Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2017). Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2017.02.121
Ethics Committee of the American Society for Reproductive Medicine. Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion. Fertility and sterility. 2017. doi:10.1016/j.fertnstert.2017.02.121
Ethics Committee of the American Society for Reproductive Medicine. "Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion." Fertility and sterility, 2017.
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RRM Academy Synopsis
ASRM discourages transfer if child is highly likely to be gravely ill
A 2017 ASRM ethics opinion on tested embryos holds that helping with transfer, or declining, is ethically permissible in most cases. One group differs. In this group, a child is highly likely to have a life-threatening illness from birth and no possibility of reasonable function. For them, the committee calls provider transfer ethically problematic and highly discouraged.
Key Findings
The committee concludes that in most clinical cases, helping with transfer or declining to help is ethically permissible.
For embryos highly likely to produce a child with a life-threatening condition, severe early debility and no reasonable function, the committee holds that refusing a request is "ethically acceptable."
For that same group, the committee calls provider help with transfer "ethically problematic" and "highly discouraged."
For a child highly likely to have a condition medical care can treat or manage, the committee holds transfer on request "ethically acceptable." Nonarbitrary, nondiscriminatory refusals also fit ethical bounds.
The committee cites a study of 18 women with only mosaic embryos. Six transfers ended in the birth of a singleton, chromosomally healthy infant.
The ASRM Ethics Committee's Position
“in circumstances in which a child is highly likely to be born with a life-threatening condition that causes severe and early debility with no possibility of reasonable function, provider transfer of such embryos is ethically problematic and highly discouraged.”
Quoted verbatim from this paper.
Interpretation
The opinion is a position statement from a professional society's ethics committee. The opinion reports no new outcome data. The committee's conclusions draw on arguments about reproductive liberty, physician conscience, avoiding harm, and child welfare. The committee says sound arguments support either helping or declining. The report says it is not meant to be the only approved standard of practice. Testing can also give false positives and false negatives, the committee notes.
RRM Context
The opinion addresses a decision that comes after embryos are made in an IVF cycle and tested. Restorative reproductive medicine works earlier. It evaluates and treats the causes of infertility in both partners so conception can happen in the body. The opinion's call to tell patients about the limits of testing fits the restorative principle of informed consent.
Our editorial summary of this paper, not the article's abstract.
Abstract
Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. This Opinion sets out the possible rationales for a provider's decision to assist or decline to assist in such transfers. The Committee concludes in most clinical cases it is ethically permissible to assist or decline to assist in transferring such embryos. In circumstances in which a child is highly likely to be born with a life-threatening condition that causes severe and early debility with no possibility of reasonable function, provider transfer of such embryos is ethically problematic and highly discouraged.
Ethics and Policy › Reproductive Ethics › Genetic Testing of Embryos · Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies
Judith Daar, Jean Benward, Lee Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Sigal Klipstein, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, S Klipstein, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 28476180 28476180 DOI 10.1016/j.fertnstert.2017.02.121 10.1016/j.fertnstert.2017.02.121 Ethics Committee of the American Society for Reproductive Medicine et al. 2017, Ethics Committee of the American Society for Reproductive Medicine 2017
