Is three-patient IVF a step in the wrong direction?

Mitochondrial disease is a genetic deformity, known to be the root of a number of serious health issues including Alzheimer’s and diabetes affecting around 150 children a year in the UK.  In 2013, the UK government announced plans to support three-patient IVF treatment, a technique that involves replacing unhealthy mitochondria in the egg with healthy DNA from a third party, in order to eliminate the risk of the disease in the child.  This technique has been likened to cloning by some and many believe that it is a step towards eugenics; however it may be an effective way of improving the lives of many children and their parents.

The Intuitive Argument

There is no doubt that by eliminating the faulty genes that cause mitochondrial disease, the future lives of many children and their parents would be improved. This would not only be evident in those who were directly involved with the treatment, but also in their future generations for whom these genes would be eradicated. By effectively eliminating this otherwise untreatable condition, many people would be spared from on-going, arduous treatment, which is supportive as opposed to preventative.

It could be argued that this is not treatment of the disease but is in fact, the creation of a new person, free of the faulty genes. The decision would lie solely with the parents as to whether this treatment should be used on their embryo, a choice that is impossible for future generations to be involved in, but one that will ultimately affect them directly for the rest of their life. Although less than 0.06% of the DNA in the final fertilised egg is from the donor, this DNA is passed from generation to generation, including any genetic traits acquired from the treatment. Regardless of the nature of the trait, there are knock-on effects that must be considered and that will effect generations to come. Without clinical trials, the exact level of these effects is unknown.

The legalisation of the use of three-patient IVF is very much a radical step, giving parents and doctors the opportunity to ‘play God’. If the technique is used only to treat medical conditions, its use would certainly be very beneficial to both parents and children (as mentioned above) however, without a sufficient amount of legislation and monitoring there is the possibility that parents are allowed to start controlling more aspects in their child such as desired characteristics. This raises questions as to who should be given the responsibility and power to make this radical step, and where can the line be drawn?

With sufficient legislation and constant monitoring, the use of three-patient IVF could be effectively used to improve the lives of many. Providing that the guidelines were outlined clearly, parents and doctors have the opportunity to eliminate this debilitating disease, and would be prevented from using this technology to create children with desired characteristics. The use of genetic engineering to prevent further generations from suffering from mitochondrial diseases is a step in the right direction, but one that has significant implications and must be observed carefully.

The Consequentialist Argument

Addressing the problem of three-parent IVF from a consequentialist point of view is inherently difficult, as the long-term effects of the procedure have not been adequately documented; critics are worried that it could introduce genetic errors into the human genepool, potentially creating new diseases. When the consequences of an act remain to be seen, it is very difficult to claim that it is ‘right’ from a consequentialist standpoint.

If a mother has the defective mitochondrial gene, it will definitely be inherited, and all of her children will develop some form of mitochondrial disease (although the severity varies). This eliminates all other courses of action for the mother to have her own healthy biological children; in this sense, the ‘good’ consequence is having a healthy child, and it can only be seen as ‘right’ to give women this opportunity.

Additionally, the procedure has the added benefit of removing negative consequences; such as the physical pain, emotional pain, and financial burden on families which arise from having to manage mitochondrial diseases. However, there have been concerns raised by some experts that patients could be at greater risk of cancer and premature aging. Furthermore, any children born after the procedure- and in fact their children- will need to be monitored for the rest of their lives, as there could be “unknown risks due to the heritable genetic changes”. Critics point out that arguments for the procedure have been over-simplified, causing MPs in the UK to pass legislation despite being ill-informed.

Another issue raised is the potential for treatments to begin editing out undesirable inheritable traits, which would amount to eugenics; similar to the policies enacted by fascist regimes in WWII. Consequentialism is of little help here, as there can be no way of telling whether or not three-parent IVF would lead to widespread human genetic engineering in the sense of eugenics or even ‘designer babies’. Certainly, strict legislation would be required to ensure that only legitimate conditions qualify for the treatment, but at what point do we distinguish between ‘disorder’ and ‘diversity’?

Numerous cultural and religious objections to the practice also exist; the Catholic Church is opposed to all forms of treatment which destroy embryos– although one method does exist which involves using an unfertilised egg. Many cultures regard the concept of families and bloodlines as being extremely important, and three-parent IVF is considered ‘un-pure’ or a dilution of parenthood.

