Friday, 17 May 2013

Time lapse imaging of embryos – exciting breakthrough or just eugenics by another name?


Various media outlets (including The Times (£), The TelegraphBBC, The Independent and The Guardian) have published articles reporting on how fertility specialists from Nottingham have developed a radical technique that will ‘dramatically improve’ the chances of IVF couples having a baby.

The original research appears in Reproductive BioMedicine Online.

About one in eight couples have trouble having children through natural conception and around 48,000 women currently undergo IVF treatment each year resulting in about 12,200 IVF births, an overall success rate of 25%.

This failure rate of 75% causes immense emotional upset to affected couples, many of whom have paid between £5,000 and £10,000 for each treatment cycle.

However the new  procedure, which uses ‘time-lapse imaging’ to monitor the health of embryos by taking thousands of digital pictures to identify ones that are developing well, could raise the chance of a live birth to 78%, about three times the national average.

The new technique identifies the ‘best embryos’ to be implanted into the womb based on the time it has taken to develop between two key stages in the early life-cycle of the embryo.

Thousands of time-lapse pictures taken during the first few days of an IVF embryo's life are used to identify the time between the first appearance of the fluid-filled cavity, called the blastula (normally 97 hours), and the full blastocyst (122 hours).

In embryos at high risk of aneuploidy (extra chromosomes) these steps occurred about 6 hours later on average. Aneuploidy is the single biggest cause of IVF failure.

To test the system, the doctors ran the program on time-lapse images of 88 embryos that had been recorded previously for 69 couples at the clinic. Some 61% of the embryos ranked as low risk for abnormal chromosomes led to live births, compared with none of those ranked as high risk.

Around a dozen private and NHS clinics are currently using time-lapse embryo imaging. It costs around £750 in addition to about £3,000 for IVF.

The £750 cost compares favourably with the current cost of £2,500 for Pre-implantation Genetic Screening, an invasive test which removes cells from the early embryo for analysis.

If the new imaging test proves to be effective in larger trials it seems likely that it will be used much more widely.

What is singularly lacking from any media coverage of this research however is any discussion of the ethics.

Not only does it seem to be taken for granted that the improved success rates override any ethical objection. There is simply no ethical objection even considered.

But let’s think about what is actually happening here.

Embryos are being created in a laboratory and those with aneuploidy are being identified and discarded.

Some of these will have the commoner trisomies (three rather than two copies of a particular chromosome) – Down’s syndrome (trisomy 21), Edward’s syndrome (18) and Patau’s syndrome (13) – where affected babies are often born alive.

Some will have other trisomies (like trisomy 15, 16 and 22) and inevitably will either fail to implant or result in miscarriages.

So is it right to implant those embryos more likely to survive and throw away the others?

Well that surely depends on what these tiny organisms actually are.

They are undoubtedly individual human lives, but what status do they have? Are they potential human beings or are they human beings with potential?

Philosophers like Singer, Glover and Harris will tell you that they are alive but non-persons because they do not yet have functioning nervous systems.

But others, who would argue that human life from the time of fertilisation should be shown the utmost respect and afforded protection would say that every living human organism – no matter how young, old or disabled and regardless of its intellectual capacity – is also a human person with rights.

I know what I think, but what do you think and why? They are either persons or not persons. Which is it?

Is this new technique the 'most exciting breakthrough in IVF treatment in 30 years'? Or is it just eugenics by another name?

It makes all the difference in the world.

26 comments:

  1. Bloody hell, Peter. Do you see any scientific discovery as beneficial? Any at all?

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    Replies
    1. Do you think every conceivable use of every technology is ethical?

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    2. Every technology has two sides to it. The wielder determines the consequence.

      Why do you hold technology relating to cloning and embryology to be particularly dangerous to civilisation?

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    3. This technology is being used to select out and destroy human embryos judged unworthy of life on genetic grounds.

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    4. And why should embryos have the rights of born human babies?

      If you want to see an end to abortion, why haven't you lobbied for artificial womb technology yet?

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    5. It's clear you take the Glover/Singer/Harris view of human worth.

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    6. Would you sacrifice yourself to save an embryo?

      Or say a hospital is burning down. To your left is a petri dish with several viable embryos that have yet to be implanted. To your right ins a newborn baby. You can only save one.

      Which do you save?

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    7. I'd grab the petri dish in my left hand and the newborn baby in my right and make for the door :-)

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    8. You dodged the core issue - you can't save both.

      By your evasion, I'll simply conclude that you would prefer to save the embryos.

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    9. Infer what you like but all human lives are equally precious.

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    10. Hey, you attempted to dodge the constraints of the moral dilemma.

      Moreover, the very idea of triage demolishes your notion of total and utter equality among all lives.

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    11. Winston, you are being more than a little disingenuous in the way you pose your question. The issue raised by Peter is not a question of which person should be saved, but which should be killed. The real choice would be (to re-phrase your question) should you save a petri dish with "healthy" embryos or one with embryos which suffer from (say) spina bifida. So then (to apply your question), in the event of a fire, which would YOU choose to save? An infant with spina bifida or one which is deemed to be "normal"?

