List of contributors p. xiii
Preface p. xvii
The challenge for medical ethicists: Weighing pros and cons of advanced reproductive technologies to screen human embryos during IVF
Introduction p. 1
To screen or not to screen: Ethical challenges p. 2
Ethical challenges for prospective parents p. 2
Ethical challenges for society p. 4
Conclusion p. 7
References p. 7
Too much information? The paradox of enlarging genetic datasets for human embryo assessment during in vitro fertilization (IVF)
Introduction p. 11
Slippery slope in other medical technologies p. 12
Preimplantation genetic diagnosis for nonlethal conditions p. 14 Preimplantation genetic diagnosis for late-onset conditions p. 14 Preimplantation genetic diagnosis for treatable conditions p. 15 Preimplantation genetic diagnosis for cancer predisposition p. 15
Preimplantation genetic diagnosis for social reasons p. 16
Preimplantation genetic diagnosis for human leukocyte antigen typing p. 16
Preimplantation genetic diagnosis for sex selection p. 17
References p. 18
A new global perspective: Geographic variations in the use of preimplantation genetic technologies to screen human embryos
Introduction p. 23
Countries where preimplantation genetic testing is prohibited p. 24 Countries where preimplantation genetic testing is permitted and regulated p. 24 Switzerland: A country with recent changes in attitudes and legislation concerning
preimplantation genetic testing
p. 25
Preimplantation genetic testing in the United States p. 25
Consequences of differential preimplantation genetic testing regulations internationally
p. 26
Summary and future directions p. 27
References p. 27
Elective gender selection of human embryos during IVF: Ethical and public policy considerations
Social gender selection p. 30
Arguments for social gender selection p. 31
Arguments against social gender selection p. 31
The communities' attitudes p. 32
Why should social gender selection be illegal? p. 33
Conclusion p. 33
Embryo mosaicism and its impact on IVF decision-making when using preimplantation genetic screening: Current challenges and controversies
Introduction p. 35
About Internet-based surveys p. 35
Two preimplantation genetic screening-related surveys p. 37
Survey: Do you believe that preimplantation genetic screening can …? p. 37
Chromosomal mosaicism p. 38
Survey: Chromosomal mosaicism detection during preimplantation genetic screening p. 38
Where to go from here p. 40
Conclusion p. 41
References p. 41
Genetic counseling for preimplantation genetic testing (PGT): Practical and ethical challenges
Introduction p. 43
Genetic counseling for preimplantation technologies p. 44
Overview of preimplantation technologies p. 44
Setting patient expectations p. 44
Benefits of preimplantation technologies p. 45
Risks and limitations of preimplantation technologies p. 46
Additional considerations p. 46
Mosaicism p. 47
Practical and ethical challenges p. 49
Transfer of affected or abnormal embryos p. 49
References p. 51
Psychological and interpersonal factors in preimplantation embryo assessment
Background p. 53
Preimplantation genetic diagnosis p. 53
Preimplantation genetic screening p. 54
Motivations to use preimplantation technologies for embryo assessment p. 54
Patient concerns p. 55
Attitudes toward preimplantation embryo assessment p. 57
Reproductive history p. 57
Moral and emotional aspects surrounding the decision-making process p. 58
Practical experiences of genetic testing p. 60
Limitations of current evidence p. 61
Implications for clinical practice p. 62
Staff communication and patient education p. 62
Psychological support p. 62
Technological limitations p. 62
Conclusion p. 63
References p. 63
Introduction to moral agency and patient decision-making about preimplantation genetic diagnosis and preimplantation genetic screening
p. 67
The role of values in decision-making p. 68
Situated subjects p. 70
Self-respect as a value in decision-making p. 72
References p. 73
Fate of non-transferred screened embryos from IVF: Current challenges and future directions
Background p. 75
Embryo status p. 76
Disposition of aneuploid and mosaic embryos p. 77
Disposition of euploid embryos of undesired sex p. 77
Donation for research p. 79
Compassionate transfer and disposal ceremony p. 79
Abandoned embryos p. 80
Summary and conclusions p. 81
References p. 81
The Islamic perspective: Application of advanced reproductive technologies to screen human embryos during IVF
General ethical considerations p. 85
How rulings are derived in Islam p. 86
The moral status of the embryo in Islam p. 87
Reproductive technologies to screen human embryos in in vitro fertilization p. 88 Islamic perspectives on various indications of genetic screening of human embryos in
in vitro fertilization
p. 89
Single-gene disorder screening p. 89
Genetic screening for detection of chromosome abnormalities p. 90
Sex selection p. 90
