people to buy and sell human eggs for much larger sums that can increase with the presumed quality of the eggs themselves.
US egg sales have become a huge business, with hundreds of donor agencies soliciting young women to sell their eggs in university newspapers advertisements. Prospective parents now buy eggs online using drop-down menus to choose donors with specific hair and eye color, height, graduate education, hobbies, religion, race and ethnicity and more – though, of course, purchasers can’t be certain which traits the future child will, in fact, inherit from the donor. Aaron Levine, a professor at Georgia Tech, found that the prices of eggs tend to increase with the donor’s college’s average SAT scores.
Because preimplantation genetic diagnosis allows parents to avoid transmitting mutations to children, CRISPR will unfortunately probably be used to enhance progeny with socially desired traits such as height, certain athletic abilities or intelligence. Such uses will be very profitable.
Due to high costs, assisted reproductive technologies, including preimplantation genetic diagnosis, are not available to everyone and are thus altering how thousands of affluent people – but not poorer individuals – thrive and live. Wealthy individuals are eliminating certain lethal mutations from their offspring while the less affluent cannot. Several types of cancers and other diseases that have affected both the wealthy and the poor alike will disproportionately affect the poor as a result.
Selection of embryos to prevent lethal diseases offers clear benefits, but government and insurers should work to make this service available to everyone, not just the rich.
Hopefully, doctors won’t insert CRISPR-edited embryos into wombs until the risks are better understood – but even then, the dangers will not be fully known until these gene-edited children are created. Extensive studies will have to be conducted over the course of their lifetimes, along with the lifetimes of their own eventual offspring.
In the competitive, profit-driven assisted reproductive technology industry, numerous doctors may well end up performing these procedures with little regulatory or administrative hindrance. And in a world where individuals with perverse intentions will stop at nothing to pursue their fantasies, having access to technology that can alter the makeup of humanity is incredibly dangerous.
It’s not hard to imagine the disturbing consequences. But as our understanding of genetics is ever-growing, using CRISPR to enhance humans is also risky due to the possibility of inadvertently creating children with severe medical problems.
Rightfully, the American Society for Reproductive Medicine has issued guidelines concerning several areas, such as choosing embryos for sex and social reasons. But these guidelines lack monitoring and enforcement and can often be strengthened. The US Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology gather certain basic statistics from IVF clinics. But these clinics are not required to provide this information, and many don’t.
Unfortunately, many clinicians appear to oppose additional reporting requirements and stronger guidelines. Nonetheless, governmental agencies should mandate that IVF clinics submit patient data so we can monitor our use of preimplantation genetic diagnosis and other practices. And in the near future, the CDC should start asking whether clinics have used any CRISPR-edited embryos.
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Luckily, altering nature is far more complicated than many think. Scientists have investigated hundreds of genes for links to intelligence. The gene with the strongest effect raises IQ by only about 1 point. Undoubtedly, multiple genes and other factors are involved.
With racism and economic divides prevalent in our society, we need to be better prepared for these ongoing technological advances that are changing generations of people and our species as a whole.
The development of gene-altering technologies, once the stuff of sci-fi movies, should prompt us to realize that eugenics is no longer a thing of the past – or of a fictional future. It is a reality that we must all now confront.