This 2016 book by Stanford Professor of Law and Genetics Henry T. Greely features many themes and subjects familiar to those initiated into bioethics. Greely foretells the innovation of a new type of preimplantation genetic diagnosis (PGD), which he terms Easy PGD, that will overcome the disadvantages of current in vitro fertilization (IVF) and make artificial reproduction the norm within the century. Part I is reserved for biology alone, and acts as an effective introductory course for those new to the biological and reproductive sciences, as well as a remedial course for those presently invested in genetic sciences. Here, he reviews DNA, chromosomes, reproduction, genetics, and stem cells in exquisite detail, including clarifying such terminology as “genes” and “genomes”, and different types of heritability. Part II transitions to futurism, in which Greely argues for the type of current technologies which will soon enable the creation of Easy PGD. He considers present limitations to be overcome: the invasiveness and danger of oocyte extraction, the cost and inefficiency of current IVF, risks of twinning, and incomplete genetic testing. He then overviews the myriad factors which will enable Easy PGD to be used widespread: the lessening cost of whole genome sequencing, the dynamics of market forces, industry, and health care economics which will motivate research, and a number of current (American) legal and political factors, such as FDA approval, which will facilitate to implement Easy PGD. His thesis is that the key technologies for Easy PGD will be the use of either embryonic, but more likely induced pluripotent, stem cells to create viable oocytes without hormonal stimulation on female “donors”, and ongoing research on creating sperm from eggs and vice versa. Part III is more practical and philosophical, considering the social, cultural, economic, political, and moral implications, involving theories of safety and coercion. Greely admits to being unable to predict how the future will actually unfold, leaving this section with more questions than answers, and reserving his own perspective for the very end.
Greely’s moral discussion is relatively shallow, consisting of a short dismissal of four of the most flimsy moral claims against IVF and Easy PGD. He also spends considerably little time on deconstructing the GATTACA-esque society which his prediction is likely to comprise. However, throughout the book, he does adhere to his own promise to remain morally impartial to the subjects which he discusses, analyzing moral objections that are likely to arise, that are not necessarily his own. Since he fails to introduce ethical theory in general, this book will function as a complement to those already familiar with the fundamentals of moral philosophy, and will promote more discussion than it concludes. A legal specialist by training, Greely is particularly skilled at considering the implications of every scenario without indicating his preference for any one: Easy PGD in an enforced, laissez-faire, or banned legal paradigm. He goes so far as to consider the inevitable conclusion of a ban catalyzing a new domain of black market genetics and reproductive tourism. For any who wish to review, know more about, and scrutinize the science, futurism, and implications of upcoming genetic and reproductive science, this is the ideal read.
Easy PGD, in whatever for it takes, is likely to be developed, then made available for commercial use. The morality of its use is tied less to intrinsic notions of human embodiment and wholeness than to unknown factors. Greely adequately points out that there is no longitudinal study on IVF children, simply because the youngest is in her forties: they may all drop dead suddenly at fifty. The social implications of a society which blames parents for not selecting an child lacking genetic disease is more concerning, but more ambiguous. True, disability rights advocates are the first to object to genetic screening on grounds that it intrinsically devalues disabled lives, yet there is a difference. Some diseases transparently interfere with the child’s future ability to both function and to reproduce. Parents selecting for a child with Tay-Sachs cannot be argued to be doing even a spiritual favor for their child: the child would die a horrible, preventable, early, and therefore pointless death. But what of diseases that disable or disfigure, but do not kill, threaten others, or disable reproductive potential: dwarfism, gigantism, Proteus syndrome, etc. How is the comparable viability of one disease to another to be judged? These questions must be answered before any laws banning or enabling Easy PGD are implemented.
Greely introduces one last scenario of shocking implications. As it will, according to state-of-the-art research, soon be possible to create sperm from eggs and eggs from sperm, it will become possible for a parent to be both the mother and father (and in the case of women, the gestational mother) of their children. While this seems an abhorrently egoistic and hubristic move, what grounds are there for denying a donor’s right to become a “uniparent?” The most viable argument is that such uniparenting is likely to produce the same problems in offspring as cloning and inbreeding: bypassing sex prevents the genetic sorting which dampens the frequency of heritable genetic diseases. However, with the ability to select embryos with Easy PGD, such offspring could be selected against. How, then, might one object to this practice?
For that matter, what is your stance on Greely’s information and his futurism?
Greely, Henry T. The End of Sex and the Future of Human Reproduction. Cambridge: Harvard University Press, 2016.