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Great expectations
NS 1 May 99
Does reproductive technology pave the way for a new eugenics, asks Arlene Judith Klotzko

MORE than 20 years after Louise Brown, the first test-tube baby, was born, we are still coming to terms with the fruits of fVF-the technology that produced her. With IVF, two things become possible: first, the embryo can be observed and tested and decisions made on whether or not to implant it. Secondly, the definition of "parenthood" loses its former clarity. A genetic mother need not be the person who actually carries the baby to term, and there can be egg donors as well as sperm donors. William Shakespeare once asked: "What's in a name?", today the answer is less and less, especially if the names are Mummy and Daddy. Now older women can give birth using donor eggs and single women can give birth to babies conceived with donor sperm. Increasingly, high-tech parenthood has made irrelevant both biological limitations such as age, and traditional notions of the family. And, most recently, we have parenthood in defiance of metaphysics-through the use of frozen eggs and postmortem extraction, dead people are becoming parents. On 17 March, in California, a baby girl was bom after sperm had been extracted from her dead father. In the US we can, and do, establish elaborate specifications for people willing to donate their eggs or sperm. Web surfers can find attributes listed such as "European features", "soft eyes", "trim", "athletic" and "lean". Recently, advertisements for an egg donor were published in several American college newspapers. T'he specifications were clear: height, 5 foot 1 0 inches (1 .78 metres), athletic build, high score on the test given to all college applicants, and no major family medical problems. The reward for the lucky winner, $50 000! So what ethical issues are involved with shopping for gametes? An obvious start is that they become mere commodities. Then there is the problem of "expectations". When a couple pays such a large sum in their quest to produce a bright and athletic child, what will happen if the young sister fails to measure dp? Parents buy tennis lessons for their children to increase their skills. Is it morally different to, buy an, egg from a tennis player to achieve the same ends? While finding an egg or sperm donor with certain characteristics might give prospective parents an edge in designing their children, a more predictable way to "intervene" comes with genetic diagnosis before implanting an embryo produced through IVF. Lord Winston of the Royal Hammersmith Hospital, London, developed the technique of "preimplantation genetic diagnosis" (PGD) in the mid-1980s using sex selection as a proxy for genetic testing for diseases, such as haemophilia, most of which are carried by women and affect only their sons. The technique has since been developed to detect a range of genetic defects. One or two cells are removed from an embryo at the eight-cell stage, amplified and then biopsied. Only embryos that are found to be healthy are then implanted in the uterus. Clearly, PGD creates an ethical problem for anyone who believes that life begins at conception. But even people who don't share this view may be troubled by, say, PGD for conditions that take many years to show up. Take for example, the cancer of the bowel that is caused by the familial polyposis coli gene (FAP) or the breast and ovarian cancers that are linked to mutations in the BRCAL and 2 genes. Is it right to test-and discard-an embryo for a disease that would not develop until after several decades of a presumably fulfilling life? Surely, in those intervening years, better methods of prevention, detection and treatment could be developed. So, is PGD really eugenics? We usually think of eugenics as a societal or governmental effort to advance humanity by "improving" heredity. But can it seem more benign-merely the sum of individual choices that prevent children with certain genetic defects from being bom? Are such genetically based interventions aimed at improving the lot of our children akin to piano lessons, or are they more sinister? We au need to think very hard about such questions. The public must participate in deciding what kinds of tests and interventions should be allowed. It is not just the preserve of the great and the good, but a matter for us all. n

Inserted Ovaries

Tokyo Japanse and United States reseuchers claimed a world first yesterday in transplanting human ovaries into mice, creating altered rodents that might produce humm eggs. 'There are many ethical and clinical issues to clear" admitted 41year-old gynecologist Akiyasu Mizukani who led the two-year experiment in the US in cooperation with the University of Utah. "But it could be a godsend for people suffering infertility. Scientists obtained the ovaries from three US women who had them removed for womb diseases. Approval was received from the university's ethics committee and the women gave consent. They dissected the ovary tissue into square pieces measuring just 2mm across, said Mizukami, who is from Japan's Asahikawa Medical College. A total of 108 pieces were then injected into nine mice under the skin of the abdomen. Reserchers injected homones into the rodents to stimulate the growth of the ovarian tissue, which includes primitive human cells capable of developing into a mature ovum. After about two weeks some of the transplanted lines of human tissue developed into 'cumulus oophoms," sacs which are the first stage in development of ova. 'We stopped the experiment at that stage as it was meant to be a pilot study. We need to find out how we can nurture eggs from that stage." "The basic idea was to create an egg bank for patients suffering infantile cancer who may survive into their adulthood md want to have a child." [email protected] chemoaierapy tmatment kills not orily cancer cells but also reproductive cells. The University of Utah hoped to obtain ovaries from brain-death donors to conduct further tests, he, said. In February 1999, a Greek doctor in Japm claimed a medical break-through with rats and mice that produce humm sperm. Nikolaos Sofikitis, a urology assistant professor at Tottori University, said he had implanted the human cells resposible for producing sperm into rat md mice testes in August, 1998. Five months later human sperm were detected in the animals.

Arlene Judith Klotzko is a health care lawyer and bioethicist at the Center for Bioethics, University of Pennsylvania, currently writing and editing books on cloning for Oxford University Press


US Eugenics Revealed Feb 2000

Philadelphia - United States doctors who once believed that sterilisation could help rid society of mental illness and crime launched a 20th-centurly eugenics movement that in some ways paralleled the policies of Nazi Germany, researchers say. 'The researchers, from Yale University' traced a once-populuar scientific movement aimed at improving society through selective breeding.

Their study indicates that state- authorised sterilisations were carried out longer and on a larger scale in the US than previously believed, beginning with the fust state eugenics law in Indiana in 1907. Despite modern assumptions that American interest in eugenics waned the 1920s, researchers said sterilizaton laws had authorised the neutering of more than 40,000 people classed is insane or "feeble-minded" in 30 states by 1944.

Another 22,000 underwent sterilization between the mid-1940s and 1963 despite weakening of support and revelations of the Nazi atrocities. according to the study by the US Holocaust Memorial Museum and Merck Co Foundation. Forced sterilization was once legal in 18 states and most states with eugenics laws allowed people to be sterilized without their consent by a third party.

The comprehensive histories fo the eugenical sterilization campaigns in the US and Nazi Germany reveal important similarities of motivation, intent and strategy, the study's authors wrote in the Annals of Internal Medicine Eugenics sprang from the philosophy known as social Darwinism, which envisioned human society in terms of natural selection and suggested that science could engineer progress by attacking such supposedly heredtary problems including moral decadence, crime, venereal disease, tuberculosis and alcoholism. German and US advocates believed that science could soive social problems, tended to measure the worth of the individual in economic terms and felt mental illness a threat to society grave enough to warrant compulsive sterilisation. . And while Nazi Germiany's claims of Aryan superiority are well known, researchers said US advocates of sterilization worried that the survival of old-stock America was being threatened by the flux of 'lower races" from Europe. The study, based partly on old editorials from the New England' Journal of Medicine and the Journal of the 'American Medical Assoctation, also demonstrated how the US eugenics movement gradually waned while its Nazi counterpart carried, out 360,000 to 375,000 sterilizations and came to encompass so-called mercy killings. 'In the United States," the study said, 'a combination , of public unease, Catholic opposition, federal democracy, judicial review and critical scrutiny by the medical profession reversed the momenum." The US practice of neutering "mentally defective" individual was justified on grounds . that it would relieve the public of the cost of caring for future generations of the mentally ill.