The introduction of PGD (Preimplantation Genetic Diagnosis) prompted a heated discussion in the 1990s, which has continued to this day. This is not unexpected, given that with PGD we are concerned with the essence of life and with influencing its earliest beginnings. We have to deal with this issue extremely carefully. Maastricht UMC+ has finally been granted a licence to use PGD to prevent serious hereditary conditions. However, in a PGD process, too, there are several points at which you can be faced with a moral dilemma. First of all, there is the question: ‘Which conditions are serious enough to warrant using PGD?’ Is a risk of hereditary breast cancer serious enough? And what about infertility? In the Netherlands, we have drawn up a set of criteria for this purpose. For every new indication, a committee will consider the question of whether or not it should be permissible to use PGD. In addition, a dilemma can arise at the moment of implanting an embryo. Imagine a scenario in which the laboratory notices that there is a case of ‘bycatch’. This is something that is possible with new diagnostic techniques. The serious disease is indeed absent, but the child has a greater chance of being infertile, for example. What do you do in such a case? Do you still implant the embryo or do you reject it? As ethicists, geneticists and also as a society, we have to consider this carefully. The possibilities currently offered by genetics are in any case growing exponentially. Examples are the non invasive prenatal screening test (NIPT) or the discovery of the CRISPR-CAS technique, with which any genetic defect can be repaired in theory. The ethical discussion now encompasses a great deal more than just PGD. With prenatal screening, the whole genome of an embryo can be examined for abnormalities, which means that you will always be able to find a genetic deficiency. And if anything is found, we may be able to repair it before the pregnancy begins. Do we want all that? Where do we as a society say: ‘This is where we draw the line’? On the job Prof. dr. Guido de Wert medical ethicist
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