Amidst current debate about the implications of allowing couples to select embryos free from conditions with later onset, incomplete penetrance and (limited) treatment options, ethicists have recommended that parents undergoing PGD should, in certain circumstances, be allowed to change their mind, transferring embryos with the genetic condition which they initially sought to avoid.
Although such requests may seem to contravene the rationale for carrying out PGD in the first place, this is not grounds for dismissing such requests, ethicist Dr Wybo Dondorp, of Maastricht University, the Netherlands, told delegates at the European Society for Human Reproduction and Embryology annual meeting today. 'As the couple's primary wish may be for a child, they may reason that if a non-affected, healthy child is not what they can get, they will also be happy with, and good parents for, a child with a condition they at first intended to avoid. Respect for autonomy at least requires taking such requests seriously, even if, in view of all other considerations, doctors decide not to agree to the requests,' he said.
Dondorp's comments are consistent with clause 14 of the UK's new Human Fertilisation and Embryology Bill, which will become law later this year and states that in assisted reproduction, embryos known to be at risk of developing 'serious physical or mental disability' or 'serious illness' must not be preferred to embryos where there is no such risk. 'The present consensus is that where the classical indications for PGD are concerned, doctors should, as a general rule, not transfer affected embryos where non-affected ones are available,' he said.
Originally, PGD was only used for relatively untreatable conditions which are caused by a single gene mutation and onset early in life. But with an ever expanding list of conditions outside the classical range licensed for PGD, including hereditary cancers and later onset disorders, Dondorp believes it is paramount to the welfare of the child for couples contemplating PGD to have discussed all the various options available to them in the event that no unaffected embryos are available for transfer, namely: implanting an affected embryo, trying a new cycle, voluntary childlessness, using donor eggs or sperm, or adoption.
A paper exploring these issues, co-authored by Professor Guido de Wert, also of Maastricht University, will be published in the journal Human Reproduction.