In vitro babies should be pre-screened for severe birth defects, argues Jacob Appel. If this creates a slippery slope, parents can find “level places on it” (and maybe save money on SAT tutors).

Question: Why do you advocate pre-implantation genetic diagnosis of babies fertilized in vitro?

Jacob Appel: I think we make an arbitrary distinction between embryos before they are implanted, or fetuses before they are born, and children once they're born.  There are certain conditions you could never enforce upon a child once it was born.  You could never, for example, say I have a child who hears, but I am deaf and deaf culture is important to me, so I'm going to puncture my child's ear drums.  Child Protective Services would show up at your doorstep tomorrow and take that child away. 

However, under our current system, you can go to a fertility clinic and ask the doctor to screen your embryos to make sure that you have a deaf embryo, rather than a hearing embryo implanted.  To me doing that is just as much child abuse as puncturing your child's ear drums.

Question: Does such screening create a slippery slope toward the engineering of “designer babies”?

Jacob Appel: I think if the slope is slippery there are far more level places on it.  I think that once simple distinction between the procedures we would require or strongly encourage and those really to remain neutral on, or oppose, would be if there are conditions that modern medicine currently tries to cure.  If they are, for example, conditions that Medicare or Medicaid would cover gives us a fairly bright line distinction.  There is no Medicare or Medicaid reimbursement for getting a nose job to look more handsome, or having your eye color changed.  In contract, few people would say that cystic fibrosis or sickle cell anemia aren't sufficiently handicapping diseases that if we could prevent them in utero, or in vitro, we should do. 

That being said, I have no particular qualms with designer babies.  I think the reality is that even if designer babies, so to speak, were available, not many people would make that choice, and the result would only be enhancement for those individuals who chose them and no harm to anybody else.  It seems to me there isn't that much difference between getting your child and SAT tutor and getting him into a good college, making him a little bit more intelligent before they're born.  In some ways you can save money in SAT tutoring if you put the effort in early on.

Question: Should we worry that engineering some genetic traits in babies might deprive them of others?

Jacob Appel: Well, I think it's no different than child rearing the introduction of one trait, or just be the child's ability to do other things.  We, for example, give children anti-depressants if they're depressed.  You want them to be happy. And they may be happy, but they might be less creative, and that's a trade off we let parents make.  I think we want to maximize the autonomy individual parents have.  The one caveat would be if we're going to induce some kind of birth defect or some kind of severe handicap in these children, we would want to intervene and stop that from happening.  We do want to make sure they don't step below a certain floor.  The advantage we have is both parents and fertility clinics are deeply vested in keeping whatever we create as a result of these interventions from stepping below that floor.  Moreover, the overwhelming majority of parents who are embracing these new technologies are also parents who are willing to terminate a pregnancy if it doesn't work out the way they want.  People who embrace one technology tend to embrace most modern technologies.  So the risk of producing severely impaired children is actually far lower.

Recorded on March 1, 2010
Interviewed by Austin rnAllen