In 1997, the film Gattaca was released and while it was not a commercial success, it did raise questions about the future of genetic technology. The movie predicted a dystopian future in which eugenics dictate the futures of humankind – those who are genetically “superior” rule over those who have less desirable genetic traits. In the movie this is done through a procedure where parents pick their embryos based on their genes prior to implantation (Maslin).
In reality, Pre-Implantation Genetic Diagnosis and Testing (PGD/T) has been around for almost 40 years. It involves the testing of genetic material from the blastula of a developing embryo that is external to the body (to be later implanted using embryo transfer). It is an extra step during the process of In-Vitro Fertilization (IVF), which begins with egg retrieval and sperm retrieval from both parents, and then fertilization occurs external to the womb to create an embryo. After the embryo reaches a certain size, a small number of cells are collected and their genomes are processed to provide genetic information on each embryo (PGD/T). The chosen embryo or embryos are then implanted in the uterus and carried to term (Mayo Clinic Staff).
There are three types of PGD/T that have been available to consumers historically. The first is PGT-A, PGT-A refers to testing embryos by counting the 46 chromosomes to look for extra or missing chromosomes (“aneuploidy”). PGT-M, which is for detecting monogenetic illness such as sickle cell anemia, cystic fibrosis, Huntington’s disease. The last of the three kinds is called PGT-SR. PGT-SR is when the chromosome abnormalities are hereditary due to one or both parents having a balanced chromosome “Structural Rearrangement” (such as translocations or inversions), and can lead to the fetus having structural abnormalities that lead to fetal or infant death. These three types of PGD/T have been around and have been used to specifically prevent death, disability, illness, or injury to the fetus, and also can help parents with genetic abnormalities conceive children without having to worry (Schattman and Xu).
Currently, there is a new form of PGD/T called PGT-P and it involves creating an embryonic “report card” where your future potential children get graded for the probability they will have certain traits. The P stands for polygenetic, and while this technology is not yet widespread, it is growing rapidly. These traits can range from probability of heart disease and certain cancers to the probability of blue eyes and blond hair. Their scope of application is wide as more and more polygenetic traits are being studied and understood. As genetic information becomes more available (primarily through clinical studies and mass consumer use of services such as 23andMe that mine genetic data information), scientists are being able to form clearer pictures of what parts of the genome are involved and working together to create a certain phenotypical expression. On 23andMe, users can see the likelihood they are able to match musical pitch – and the company identified this using 660,000 research participants (23andMe Research). Consumers can see the risk assessment of traits such as eye color, hair texture and color, dandruff, and even type 2 diabetes (which involves over 1,100 genetic variants) (23andMe Research). This type of data mining and extraction lends itself well to PGT-P, where prospective parents can view their embryos’ “grades” or risk assessments to make decisions accordingly, whether they choose cosmetic or health related polygenetic traits.
But PGT-P, if used for cosmetic or enhancement based selection, can influence the way that lineages change over time in terms of genetic variants that are favorable in the eyes of society. Parents who pick embryos that have a lower risk of polygenetic disorders combined with desired cosmetic traits (usually based on social or communal values) are artificially selecting their future lineages. They are choosing children based on their genes, rather than leaving that up to random fertilization (which is extremely important to ensuring genetic variation in a population of any species). Genetic variation is critical to natural selection’s mode of action, and altering it in any sort of way is a form of unnatural selection (or artificial selection).
There are a number of companies on the forefront of this technology – including Genomic Prediction, and Fertility Institutes. One of the founders of Genomic Prediction said his inspiration was the film Gattaca (Regalado). Genomic Prediction’s website currently displays relative risk reduction by using their services – for example for heart attack risk, diabetes, breast cancer, and schizophrenia. The majority of their services, however, are catered towards people with European ancestry (Genomic Prediction Clinical Laboratory) and has the potential to contribute to the already existing issue of racial/ ethnic disparities. The founder of the other organization, Fertility Institutes, has said “This is cosmetic medicine […] Others are frightened by the criticism but we have no problems with it” (Naik). The latter, Fertility Institutes is already based in the United States and Mexico, and is in process of expanding to India (The Fertility Institutes).
The central ethical issue of allowing PGT-P is that it is a technology that would provide an unfair genetic advantage to those who can afford it, and that genetic advantage is heritable by future offspring. There is a large disparity in terms of distributive justice when it comes to this expensive, elective medical technology when introduced into countries where income inequality is already rampant which can cause detriment to the aggregate good of the nation. According to data released by the Federal Reserve in 2020, “the top 1% of Americans have a combined net worth of $34.2 trillion (or 30.4% of all household wealth in the U.S.), while the bottom 50% of the population holds just $2.1 trillion combined (or 1.9% of all wealth)” (Beer). This service predominantly caters to those who are wealthy and have European ancestry in a world where there are clear implications related to a person’s socioeconomic status and race/ ethnicity. Regulation of PGT-P is necessary when considering the inequality it could further exacerbate.
23andMe Research. “Ability to Match Musical Pitch.” n.d. 23andMe.<https://you.23andme.com/reports/trait.match_pitch/>.
—. “Type 2 Diabetes.” n.d. 23andMe. <https://you.23andme.com/reports/type_2_diabetes/>.
Beer, Tommy. “Top 1% Of U.S. Households Hold 15 Times More Wealth Than Bottom 50% Combined.” 8 October 2020. Forbes. <https://www.forbes.com/sites/tommybeer/2020/10/08/top-1-of-us-households-hold-15-times-more-wealth-than-bottom-50-combined/?sh=3a08ac725179>.
Genomic Prediction Clinical Laboratory. “Relative Risk Reduction.” n.d. Genomic Prediction.<https://gpclaboratory.com/relative-risk-reduction/>.
Maslin, Janet. “‘Gattaca’: A Fully Imagined Future.” 24 October 1997. The New York Times.<https://archive.nytimes.com/www.nytimes.com/library/film/102497gattaca-film-review.html>.
Mayo Clinic Staff. “In Vitro Fertilization (IVF).” 22 June 2019. Mayo Clinic. <https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716>.
Mishra, Neha. “India and Colorism: The Finer Nuances.” 2015. Washington University Global Studies Law Review. 25 February 2020.
Naik, Gautum. “A Baby, Please. Blond, Freckles — Hold the Colic.” 12 February 2009. The Wall Street Journal.<https://www.wsj.com/articles/SB123439771603075099>.
Regalado, Antonio. “The world’s first Gattaca baby tests are finally here.” 8 November 2019. MIT Technology Review.<https://www.technologyreview.com/2019/11/08/132018/polygenic-score-ivf-embryo-dna-tests-genomic-prediction-gattaca/>.
Schattman, Glenn L and Kangpu Xu. “Preimplantation genetic testing.” 3 March 2020. UpToDate.<https://www.uptodate.com/contents/preimplantation-genetic-testing>.
The Fertility Institutes. “Center Locations: Contact Us.” n.d. The Fertility Institutes. <https://www.fertility-docs.com/contact-us/center-locations.php>.