Next week, Barack Obama will be inaugurated as president of the United States. There will be parties, cameras, a ceremony, and a parade. The world will watch and celebrate. In politics, revolutions are clearly marked.
Social revolutions that emerge from science, however, are often overlooked. One of those revolutions is happening right now, a week before Obama's inauguration, across the Atlantic Ocean.
"First baby tested for breast cancer form BRCA1 before conception born in UK," says the press release from University College London. "The first baby tested preconceptionally for a genetic form of breast cancer (BRCA1) has been born." The release quotes Paul Serhal, medical director of the hospital's Assisted Conception Unit: "This little girl will not face the specter of developing this genetic form of breast cancer or ovarian cancer in her adult life. The parents will have been spared the risk of inflicting this disease on their daughter. The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations."
It's happy news. But let's take a closer look at the announcement, starting with the test "before conception." This baby was tested as an embryo in a dish. She was one of 11 such embryos made by injecting drugs in the mother to stimulate production of excess eggs, which were then fertilized with the father's sperm. Six of the embryos had the gene for breast cancer. Three more had "other abnormalities." All nine were "discarded." The other two were implanted, and one became this baby.
In sum, at least six human embryos were made and then thrown away because they failed a test. We now call such tests "preconception." This is the next step in our gradual devaluation of embryos. First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is preconception. Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."
Second: "This little girl will not face the specter of developing this genetic form of breast cancer or ovarian cancer in her adult life." Why the word specter? Because the cancer was far from guaranteed. If the parents had conceived naturally, the child would have a 50 percent chance of inheriting the gene. If she got the gene, her risk of breast cancer would be 50 percent to 85 percent. So the IVF and testing were done to avoid not certain death, but a 25 percent to 45 percent chance of getting a disease that, even if it arose, might be cured. And if it arose, when would that happen? "In her adult life," say Serhal. Embryo screening is advancing from guaranteed, fatal childhood disease to potential, survivable adult diseases.
Third: "The parents will have been spared the risk of inflicting this disease on their daughter." The key word here is inflicting. Before this kind of embryo test (known as preimplantation genetic diagnosis), parents weren't held responsible for a bad roll of the genetic dice. If you had a 50 percent chance of passing along a disease and your child got it, that was a tragedy, not your fault. But with the advent of PGD, the equation has changed. Now you can eliminate your risk of transmitting the bad gene—and if you don't take that precaution, you're "inflicting" the consequences. In this way, today's embryo-screening option becomes tomorrow's obligation.
Fourth: "The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations." Lasting. Legacy. Eradication. Families. Generations. We're no longer talking about protecting an individual. We're talking about cleansing families forever. "We are eliminating the gene from our line," says the happy mother. Serhal agrees: "We are eradicating it from the whole family tree." From the standpoint of efficiency, this is wonderful. But efficiency and collective cleansing are the core principles of eugenics. Even if your daughter doesn't get breast cancer from the gene, why burden her with the question of whether to test her own embryos for it? Why not make the decision for her, and for her daughters, and for their daughters?
In fact, why not spare everyone this burden? The press release boasts that University College London doctors have already "applied this technology for avoiding transmission of cancer predispositions in a whole host of cancers," including cancers of the retina and bowel. Why allow anyone to inflict on her children the specter of such adult diseases? Why not leave a lasting legacy of cleansed families? It's a moral no-brainer. All we have to do is test and discard a few clusters of cells before conception.
I'm happy for this woman and this baby. We all want to protect our descendants from disease. But let's not protect them from conscience or the truth.
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