Author Affiliations: Department of Obstetrics and Gynecology (Dr Towner) and Bioethics Program (Dr Loewy), University of California, Davis, Sacramento.
Since the birth of the first child conceived by in vitro fertilization
more than 20 years ago, the applications of assisted reproduction have expanded
rapidly. A single sperm can be injected directly into a single ovum to overcome
severe male-factor infertility. An ovum from a young donor can be fertilized
and implanted in a postmenopausal woman so she can carry the fetus. In vitro
fertilization, in combination with DNA or karyotype analysis of a single cell
from the developing embryo (preimplantation diagnosis), allows implantation
of embryos that are free of genetic defects in couples without infertility.
At every new step along the evolving pathway of assisted reproduction, ethical
concerns have been raised. However, thus far, the techniques have been permitted—in
part because of a widespread but tacit assumption that promotion of reproductive
freedom, or in today's language, reproductive autonomy—is an unqualified
interest or good. But is reproductive freedom an unqualified good to society,
the individuals undergoing the procedure, the medical profession, the businesses
sponsoring such technologies, or the offspring thus produced?
Towner D, Loewy RS. Ethics of Preimplantation Diagnosis for a Woman Destined to Develop
Early-Onset Alzheimer Disease. JAMA. 2002;287(8):1038-1040. doi:10.1001/jama.287.8.1038