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The future of reproduction: where do we draw the line?

November 2014

The Anatomy lecture theatre on the 6th floor of the King’s Building was the location for two presentations in  KCL’s Ethics series, with Professor Bronwyn Parry talking about paid surrogacy in India and Professor Rosamund Scott talking about pre-implantation genetic diagnosis (PGD). The presentations were introduced by Dr Annette Rid, Senior lecturer in Bioethics and Society at KCL.

Professor Parry’s presentation corrected misconceptions held by many people about paid surrogacy in India. Far from it being principally undertaken by Westerners, or even ethnic Indians living in the West, 80% is commissioned by resident Indians. There are several reasons for this: rapid professionalisation in the Indian middle classes is leading women to delay childbearing, also infertility arising from disease is much more common than in the West.

Women who offer to be surrogate mothers normally have very limited life choices, making surrogacy a very attractive option. These women primarily use the money to educate their other children. Seen from this angle, if we deny them this option, are we also perpetuating inequality? There are also side-benefits for the surrogate mother in that her nutrition and medical care is better than it would be otherwise, as the donors, surrogate mother and the hospital or clinic have a common interest in ensuring a good outcome (a healthy baby).

Professor Scott’s presentation, in comparison, addressed an area that is of particular interest in the West at present. PGD is still a relatively rare procedure and is used almost exclusively for conditions where a previous child has had a serious defect, or there is a familial history of the defect, or where there have been certain types of miscarriage. As for abortion on medical grounds, the criterion is to avoid a baby being born with a significant risk of mental or physical disability, or another serious condition. The use of the word serious is indicative rather than objective and different doctors may draw the line at different points.

PGD based on gender is not permitted in the UK, except for serious conditions like Duchenne muscular dystrophy, where the defective gene is on the X-chromosome and boys only have one copy of this from their mother. Professor Scott shared the results of a survey on the quality of life for Duchennes boys: their parents rate their quality of life lowest, the boys themselves rate it highest (and almost the same as unaffected boys), while clinicians rate it in between. Clearly, whose opinion we choose to put most weight on will have an effect on decisions whether to use PGD in cases that are less clear-cut.

Professor Scott also mentioned PGD in preventing cases of Tay-Sachs disease and this led to a question from the audience about the New York rabbi, who set up a programme to prevent this and other recessive genetic diseases in his community after he had four of his own children die from the disease. This approach raises an interesting ethical question: is it better to test people before marriage and tell them if they are incompatible (1% of all tests for this community) with their prospective partners; or to allow people to marry freely and deal with the resulting problem through PGD? In this case, being in a close-knit community with many shared ancestors and a reverence for the authority of the rabbi, pre-marital testing worked effectively.

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