Pro-Life Advocates Should Still Support Preimplantation Genetic Testing (PGT)

If a couple is already using IVF, they should choose the embryo they expect to live the best life even if IVF is immoral.

Photo by Maria Oswalt

There are quite a few moral objections to polygenic screening during embryo selection. Many progressives are concerned about eugenics, inequality, unfairness, and unintended side effects. These objections have been a focus of several of my articles (e.g., Harmless Eugenics, An Irony of the Eugenics Objection to PGT-P, You Can't Ban Embryo Selection Because it's Unfair). Religious conservatives and some secular pro-life advocates propose other objections, most notably that destroying a human embryo is morally equivalent to ending a human life.

This objection does not pose a significant threat to PGT-P because it generally applies to in vitro fertilization (IVF), which is broadly accepted by the public. In 2013, only 12% of American adults considered IVF immoral (Pew Research, 2013). Only 13% of Catholics found it immoral despite the official church teachings “that it is ethically unacceptable to dissociate procreation from […] the conjugal act” (Dignitas Personae, 2008, 16).

If an IVF couple were only to create and transfer a single embryo, pro-life advocates should find nothing morally objectionable. However, when couples create supernumerary embryos (additional unused embryos), absolutist pro-life advocates may have a reasonable moral objection when those embryos are discarded or destroyed. Among less radical pro-life advocates, many assign less moral value to embryos and are more abhorred by the termination of fetuses, especially later-stage fetuses.

Some pro-life advocates have adopted intermediate positions that it is acceptable to use embryonic stem cells from supernumerary embryos for research, but it is morally unacceptable to create embryos solely for research. Although, this intermediate position is not morally tenable (see Devolder, 2005; Douglas & Savulescu, 2009). The willingness to take moderate pro-life positions favoring IVF may be attributable to the fact that it aids in family formation, something most religious conservatives like. Without IVF, many children would not have otherwise existed. If one weighs born human lives substantially over embryos, it may be an acceptable trade-off.

Seeing IVF as equivalent to abortion may be a mistake. Many moral intuitions and analogies regarding abortion do not port well to IVF because they rely on the idea that the counterfactual situation is a child being born. Ironically, without the help of IVF, fewer children will be born. Furthermore, the injustice to the supernumerary embryos is not apparent. They are not deprived of a life they would have otherwise had. If couples were prohibited from using IVF, those embryos would not have been created in the first place. Additionally, the intuition that abortion is akin to killing is undermined by the fact that supernumerary embryos are not in a position to become human children without being implanted. If they were merely left undisturbed on a laboratory table, they would die. In contrast, abortion involves a deliberate action to kill the fetus, not merely withholding resources. Also unclear is the proper analogy for a couple keeping their supernumerary embryos indefinitely via cryopreservation.

Even if one adheres to a strict pro-life position, they should still advocate that couples already undergoing IVF use genetic screening. Even if it is morally abhorrent to undergo IVF, selecting the healthiest or happiest embryo is a better criterion than randomness. If a couple is already going to discard all embryos except one, it seems wise to pick the one they expect to live the best life.

While one can object to an action generally, there is still room for preferences over how the action is done. For example, one could oppose the death penalty while preferring lethal injection over guillotine. One could advocate for an absolute gun ban while having a preference over what sort of safety precautions gun owners take in their homes. An egalitarian could believe that all children should be given equal access to educational resources while conceding that if some students are given more, it should be the less economically privileged.

It is reasonable for a pro-life advocate to prefer genetic testing if IVF is already taking place, but it is understandable if a pro-life advocate dislikes it when it motivates more couples to use IVF. Especially concerning may be the discovery of in vitro gametogenesis (IVG) which would enable the creation of eggs from skin or blood cells. With IVG, couples could create hundreds or thousands of embryos. At present, miscarriage is extremely common but not considered a moral priority by most pro-life advocates. This inconsistency in concern was investigated in philosopher Toby Ord’s article “The Scourge: Moral Implications of Natural Embryo Loss.” Ord argues that those who give embryos full moral status should believe that natural embryo loss is one of the greatest problems of our time. If IVG achieves widespread adoption, this issue of discarded embryos could become orders of magnitude more important. A principled pro-life advocate could consider it the worst technology ever created.

Even if genetic testing motivates the use of more IVF, if couples already have the embryos, they should use genetic screening from a pro-life perspective. When couples use genetic screening during IVF, they reduce the likelihood of miscarriage, which pro-life advocates view as the moral equivalent of a human death. Ensuring a successful pregnancy reduces the couple's willingness to undergo additional rounds of IVF, preventing additional embryos from being created and discarded. If one places a much higher moral value on a fetus than an embryo, as many pro-life advocates do, opponents of abortion may even want to advocate that couples decide to use IVF with genetic screening to reduce the chance of miscarriage. Under certain assumptions about the relative values of embryos compared to fetuses, it may be a moral obligation to use IVF with genetic screening rather than naturally conceive!

---