The overarching ethical concern related to type 2 PGD/HLA testing is the moral status of the embryo. Many books have been written on this topic and many more are being contemplated.
One set of outliers on the bell curve of ethical commentators states that life begins at conception (or, variously, fertilization). The antipodal group states that as embryos are neither persons nor sentient, they have no moral status and may be experimented upon without ethical constraint.
A middle position asserts that although embryos are not persons and are not sentient, they are due special concern as symbols of humanity. This moral configuration may be described as “the dominant view that the preimplantation embryo has only limited moral value”.1
But this view doesn’t imply that any and all forms of experimentation are appropriate. Considerable value for humanity must be derived from embryo research for it to be deemed ethical. Research ends cannot be trivial — such embryo research would not be morally justifiable.
Many would be concerned about creating embryos for solely instrumental purposes. Seemingly this violates Kant’s proscription against using people solely as a means. But embryos are not people, and Kant’s means/ends imperative is not applicable to embryos created solely to provide HLA-matched stem cells.
Regardless, for those who believe that embryo destruction is murder, other moral and philosophical considerations and arguments are irrelevant. For those persons, PGD/HLA testing is evil and should be banned.
Many who are not so extreme may still have concerns about creating a living human-to-be for purposes involving its destruction. One counter-argument might note that many embryos are created as part of the PGD/HLA testing procedure. Some of the healthy embryos of this cohort could be donated to infertile couples, so there would be a net gain of life. Another counter-argument relates to value and proportionality. The destruction of the embryo — which is 9 months removed from the possibility of gaining any life experiences — is weighed against saving the life of an individual who already has many years of life experiences and who has goals, hopes, and intentions.
Type 2 PGD/HLA testing has many significant advantages compared to type 1 testing. The foremost advantage is avoiding the necessity of gestating a fetus and delivering a newborn. All potential ethical difficulties with bringing a new child into the family are similarly avoided with type 2 testing. Such an ethical dilemma involves a diseased parent, whose ability to make objective choices concerning a savior child would be seriously compromised. This situation is avoided completely with type 2 testing.
The question of distributive justice is a key concern in all aspects of reproductive genetics and genetic medicine generally. The costs of both type 1 and 2 PGD/HLA testing are significant. In the absence of financial support for persons in middle and lower socioeconomic strata, these procedures will be utilized exclusively by the wealthy. Moral and ethical considerations demand equitable distribution of these resources. In Europe, centralized governments could make PGD/HLA testing available to a defined group. A national lottery could distribute limited funds. In the U.S. funding would need to come from private foundations. It is unlikely that federal funds would ever be made available for procedures involving creation and destruction of embryos.
PGD/HLA testing should be regulated by governments. For example, testing for phenotypic characteristics such as body type and hair and eye color should be disallowed. Ongoing nationwide campaigns should be directed toward functional medical and scientific education of the citizenry.
1de Wert G, et al: The future (r)evolution of preimplantation genetic diagnosis/human leukocyte antigen testing: ethical reflections. Stem Cells 25(9):2167-2172, 2007
