Until just a few years ago, making a baby boy or a baby girl was pretty much a hit-or-miss affair. Not anymore. Parents who have access to the latest genetic testing techniques can now predetermine their baby's sex with great accuracy--as Monique and Scott Collins learned to their delight two years ago, when their long-wished-for daughter Jessica was born after genetic prescreening at a fertility clinic in Fairfax, Va.
And baby Jessica is just the beginning. Within a decade or two, it may be possible to screen kids almost before conception for an enormous range of attributes, such as how tall they're likely to be, what body type they will have, their hair and eye color, what sorts of illnesses they will be naturally resistant to, and even, conceivably, their IQ and personality type.
In fact, if gene therapy lives up to its promise, parents may someday be able to go beyond weeding out undesirable traits and start actually inserting the genes they want--perhaps even genes that have been crafted in a lab. Before the new millennium is many years old, parents may be going to fertility clinics and picking from a list of options the way car buyers order air conditioning and chrome-alloy wheels. "It's the ultimate shopping experience: designing your baby," says biotechnology critic Jeremy Rifkin, who is appalled by the prospect. "In a society used to cosmetic surgery and psychopharmacology, this is not a big step."
The prospect of designer babies, like many of the ethical conundrums posed by the genetic revolution, is confronting the world so rapidly that doctors, ethicists, religious leaders and politicians are just starting to grapple with the implications--and trying to decide how they feel about it all.
They still have a bit of time. Aside from gender, the only traits that can now be identified at the earliest stages of development are about a dozen of the most serious genetic diseases. Gene therapy in embryos is at least a few years away. And the gene or combination of genes responsible for most of our physical and mental attributes hasn't even been identified yet, making moot the idea of engineering genes in or out of a fetus. Besides, say clinicians, even if the techniques for making designer babies are perfected within the next decade, they should be applied in the service of disease prevention, not improving on nature.
But what doctors intend is not necessarily what's going to happen. Indeed, the technology that permitted the Collinses family to pick the sex of their child was first used to select for health, not gender per se. Adapting a technique used on livestock, researchers at the Genetics & IVF Institute in Fairfax took advantage of a simple rule of biology: girls have two X chromosomes, while boys have one X and one Y. The mother has only Xs to offer, so the balance of power lies with the father--specifically with his sperm, which brings either an X or a Y to the fertilization party.
As it happens, Y chromosomes have slightly less DNA than Xs. So by staining the sperm's DNA with a nontoxic light-sensitive dye, the Virginia scientists were able to sort sperm by gender--with a high rate of success--before using them in artificial insemination. The first couple to use the technique was looking to escape a deadly disease known as X-linked hydrocephalus, or water on the brain, which almost always affects boys.
But while the technique is ideal for weeding out this and other X-linked disorders, including hemophilia, Duchenne muscular dystrophy and Fragile X syndrome, most patients treated at Genetics & IVF want to even out their families--a life-style rather than a medical decision. The Fairfax clinic has been willing to help, but such a trend doesn't sit well with some other practitioners. "Our view at the moment," says Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at Cornell Medical Center in New York City, "is that these techniques should be used for medical indications, not family balancing."
But now that parents know that the technology is available, and that at least some clinics will let them choose a child's gender for nonmedical reasons, it may be too late to go back. In a relatively short time, suggests Princeton University biologist Lee Silver, whose book Remaking Eden addresses precisely these sorts of issues, sex selection may cease to be much of an issue. His model is in vitro fertilization, the technique used to make "test-tube" babies. "When the world first learned about IVF two decades ago," he says, "it was horrifying to most people, and most said that they wouldn't use it even if they were infertile. But growing demand makes it socially acceptable, and now anybody who's infertile demands IVF."
That's not to say in vitro fertilization hasn't created its own set of ethical problems, including custody battles over fertilized embryos that were frozen but never used, questions about what to do with the embryos left over after a successful pregnancy, and the increased health risks posed by multiple births. Yet no one is suggesting the practice be stopped. Infertile couples would never stand for it. Sex selection will undoubtedly raise knotty issues as well. Societies that value boys more highly than girls, including China and India, are already out of balance; this could tip the scales even further. Such an outcome is unlikely in the U.S., where surveys show that equal numbers of parents want girls as boys. But the same polls report that Americans believe an ideal family has a boy as the oldest child. Boys often end up being more assertive and more dominant than girls, as do firstborn children; skewing the population toward doubly dominant firstborns could make it even harder to rid society of gender-role stereotypes.
The ethical issues raised by techniques emerging from the genetics labs are likely to be even more complex. What if parents can use preimplantation genetic diagnosis to avoid having kids with attention-deficit disorder, say, or those predestined to be short or dullwitted or predisposed to homosexuality? Will they feel pressure from friends and relations to do so? And will kids who are allowed to be born with these characteristics be made to feel even more like second-class citizens than they do now?
Even thornier is the question of what kinds of genetic tinkering parents might be willing to elect to enhance already healthy children. What about using gene therapy to add genes for HIV resistance or longevity or a high IQ? What about enhancements that simply stave off psychological pain--giving a child an attractive face or a pleasing personality? No one is certain when these techniques will be available--and many professionals protest that they're not interested in perfecting them. "Yes, theoretically you could do such things," says Baylor University human-reproduction specialist Larry Lipshultz. "It's doable, but I don't know of anyonec doing it."
Sooner or later, however, someone will do it. In countries with national health services, such as Canada and Britain, it tends to be easier to dictate what sorts of genetic enhancement will be permitted and what will be forbidden. But in the U.S., despite the growth of managed care, there will always be people with enough money--or a high enough limit on their credit cards--to pay for what they want. "Typically," says Princeton's Silver, "medical researchers are moved by a desire to cure disease more effectively. Reprogenetics [a term Silver coined] is going to be driven by parents, or prospective parents, who want something for their children. It's the sort of demand that could explode."
Silver even contemplates a scenario in which society splits into two camps, the "gen-rich" and the "gen-poor," those with and those without a designer genome. The prospect is disturbing, but trying to stop it might entail even more disturbing choices. "There may be problems," admits James Watson, whose co-discovery of the structure of DNA in 1953 made all this possible. "But I don't believe we can let the government start dictating the decisions people make about what sorts of families they'll have.
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