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Needed: Embryo Screening Review Process
However, says Wolmer, "We need a review process that allows people who aren't just doing it to be self-serving. Some couples are asking for a blanket embryo screening, to look at the huge realm of possibilities. That's the slippery slope to me, that people with no family history of a disease are asking us to take a blanket look at the huge realm of possibilities like Down syndrome, for example, which is a genetic abnormality but not an actual genetic disorder."
It's important "to be very careful at that point," Wolmer says. "We need to look at the family's intent when they request embryo screening. In our society today, different yardsticks are used to measure if this is OK or not -- science, theology, law. I think that an Institutional Review Board process in the U.S. needs to be applied here. We can't lose sight of what is research and what is accepted therapy."
Everyone involved in IVF and embryo screening must consider ethics at every point, says Wolmer.
Embryo Screening Not 100% Accurate
Wolmer brings up another point: Embryo screening is not a perfect process; there is no 100% guarantee. "There's a question whether that one cell may be abnormal, but the others may be normal," says Wolmer. "Also, one abnormal cell doesn't mean the whole trait or disorder will develop."
Ordering up "basketball player genes" or green eyes -- those things just aren't possible with current technology, Dominguez tells WebMD. "Figuring that out from one or two embryonic cells is very tricky. We're not anywhere near the point of being able to do that."
Even after embryo screening for genetic abnormalities, "there's still a chance you're wrong," Dominguez says. "Screening is very difficult to do, and it can only be done in the best labs. Some day we will be able to fully fingerprint an embryo. But even if someone has a cancer gene, there's no 100% certainty they will develop the disorder. There are other factors, like environment, that play into this, too."
Published Nov. 4, 2004.
SOURCES: Art Caplan, PhD, director, University of Pennsylvania's Center for Bioethics. Cecilia Dominguez, MD, reproductive endocrinologist, Center for Reproductive Medicine, Emory University School of Medicine. David Wolmer, MD, chief of reproductive endocrinology and fertility, Duke University School of Medicine.