Editor's Note: This article is part of "The Ten Today," a series that examines the Ten Commandments in modern society. This story explores the first commandment, "Thou shalt have no other gods before me."
Male or female? Brown eyes or green? Intelligent, athletic or both?
Most parents have some idea of who they would like their child to be — and someday science could let them decide.
"It seems like science fiction," said John Evans, a professor of sociology at the University of California, San Diego, describing the possibilities created through reproductive genetic technologies.
At one point, so did screening for genetic diseases or using in vitro fertilization. But over the last 25 years, scientists have refined a process called preimplantation genetic diagnosis (PGD), making it possible to test for disorders like Tay-Sachs disease or cystic fibrosis in embryos created in a lab. The procedure is widely praised for its ability to eliminate these sources of human suffering, as only healthy embryos are implanted in the woman's womb.
As with abortion and other reproductive issues, the ethics of PGD are murky, and they're bound to become even more complicated, Evans said, if and when geneticists isolate the genes that determine intelligence and other, more superficial traits. Already 50 percent of U.S. adults think using genetic modifications to reduce the risk of serious diseases in offspring represents "taking medical advances too far," and 83 percent say the same about making the baby more intelligent, according to a recent survey from Pew Research Center.
The potential for PGD to enhance an embryo is difficult to grasp, especially for the many Americans who are unaware of the reproductive technologies that already exist. Evans and other academics, as well as leaders of religious communities, are raising awareness of the issue, asking people to consider the ethics of a procedure that could eventually — and, for some, already does — feel like playing God.
"It's like, 'OK folks, let's take stock,'" said Ronald Cole-Turner, a Pittsburgh Theological Seminary professor and ordained minister in the United Church of Christ. PGD can't yet produce a more intelligent or athletic child, "but it seems to be where we're going."
The process of PGD
Reproductive genetic technologies steadily advanced during the 20th century, evolving from genetic counseling that identified an individual's risk of passing on disorders to techniques like PGD that mitigated that risk through selective implantation.
Karen Litwack, senior adviser for national and educational initiatives at the Center for Jewish Genetics, remembers being tested for the enzymes associated with Tay-Sachs disease in the mid-1970s. The disorder progressively destroys neurons in the brain and spinal cord, often leading to death during childhood. Although rare, Tay-Sachs disease disproportionately affects Ashkenazi Jews, or Jews whose ancestors lived in central and eastern Europe.
At the time of Litwack's test, the goal was to determine who was a carrier of the disorder, with no options for future reproductive decisions beyond using birth control or having a partner tested as well. Couples might quietly break up if they both tested positive for the enzymes, but the ethical guidelines for making reproductive decisions were foggy.
"It really stayed that way, to the best of my knowledge, until about the 1990s," Litwack said. "Then, there were breakthroughs in finding the genes for disorders like Tay-Sachs," which allowed geneticists to create new possibilities for affected couples to reproduce with a reduced risk of passing on disorders.
In PGD, a couple turns over egg and sperm samples to a lab. Fertilization happens outside of the woman's body so that doctors can isolate embryos that don't carry the disease.
"As long as the problematic trait is recessive — and many of these diseases are — only a quarter of the embryos will express the disease," Evans said, calling to mind high school biology lessons on Gregor Mendel. "Half will be carriers and a quarter of them won't be affected at all."
The procedure is no more invasive than IVF, but it involves the destruction of at least three-quarters of the embryos. Evans said that's why some religions, including Catholicism, would reject PGD at face-value, because their official teaching is that all embryos represent human life.
However, for many people, PGD inhabits a moral grey area. Its ability to avoid the suffering caused by genetic disorders is viewed by many as a cause for celebration, Evans said, including some religious people who might otherwise protest embryonic death.
"In contemporary society, human health and the reduction of suffering is really one of the most powerful ideas. It's quite hard to argue against," he said.