In conclusion, the consequentialist argument proposed here suggests that three-parent IVF is indeed a step in the wrong direction. Despite the obvious benefits; the unknown health-risks and issue of eugenics coupled with strong religious and cultural opposition affirm this viewpoint. In addition, the vast majority of people with mitochondrial disease display mild or even no symptoms, reducing the significance of beneficial consequences.

20: Harry Popplewell, Sophia Rawlins, Harry Morgan, Matthew Wayland

 

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10 thoughts on “Is three-patient IVF a step in the wrong direction?

  1. Is the IVF treatment economically viable for the NHS? There is no treatment yet for any of the mitochondrial diseases which means it will be lifelong supportive management and so could save the NHS a lot of money.
    It’s important to emphasise that mitochondrial donation does not alter any other genetic components of the child other than mitochondrial function and that both the techniques used are specific for mitochondria and the technology needed for ‘designer babies’ (eye colour / hair / body type) is vastly different and mainly I discovered allowing easier legislation to take place based on the current techniques used.

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  2. Could researchers look into new methods of treatment? Or more effective management of the symptoms of various mitochondrial diseases? It seems like this procedure could potentially affect more in patients than doctors currently think. If it was to be brought in then it needs controlled trials. I don’t think that there is any ethical problem with trials, as long as the parents have all the usual rights to pull their children out of them whenever they want until they’re 18 years old.

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  3. Are there any other avenues of research into treating mitochondrial diseases which could be funded? It seems like this treatment method might cause a lot of heated debate, which could stall actual progress. Regardless, I definitely think that it needs controlled trials to be carried out to assess the long term effects. I don’t foresee any ethical problems as long as these trials are subject to all the usual legal constraints; parents should be able to withdraw their children at any time, and once the patients are 18 they should then have the right to drop out.

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  4. On the whole I agree with the argument proposed here. Although I am sure the government would impose strict guidelines on when 3 person IVF can take place – the danger of a slippery slope emerging still seems probable. Something I would be interested in is how the government proposes to fund this treatment, and whether it would be available from private medical organisations. If it becomes a legal private service, and as such a money for goods exchange, then I think likely that some may see it as an opportunity for eugenics.

    Interesting debate!

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  5. An interesting article that raises ethical issued around a new technique to prevent an inherited serious disease. There are clearly strong arguments on both sides. It would be interesting to hear from people and families with first hand experience of mitochondrial disease. It would also be interesting to know why this disease has been targeted. Maybe it is relatively simple to identify the gene that needs manipulating? It may lead the way to further breakthroughs in other far more common diseases, such as diabetes and Alzheimers as well as inherited cancers. Clearly the process will need strict monitoring, as the article says and the debate will continue.

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  6. For me the fact that less than 0.06% of the DNA in the fertilised egg is from the donor means that concerns regarding the effect on human genetics are minimal, particularly as I imagine 3 person IVF is not that widespread. Also, issues with the idea of parents ‘playing God’ make the assumption that there is a God to play in the first place…

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  7. You provide good points for each side of the argument. IVF may be a solution to mitochondrial diseases as it is a preventative measure and at the moment prenatal and preimplantation diagnosis has its limitations. Mitochondrial mutations often contain a mixture of mutated and non-mutated mitochondrial DNA. The clinical outcome of an individual depends on the ratio of mutated DNA to non-mutated DNA. Therefore two people with the same mutation may have a different phenotype depending on their ratio that the tissue inherits. It might also be worth looking at current/future animal trials due to the fact that we are unable to test this on humans. This might give an indication of the long-term effects this procedure may have.

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  8. This is an interesting and well balanced introduction to the issues at stake.
    I would be interested to learn more about the long term financial implications in terms of the cost-benefit of eradicating mitochondrial disease versus the long term side effects of such a step – if indeed such things could be reasonably accurately forecasted.
    Further, what other tools might we have at our disposal besides a consequentialist framework to assess whether 3-patient IVF is a morally desirable undertaking? If medical professionals (and by extension medical scientists) have a duty to “do no harm”, is DNA manipulation an example of on one hand discharging, or on the other hand evading that duty?

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