Prenatal genetic screening: the enigma of selective abortion.

Author:Stoller, David
 
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In the survival of favoured individuals and races, during the constantly-recurring Struggle for Existence, we see a powerful and ever-acting form of Selection ... Thus, from the war of nature, from famine and death, the most exalted object which we are capable of conceiving, namely the production of the higher animals, directly follows.

And I think that our braver and better youth, besides their other honors and rewards, might have great facilities of intercourse with women given them; their bravery will be a reason, and such fathers ought to have as many sons as possible.

Plato, THE REPUBLIC, Book V, 460b

  1. INTRODUCTION

    As we near a new millennium, technology changes the world at an astonishing rate. Almost no aspect of our world is as it was only a few years ago. Included within this change is the advent of new reproductive technologies which influence the choices available to prospective parents.

    Among these new technologies is the ability for science to accurately predict the genetic make-up of a fetus.(2) Available methods obtain samples of pre-natal cells and perform a battery of genetic testing.(3) Advances in molecular biology and genetics will soon produce a "genetic map"(4) which prospective parents can use to assess a full complement of the genetic traits of a potential child.(5) The advent of these technologies also brings questions of whether this "science" is ethically and legally acceptable.(6)

    This paper examines the issue of pre-natal genetic testing and its ethical and legal concerns. Part II details the scientific techniques involved in pre-natal genetic testing. Part III discusses the Human Genome Project and its influence on the choices available to prospective parents. Part IV analyzes the moral and ethical issues raised by pre-natal genetic screening. Part V presents the legal issues raised by pre-natal genetic screening. Finally, Part VI concludes and offers a prospective on the future of these technologies.

  2. SCIENTIFIC TECHNIQUES

    1. Amniocentesis

      Amniocentesis allows doctors to withdraw fluid from the amniotic sac and harvest the fetal cells contained therein.(7) This is accomplished by piercing the abdomen of a pregnant woman to gain access to the amniotic sac. A portion of the amniotic fluid is withdrawn and incubated to increase the concentration of the fetal cells found in the amniotic fluid.(8)

      One of the major drawbacks of amniocentesis is that it cannot be performed before the fifteenth or sixteenth week of pregnancy. Adding the time for incubation of the cells, the earliest an expectant mother can learn the results is around nineteen or twenty weeks. Additionally, amniocentesis has resulted in approximately a 0.5 percent pregnancy loss in the United States.(9)

    2. Chorionic Villi Sampling (CVS)

      CVS extracts fetal cells through biopsy of the chorionic villi.(10) The chorionic villi are hair-like projections that surround the embryo in the early stages of pregnancy. CVS can be performed by a physician using ultrasound to guide a thin catheter through the cervix. Once in the uterus, a small plug of tissue is removed. This plug contains chorionic villi from which fetal cells can be harvested.(11)

      The major advantage to CVS is that the procedure can be performed within the first three months of pregnancy. Because the chorionic villi will disappear in later stages, this procedure must be performed before the tenth week of pregnancy. CVS has the additional advantage of needing no time for incubation of the fetal cells. Thus CVS provides patients quicker results than amniocentesis.(12) However, the incidence of pregnancy loss as a result of CVS is slightly higher than that associated with amniocentesis.(13)

    3. In Vitro Fertilization

      In in vitro fertilization, sperm and egg samples are artificially conceived outside of the womb.(14) Once conception occurs, the resulting zygote begins to divide. At the eight cell stage, a single cell can be removed and genetic screening can be performed.(15) Once the cell is removed, the zygote can be frozen awaiting the results of a genetic screening. If the resultant screening shows that the zygote has no genetic diseases, it can be implanted into a woman and carried to term.(16) Because the rate of successful pregnancies per implanted egg is relatively low,(17) multiple zygotes are often implanted during each separate procedure.(18)

  3. THE HUMAN GENOME PROJECT

    The Human Genome Project is a worldwide effort to completely map and sequence the entire human genome.(19) The Project began in the United States in 1989 and continues running in laboratories throughout the country. The project is expected to last up to fifteen years. Current funding for the project is near $200 million per year.(20) Of this expenditure, three percent is spent on funding discussions into the ethical and social implications that have and will result from the project.(21)

    The goal of this project is to sequence each of the 50,000 to 100,000 genes found on the twenty-three pairs of chromosomes that comprise the human genome.(22) Once the project has sequenced and mapped each chromosome, scientists will have a guide that will allow them to know where each gene is located and what is the "normal" sequence of that gene.