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    12. If they're embryos, then I would save the one without spina bifida. If they're equally valuable, according to you, then there is no moral difference between saving one or the other.

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    13. and if they're infants?

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    14. If they're infants, and I couldn't save them both, I would also save the one without spina bifida. Like you said, they're equally worthy of saving, so how could you fault me either way?

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    15. So your judgement is based purely on their physical condition. What if it was a question of a blind infant and a sighted one?

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    16. I would save the sighted one. What's your point? It's a far cry from infanticide, which Peter Singer advocates.

      Would you decide by tossing a coin?

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    17. My point is that your position is based on the value you attribute to individuals. Evidently you consider a blind child to be less valuable than a sighted one. But triage is based on need, not perceived value. Would you prioritise a sighted child's grazed knee above a blind child's broken leg? The claim that some humans have greater value than others leads to a very dangerous, slippery slope at the bottom of which is eugenics. BTW I would save the one I could get to first

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    18. Triage also accepts the human inability to save everyone. It is also not an all-or-nothing scenario where some are guaranteed to die. Doctors frequently euthanise infants now. It's rare, but it does happen. It has an unintended benefit - organs from euthanised infants are more readily transplantable.

      You also ignored an implicit assumption in my moral dilemma, which is thus: both infants are equidistant.

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    19. Nothing you have said contradicts my point that ethical triage prioritises on need not some arbitrary attribution of value. (Incidentally, I am intrigued as to how doctors can "frequently" euthanise infants but it then only happens rarely?) It all comes down to your position which is that some people are of more value than others (and therefore more worthy of life). In holding that position, you share common ground with eugenicists and the proponents of the final solution. You may disagree with them about which people are worthy of life but your position is no less arbitrary than theirs.

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    20. My apologies. I should have worded my post more carefully.

      It's been going on for centuries, if not acknowledged. As for eugenics, well, if we can prevent abnormalities like Harlequin Fetuses and full-blown Cystic Fybrosis, it would be a net benefit to everyone.

      It is not anything near the final solution (unless parents refusing medical care for their children is also analogous to the final solution).

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    21. I fear, Winston, that you are in denial. By your own admission, you believe some individuals have more right to life than others. By your own admission, you would prefer the sighted to the blind. The classes of people you would favour are those YOU deem to be most worthy of survival. I didn't ask you how you would judge those who have mental disability, but (since you seem keen for me to draw inferences about your unstated opinions)I would infer that you would deem them also to be less worthy of survival. This aligns very closely with the views of eugenicists. I think you need to face up to the implications of your belief system and stop pretending that it is as innocent as you would like to believe

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    22. OK, let's say you can save a convicted murderer or a social worker who works at homeless shelters every weekend?

      If discriminating in one situation is acceptable, why is discrimination in the other situation not acceptable?

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  2. "Is it possible to be a human being but not a person?"

    There is a strict scientific approach to this question, as follows: It is up to any who wish to answer "yes" to the question, to provide an operational definition of the word "person" as they are using it. An operational definition is an observation, measurement or experiment which is capable of distinguishing between a human who is a "person" (as the proponent of the "person" hypothesis intends the word to be understood) and a human who is not a "person" (as they intend the word to be understood).

    To offer any answer to the question that isn't rooted in science, is, I have argued in a post on my own blog which is too long to paste here, simply to engage in "mumbo-jumbo". The post is entitled "The mumbo-jumbo of choice", because the argument is applied to abortion, and those in favour of non-criminal elective abortion other than in extremis, like to refer to themselves as "pro-choice". However, the argument works just as well in the present context, in which the ethical considerations are not dissimilar.

    It is ultimately a pointless question that is being posed. Modern jurisprudence worldwide exalts *human* rights. It is largely silent on the subject of "personal rights". No human right may be denied to a human because he or she is not a "person" (according to this or that definition). Nor are there any additional "personal" rights that belong only to humans who are also considered to be "persons".

    Pro-choice people have to resort to metaphysics or (as I call it) "mumbo-jumbo". Typically they deploy circular arguments. I imagine that that is all that Messrs Glover, Singer and Harris are doing. The more verbose their polemics, the harder it is to spot the hidden mumbo-jumbo, but appeals to a fictional ensoulment event (or enpersonment) that cannot be observed by a scientist, are bound to be lurking in there somewhere.

    "Enpersonment" is an interesting word to Google. "How does one observe, measure or detect enpersonment?" is the killer question, when questioning would-be killers. It exposes that their position depends upon something other than science, something fictitious that they have simple made up, to get the answer they want, and which is the answer they want in disguise, the hallmark of a circular of argument.

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  4. Do you know anything at all about trisomies? Having three copies of 21 leads to Down syndrome, and a person with Down syndrome people can have a good life. Babies with three copies of 13 or 18 die a matter of days or weeks after birth and have severe mental and physical problems. Fetuses with other chromosome trisomies spontaneously abort, usually around week 10. So, in most cases, we're not talking about embryos that are going to become people. We're talking about keeping women from the heartache of not becoming pregnant or from losing a pregnancy.

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