Abstract

PIP: With the advent of new and better contraceptive methods and the ability to facilitate and manipulate fertilization and gestation, couples will gain greater control over their fertility. Once a pregnancy has been established or an in vitro embryo created, the ability to evaluate the embryo and fetus will increase dramatically with progress in human genetic research. Preconception and preimplantation genetic testing and screening are now possible, and the technology to perform prenatal screening early in gestation is advancing rapidly. Nonsurgical methods facilitate induced abortion with a relatively lower degree of trauma upon the woman undergoing the procedure. These capabilities may all be used to enable and even encourage the genetic selection of future children. Despite the ethical concerns associated with prenatal testing and abortion, these services will continue to be an integral aspect of reproductive medicine. As technology advances, however, it will be possible to test and screen for conditions which do not produce serious defects. Genetic conditions which produce relatively mild impacts upon health will be identifiable in the embryo or fetus, while late-onset conditions and genetic factors which have only a probability of affecting health will also be located in the fetal genome. Prospective parents may therefore soon have the capability of selecting their most desirable embryo in vitro, or terminating all undesirable fetuses in vivo until the preferred child is delivered. The medical profession must take some responsibility for establishing guidelines on the use of reproductive technology. The standards of practice for the medical profession must reflect the results of a broad social debate over competing moral values. The author develops an argument for legal and ethical limitations on the application of prenatal testing and screening technology, suggesting that for some medical conditions, respect for the privacy and confidentiality of the fetus outweighs parental rights to information about the fetus. Preliminary definitions for what constitute serious defects and minor conditions are developed.