PGD: pre-implantation diagnostics – pros and cons

In July 2010, the Berlin doctor Matthias Bloechle turned himself in for treating couples who wished to have children with the help of pre-implantation diagnostics (PGD) in his practice. Shortly thereafter, he was acquitted by the Federal Constitutional Court because his arguments showed that the Embryo Protection Act does not expressly prohibit PGD, as had been assumed up to that point. Since then, there has been an intensified public discussion about the procedure, which is led by representatives from politics, medicine, the church, the judiciary and many other social groups and in which medical and moral arguments are opposed.

PGD ​​allowed within narrow limits since July

This loophole should now be clarified in the Bundestag. There were three different versions of the law. There were no party-political obligations, all deputies were allowed to follow their conscience. A permit has prevailed in strictly regulated exceptional cases and under strictly controlled conditions. In the future, preimplantation diagnostics may only be used if one of the potential parents is predisposed to a serious genetic defect and there is therefore a risk of a stillbirth or later damage to the child. In order to obtain permission, however, parents must undergo consultation with an ethics committee, which must examine and approve the individual case. The medical associations also emphasized once again after this vote that that there will be no designer babies with them. Frank Ulrich Montgomery, President of the German Medical Association, is quoted online by SPIEGEL: “We doctors will take responsibility for using this procedure under controlled conditions and only with prior expert advice. We definitely don’t want PGD to become a routine in vitro fertilization procedure.”

But what exactly happens during preimplantation diagnosis (PGD)?

PGD ​​is a medical method that makes it possible to examine embryos created by artificial insemination for possible genetic or chromosomal defects before implantation in the uterus. There are two methods for the investigation.

• In the first method, about three days after fertilization, a few cells are removed from the embryo, which has already divided into eight cells, using a thin needle, and these are examined for suspected defects or defects that are likely due to the parents’ predisposition. This method is forbidden in Germany because each of the individual cells theoretically has the predisposition to become its own person at this point in time.
• In the second method, which is also the subject of public debate, the cells are only removed from the embryo after five days, when cell division is more advanced and the individual cells no longer meet the requirements for developing into independent life . The further course of the investigation corresponds to that of the other method.

With PGD, the genetic information of each embryo can be decoded and genetically heavily burdened or presumably non-viable embryos can be identified and, if necessary, sorted out. Healthy cells are implanted in the patient, the rest die off.

Arguments against preimplantation genetic diagnosis (PGD)

The new legal regulation caused an outcry among many Christian and social organizations. The handicapped associations in particular see the permission of the PGD as a slap in the face. Why is that when all it seems to do is save lives?

• First of all, the opponents of PGD argue that this procedure means a selection on humans, because when selecting the embryos, a selection is made according to certain criteria (viability, presence of certain predispositions for diseases). For many opponents, a “euthanasia” of the embryos takes place at this point. For many Christian associations in particular, human life begins with the fusion of egg and sperm. Because then the person already has all the predispositions for his later life.
• Furthermore, the PGD opponents fear increasing social intolerance towards disabled people. In their view, the artificial selection of healthy embryos discriminates against the disabled and disregards their dignity. No distinction should be made between a life worth living and a life not worth living. In addition, the approval of PGD could create a sense of obligation for expectant parents to take the opportunity to give birth to a healthy child using PGD and artificial insemination, even if they could in fact conceive naturally.
• Opponents also see major problems in limiting usability. Contrary to what is envisaged in theory, no clear limits can be drawn in practice in practice, since the final decision as to whether treatment is indicated for a couple or not is ultimately always subjective. There is a fear that medical and legal limits, which were initially strictly drawn, will continue to loosen in practice and that moral limits will eventually be expanded every year. This results in the risk of an application without this being medically necessary and which, for example, should determine the sex of the child in advance. There have already been similar cases in the USA or in Russia.
• Last but not least, the opponents of PGD point out that during the procedure embryos are always only examined for a single gene disorder that is likely or suspected based on the medical history of the parents and that an alternative disease cannot therefore be ruled out. For this reason, they massively question the actual benefit of the complex treatment.

Arguments for Preimplantation Genetic Diagnosis (PGD)

Proponents of PGD primarily describe the benefits of the method to expectant parents to support their argument. In the discussions, most of them keep pointing to the definition of clear limits, so a general approval of PGD is not desirable even for most of its advocates.

• Proponents of PGD often argue that its purpose is not to select the best genetic material for one’s child, thereby creating a kind of elite, but to help parents give birth to a viable child. The examinations are only about checking the suspicion of genetic or chromosomal defects, such as hereditary diseases or severe disabilities. A selection of the embryo according to the future eye color or gender should remain punishable in order to prevent abuse. For this reason, most advocates welcome the establishment of a special ethics committee to decide whether PGD is necessary or not.
• Furthermore, by allowing PGD, the emotional situation of the parents, especially the mothers, should be taken into account. The plight of many parents, which is caused by repeated miscarriages or stillbirths, is largely ignored. Going through a pregnancy that ends in a miscarriage or has to be terminated due to serious impairments in the child represents an enormous psychological burden that no woman should be exposed to.
• Furthermore, it is incomprehensible that prenatal diagnosis, in contrast to PGD, is allowed. The fact that the abortion of an already well-developed fetus due to a detected disability is not prohibited, but the destruction of a diseased “cell pile” should be punishable, is disproportionate. Above all, she sees this argument against the fact that artificial insemination always produces several embryos that cannot be placed in the woman’s uterus and are destroyed or frozen.
• They also state that PGD has been permitted in many other European countries for years, which means that expectant parents have to put up with the hardship of traveling to another country for treatment in addition to the unfulfilled desire to have children. This means an additional financial and emotional burden and leads to a kind of “PGD tourism”.

The deep division of all parties and many social groups shows that the topic of PGD is seen by many people as the beginning of a more in-depth discussion. Christian and social organizations are right to ask whether this decision will also affect the acceptance of abortion and euthanasia. You see a big, long-term discussion coming up in Germany about how much suffering we want to accept from sick, old and disabled people in the future and endure ourselves. And when our tolerance will reach a moral limit in the future. Will we implement everything that we are medically able to do? Will we lose the tolerance to endure, see and live with suffering and disability? Or does a stable moral framework help us to keep this balance? The level of confidence in this stability is not pronounced among all groups. The next few years will allow an evaluation of this political decision. But would it then be too late to turn back? The answer is probably yes.