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The questionable future of unregulated reproduction


by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

The American Society for Reproductive Medicine, the major professional society for the specialty, just issued a ruling that recommends restricting use of a technique that can test the gender of embryos and therefore select the gender of future children.

The ruling is a revision of an earlier position suggesting that using gender genetic testing on embryos would be acceptable. That position raised serious ethical concerns, however, both because it seemed to endorse the practice of choosing embryos for no other reason than their gender, and because it would entail first making embryos, and then choosing some but discarding others -- again based solely on their gender. The new ruling states that "the need for gender variety in a family does not at this time justify the use" of genetic testing of embryos.

Will this ruling prevent people from seeking to implant only male of female embryos? Should there be rules about how far reproductive technologies should be allowed to go, and if so, who should make and enforce them?

Is self-regulation enough?

The world of reproductive medicine is almost totally self-regulated. There are almost no federal rules about what can and can't be done in making and testing embryos for reproductive purposes. Reproductive technologies are constrained only by scientific limits and what patients are willing to pay for. As repeated news about new technology indicates, physicians and patients are willing to push the envelope.

So are voluntary restrictions enough? While it would be nice to hope so, given the market-driven nature of reproductive medicine, it will only take a single clinic offering an unproven or ethically questionable technology for other clinics to follow suit as a matter of economic competition.

Why Congress cares

The problem is that if the profession won't regulate itself, there are plenty others ready to step in and regulate it for them, including federal and state governments.

The main impetus isn't the prospect of gender selection, although that will add fuel to the fire, but the controversy surrounding embryonic stem cell research. The connection is that embryos for stem cell research primarily come from fertility clinics. So the controversy over government funding of embryonic stem cell research quickly reaches into the unregulated domain of reproductive medicine.

The government is now reviewing the authority of the Food and Drug Administration (FDA) to oversee and control reproductive medicine. If the FDA doesn't have authority, Congress can intervene and pass legislation controlling reproductive technologies.

This happened last summer when the House of Representatives passed legislation that bans all applications of human cloning -- both research and reproductive -- with stiff penalties for violators. The Senate has yet to act, but passing a similar bill to the House would be an ill-advised rush to policy-making.

The road ahead

There is no doubt that rules for reproductive medicine are a must, with the only serious question being what they should look like and where they should come from. Until then, the key will be self-control by medical professionals in order to buy enough time for well-reasoned policies.

Unfettered technology will force the hand of lawmakers, making the choice between a brave new world and overbroad government regulation. Neither is a good option for today's patients or tomorrow's children.

Visit the
"Ethics Matters" Archive
where you'll find other columns from Jeffrey Kahn
on a wide range of bioethics topics.

"Ethics Matters" is a biweekly feature from the
Center for Bioethics and CNN Interactive.


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