Agency Allows Broader Embryo Screening

Parents who use in vitro fertilization in the United Kingdom will be able to test their embryos for inherited forms of cancer, following a decision announced today by the Human Fertilisation and Embryology Authority (HFEA), a government fertility watchdog. Supporters say the decision will help parents prevent potentially lethal illnesses in their offspring, but critics worry it could pave the way for "designer babies."

Ten clinics in the U.K. are currently licensed to carry out embryonic disease screening. Doctors use a technique called preimplantation genetic diagnosis (PGD), in which a single cell is removed from the embryo and genetically tested. If markers for a disease such as cystic fibrosis or Huntington's disease show up, the embryo is discarded. The new policy arose from a public discussion sponsored by HFEA in November 2005, where patients, doctors, politicians and other members of the community shared their views on extending embryo testing.

The new policy allows tests for genetic markers such as BRCA1 and BRCA2, which together can increase the risk of breast cancer by up to 80%. It also allows testing for markers that convey susceptibility to ovarian cancer and bowel cancer. This represents a leap from testing for diseases which will eventually kill you to testing for diseases which might kill you and can be treated, says bioethicist Arthur Caplan, of the University of Pennsylvania in Philadelphia.

Still, in today's announcement, HFEA chair Suzi Leather says the authority's decision is "not about opening the door to wholesale genetic testing." Rather, the genetic tests would be available to a minority of people if there were a clear history of cancer in the family. Applications for the testing will be considered on a case-by-case basis, she said, considering all the factors of the condition, including treatability and family medical history.

Bioethicist John Robertson of the University of Texas School of Law in Austin believes HFEA's decision is sound. "[These diseases pose] a high enough risk that it falls squarely within a medical model of the use of preimplantation genetic diagnosis," unlike screening for sex or cosmetically desirable traits, he says. Robertson chaired an ethics committee of the American Society for Reproductive Medicine that last year deemed screening for high-risk cancer genes "ethically acceptable."

Some U.K. lobby groups and disability campaigners oppose the policy, however, saying it smacks of eugenics. And Caplan says the decision could lead to problems in the future. "We have started down a road which will raise difficult questions later on," such as where you draw the line for which diseases and conditions to test for, he says. A policy such as this could be misused to test for less serious medical conditions, or for sex selection in countries where there is little regulation, he says. "Controversy inevitably awaits."

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