Healing vs. enhancement
Due to its high cost and the small size of the population impacted by the disorders it's able to address, PGD has maintained a low profile. Discussions on the ethics of its use generally stay in scientific or academic circles, Evans said, even though America has a history of fiercely debating reproductive issues like abortion.
"People haven't really been concerned about it, because it's still a bit abstract," he said.
This abstractness comes from the debate's focus on suffering, Cole-Turner said. Conversations about PGD grapple with what counts as a legitimate reason to intervene, a process that will become more and more complicated as geneticists isolate additional disease-linked genes.
"How do we know what is a disease versus what is a cultural taste or trend?" he asked. "By and large, people take Bible stories about Jesus healing the sick as authorization for us to use the latest (medical) technologies to … somehow circumvent the symptoms of diseases. But what about enhancing people who aren't particularly sick?"
Cole-Turner offered the example of age-related dementia. For those who have experienced the pain of watching a family member struggle through Alzheimer's, the chance to avoid mental deterioration might seem like a godsend. But it could also be understood as a scientific overreach, one that would change the nature of being human, he said, or violate the first commandment by allowing the "god" of medicine to interfere with God's plan.
Because of its current focus on serious genetic disorders, Evans said most people of faith could think of PGD as "playing God as God would play God." It modifies the human body to address disease, just like vaccines and other widely accepted medical treatments.
Additionally, the healthy embryo selected for implantation is still a natural product of the pairing between the man and woman using PGD, even if a noncarrier of the disease would only be expected in 1 in 4 pregnancies, Evans noted.
He expects that a sustained outcry about PGD, from religious communities and others, will come only when the process enables couples to add genes to their embryos that could never have arrived there naturally, such as a gene that would boost intelligence.
Enhancing an embryo, unlike protecting it from an inherited genetic disorder, can be understood as an act of creation, an idea that makes many people uncomfortable, Evans said.
"I would argue that the moment someone creates the first synthetic human or really creates the ability to influence some genetic quality of children that's not currently defined under health, (we'll see protests)," he said.
However, there's already a community of people in the United States — again, mostly contained in the academic world — who not only predict the ability to enhance embryos, but also welcome it.
The movement is called transhumanism, and its members are well-versed in technologies like PGD, Evans said.
"Their basic premise is that we're inhabiting humanity 1.0 and our bodies don't work very well. They want to consciously create humanity 2.0," he said.
The most helpful response to the debate about the ethics of PGD is to support better dialogue around it, said Cole-Turner, who wrote the book "Transhumanism and Transcendence: Christian Hope in an Age of Technological Advancement."
He speaks in congregations six to 10 times a year, helping church members grapple with how reproductive genetic technologies can be viewed through the lens of faith.
At the Center for Jewish Genetics, Litwack and her colleagues focus on education. The Jewish community is vulnerable to a variety of genetic disorders, and the organization was founded to ensure people had the resources they need to make the healthiest reproductive decisions.
The goal of genetic counseling isn't to push couples in any one direction, said Jason Rothstein, the center's director. Instead, it works to raise awareness, helping clients understand the blessing of being able to prepare for difficult situations.
"There are so many identified (genetic) issues in the Jewish community," making conversations about screening and technologies like PGD a priority for many in the religion, he said.
Although Cole-Turner would like more groups to be as proactive as the Jewish community, he said one benefit of the relatively limited scope of debates over PGD is that important advancements have happened free from the at-times unfair scrutiny that occurs when an issue is in the public eye.
"Once issues get swept up in the political vortex, it gets polarized and simplistic," he said.
But a lack of engagement on the issue of PGD cannot continue forever, especially as opportunities for genetic enhancement appear on the horizon, he said. The only way to create a healthy ethic around its use is to start conversations now with people of all backgrounds, including scientists, academics and people of faith.
"Incremental advancement is a very human phenomenon. It allows for adjustments, for reconceptualizing and reorienting," he said. "But it's true that it can lull you to sleep."
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