    This map can then be used as a measuring stick against which prospective parents can compare their potential children.(23) This map will be beneficial in that it will allow prospective parents to determine whether their children have any of the 5,000 diseases believed to be linked to genetic malformities.(24) However, the map's benefits must be weighed in light of other information that it will divulge. This information deals with non-disease traits that involve the more aesthetic details of being human.

  4. ETHICAL ISSUES

    As the Human Genome Project moves closer to a completed map of the human genome, more and more links will be made between specific genetic compositions and resulting external physical traits and genetic diseases.(25) As this information becomes available to the public, an increasing number of parents will likely wish to have their potential children screened. In addition, physicians worried about malpractice claims based on wrongful life, wrongful birth, and wrongful pregnancy will likely increase the number of patients that they recommend should take these tests.(26) This increase in use of these procedures will create a number of ethical issues which must be addressed.

    1. Eugenics

      The term "eugenics" was first described by Sir Francis Galton.(27) The term was used to refer to the belief by certain scientists that socially undesirable traits such as disease, poverty, and criminal tendencies were linked to an individual's genetic make-up.(28) Eugenicists used this theory to support their belief that persons exhibiting such traits should not be allowed to reproduce. These scientists believed that such a practice would lessen the impact and scourge of the underclass on modern society.(29)

      1. Types of Eugenics

        There are two categories of eugenics. The first is positive eugenics. This category involves genetic screening and use of the results to fix any problems evident from the procedure.(30) In other words, where the genetic screening manifests a problem, the problem can be fixed by genetic manipulation of the embryo or fetus to correct the problem. Even with all of the surges in technology, this process is still some time away from practical application.(31)

        Negative eugenics, the second category, involves testing for the genetic make-up of the individual and then using the results to determine whether that individual should be carried to term or aborted.(32) The eugenicists believe that if individuals with problematic traits are not born, the traits will disappear through the use of "selective abortion."(33) It is this category of eugenics which this paper seeks to explain and analyze.

      2. Government Attempts at Eugenic Control

        Different governments have attempted to institute eugenic control programs in an effort to "better" their genetic pool.(34) These efforts have even been exercised in the United States. Eugenic scientists influenced Congress to severely limit levels of legal immigration in the 1924 Immigration Restriction Act.(35) The eugenic scientists were able to persuade Congress that much of the crime and poverty in the United States could be avoided by limiting the immigration of persons from Eastern Europe who were the purported "carriers" of these genes.

        In Buck v. Bell,(36) the Supreme Court upheld a Virginia law that allowed forced sterilization of persons in state custody who had hereditary forms of insanity or imbecility. The state believed that it had an interest in stopping reproduction of genetically diseased individuals who it believed were taxing state resources. The Court upheld the statute by reasoning that such measures were an adequate exercise of state powers and were not contrary to patient's Fourteenth Amendment Due Process guarantees. Speaking for the majority, Justice Holmes wrote "three generations of imbeciles is enough."(37)

        In Skinner v. Oklahoma,(38) Oklahoma's forced sterilization law for "habitual criminals" was challenged. The defendant challenged the law on grounds that it violated the equal protection clause of the Fourteenth Amendment. He claimed that there was no empirical evidence correlating the commission of certain crimes with the incidence of producing children with criminal tendencies. The Court found the statute to be a violation of the Equal Protection Clause because the application of the statute did not have an adequate factual foundation.(39)

        The country of Singapore is an example of current government sponsored eugenic control.(40) The government has created a program whereby the most desirous women are actively courted to participate in programs that seek to match these high caliber women(41) with men of similar talents. The program involves government sponsored gatherings where these...

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