Gene therapy p. 91
Improving results of in vitro fertilization program p. 91
References p. 92
An Orthodox Jewish approach to ethical and social aspects of embryo testing
Introduction p. 95
Jewish law and ethics p. 95
Specific issues related to preimplantation genetic diagnosis p. 96
Discarding of embryos p. 96
Danger p. 97
Preimplantation genetic diagnosis applications p. 97
Changing attitudes to fertility treatment p. 99
Conclusion p. 100
References p. 100
The Australia experience: Cultural and political factors shaping human embryo assessment during in vitro fertilization
Introduction p. 103 Current factors shaping the environment for preimplantation genetic diagnosis and
screening in Australia
p. 104
Guidelines, regulations, and legislation p. 104
Public consultation in policy-making p. 105
Main issues influencing social and ethical debate in Australia p. 106
Commercialization p. 106
Sex selection for nonmedical reasons p. 106
Normalization of the use of prenatal diagnosis and screening p. 108
Summary p. 109
References p. 110
The Belgian experience: Cultural and political factors shaping preimplantation genetic diagnosis during in vitro fertilization
Introduction p. 113
Actual practice of preimplantation genetic diagnosis p. 114
The law p. 114
Two controversial applications p. 115
Cross-border patients p. 116
References p. 117
The Brazil experience: Evolution and future trajectories of public health policy regarding human embryo assessment
Preventive medicine in the context of reproductive medicine p. 119
Overview of genetic disease in Brazil p. 120
Assisted reproductive technologies and human embryo genetic assessment in Brazil p. 122
Private reproductive medicine centers p. 122
Public reproductive medicine services p. 123
Future remarks p. 123
References p. 124
The Chilean experience: Cultural and political factors shaping human embryo assessment during IVF
Introduction p. 127
Legal background and related laws p. 128
Report on the practice OF preimplantation genetic testing in Chile p. 129 Outcome of abnormal embryos after preimplantation genetic testing in Chile p. 130
References p. 133
The Croatian experience: Cultural and political factors shaping human embryo assessment during assisted reproductive technology
Introduction p. 135
Cultural factors p. 135
Political factors p. 136
Legal framework for in vitro fertilization in Croatia p. 137
In vitro fertilization centers in Croatia p. 138
Conclusion p. 139
References p. 140
The Ireland experience: Cultural and political factors shaping the development of
regulation of assisted human reproduction, ethical status of human embryos, and proposed regulation of surrogacy
Introduction: legal context of assisted reproduction in Ireland p. 141
Catholic teaching and sexual relations p. 142
Influence of catholic church on legislation p. 142
Fertility treatment in Ireland p. 144
Role of the medical profession p. 145
Catholic teaching on assisted human reproduction p. 145
The regulation of assisted human reproduction: Commission on assisted human reproduction, 2000-05
p. 145
Moral status of embryos and assisted human reproduction p. 146
Professional regulation p. 147
Legal status of in vitro embryos p. 147
Gestational mother as birth mother p. 148
Overview of the assisted human reproduction bill, 2017 p. 149
References p. 152
The Thailand experience: Cultural and political factors shaping human embryo assessment during IVF
p. 153
Introduction p. 153
Thailand 101: Culture, economics, politics, and health care system as we are p. 155 Regulation of assisted reproductive technology in Thailand: Past, present, and
future
p. 157
Rituals and pseudoscience in Thai assisted reproductive technology p. 163 Getting it together: How all of these factors affect fertility treatment p. 164
Conclusion p. 168
References p. 168
The Ukraine experience: Preimplantation testing of human embryos
Background p. 173
Embryo testing in Ukraine: The beginning p. 173
Regulatory issues p. 174
A rationale for assessment p. 175
References p. 176
Mitochondrial replacement therapy: Ethical, sociocultural, and public policy considerations
Background p. 178
Mitochondrial disease p. 179
Technology of mitochondrial replacement therapy p. 179
Ethical considerations p. 181
Legal considerations and public policy p. 181
References p. 182 Editing human reproduction? Legal and ethical aspects of genome editing
Introduction p. 185
Reactions to the first attempts to use genome editing p. 186
Response by bioethicists and philosophers p. 187
Policy aspects p. 188
The potentials to shake the legal status quo p. 190
Can we assess the welfare of children to be born? p. 191
The problem of informed consent in genome editing p. 193
Prohibition of the germ line intervention p. 193
Fear of eugenics p. 194
The limited use of reproductive rights p. 195
Patentability p. 196
Conclusions p. 197
Index p. 199