We retrieved a total of 88 articles, out of which 59 were original and the remaining 29 were republications by other news sources (Supp. Table S1). Most original articles were published in United States-based media (43%, Fig. 1). Half of the articles (54.4%) had a neutral tone: while acknowledging the developmental initiative, they also highlighted practical and technical limitations of polygenic scoring in IVF settings. One third of articles (36.8%) expressed a negative attitude towards PGT-P and only 8.8% saw it as a positive advancement in the field (Fig. 1). Articles were published in various media sources, such as serious broadsheet newspapers, tabloid newspapers, science magazines and religious magazines. Next, we extracted five main themes with respective subthemes that addressed ethical aspects of performing PGT-P (Table 1). Although PGT-P indications include various complex trait diseases, such as diabetes or cardiovascular diseases, the main issue discussed in the news articles concerned embryo screening for intelligence.
Table 1
List of themes and sub-themes
Theme
|
Subtheme
|
Theme 1. A slippery slope towards designer babies
|
Concern about a slippery slope
Concern about eugenics
Reassurance about the misuse of PGT-P
Recurring argument
Limited possibilities and usefulness
|
Theme 2. Well-being of the future child and parents
|
Positive impact on well-being of the future child
Moral duty to improve quality of life of future child
Concern about well-being of the child
Value conflict for parents
Positive impact on well-being of the parents
Pressure to use artificial reproduction
|
Theme 3. Impact on society
|
Socio-economic impact
Concern about economic incentives
Issue of discrimination and stigmatization
Attitude of society towards disabled people
More equality in society
Individual rights vs needs of society
Relative significance of individual characteristics
|
Theme 4. Deliberate choice
|
Positive impact on deliberate choice
What lives are worth living?
Concern about deliberate choice
Dilemma of one remaining embryo
Reassurance about deliberate choice
|
Theme 5. Societal readiness
|
Concern about unregulated commercialization
Need for ethical debate
Need for protection
Lack of scientific validity
Drawback of polygenic risk scoring
Unwanted consequences
|
Theme 1: A Slippery Slope towards Designer Babies
The most common concern present in the news coverage was the potential use of PGT-P for non-medical traits, such as hair or eye colour. This was often described as a slippery slope towards designer babies (Q1, Supp. Table S2). This ‘slippery slope’ was mentioned in 50 out of 59 included articles (84,7%). The negative reaction was associated with eugenic practices and many feared that the technique would be used for genetic enhancement (Q2-Q3, Supp. Table S2). At the same time, many articles cited Genomic Prediction founders, who reassured that the company will always consider the ethical standards of the community and will not use the technique for controversial reasons (Q4-Q5, Supp. Table S2). Moreover, recurring arguments about designer babies and eugenics highlighted that this type of ethical debates appeared with the introduction of every new reproductive technology (Q6-Q7, Supp. Table S2). From a practical side, various articles mentioned that PGT-P provides very few benefits: considering that as IVF treatment yields a relatively small number of embryos and that children from same parents show little significant genetic variation, the number of options to choose from will be limited. As such, the use of PGT-P will only have limited consequences, making the fear of a slippery slope unjustified.
Theme 2: Well-being of the Child and Parents
Positive elements of PGT-P for well-being of children and parents appeared in 55,9% of articles. Several articles emphasized the positive features of PGT-P, such as reducing the risk of certain diseases and the possibility of improving future children’s health and well-being (Q1-Q2, Supp. Table S3). Others noted that the new technique will lead to more successful pregnancies and better IVF care (Q3, Supp. Table S3). Furthermore, by improving the child’s well-being, the parents’ emotional and financial burden of care is also moderated (Q4, Supp. Table S3). Because of these positive outcomes, some argued that if we agree that parents are obliged to promote their children’s life quality, they should be able to use this technique to ensure best quality of life for their children (Q5, Supp. Table S3).
Opposing views feared that children might feel pressured due to high expectations, which could consequently bring a great deal of emotional frustration and harm (Q6, Supp. Table S3). The parents might be disappointed in their future child, if he or she does not meet their standards, especially when they spent money for the “best” embryo. In addition, even if there is no medical reason stricto sensu, future parents may consider using IVF to have healthier children, despite it being time-consuming, invasive and expensive (Q7-Q8, Supp. Table S3).
Theme 3: Impact on Society
Socio-economic Impact
71,2% of articles referred to the impact of the technology on society. According to some authors, embryo selection might have a positive socio-economic impact: social costs would lower, economic performance would augment, and medical resources could be allocated more efficiently in the future. At the same time, the importance of economic incentives was questioned. Although hypothetically populations could be altered in favour of higher economic performances by continuously selecting for higher IQ, high economic performance and improved healthcare might not be the only driving force on the market. Selection could for example also be requested for other traits such as skin colour (Q1, Supp. Table S4). Hence, many articles highlighted the difficulty of solving the dilemma between what is ethically desirable and economically advantageous for our current and future society.
Issues of Discrimination and Equity
With regards to equity, there were concerns that access to PGT-P would be limited to those who could pay for it. Consequently, this could further increase the already existing social gap, with wealthy class trying to improve the intelligence and health of their offspring (Q2, Supp. Table S4). Another concern was the message we give as a society to people with disabilities. By performing trait selection at embryo level, people with “undesirable” traits could be regarded as less valuable than the ones without disabilities or diseases. One author argued that by eliminating disabilities and biological diversity, we risk losing differences between people, and thus also sources of creativity (Q3, Supp. Table S4).
Individual Rights vs. Needs of Society
Potential unequal access to PGT-P also raised questions about the balance between what is good for society and what is good for the individual. Promoting individual welfare might not be good for society, because it could create a societal division between those who have access to the test and those who do not (Q4, Supp. Table S4). At the same time, access to the test would depend on differences between countries’ healthcare systems, which is part of a broader debate. One author argued that using PGT-P for selecting embryos is not very different from what we already do in everyday life: after birth, we try to promote advantageous characteristics like intelligence by, for example, sending children to private education. The same author also pointed out that a strong society is determined by collective intelligence, which comes as a result of many people working together, rather than reliance on the individual “braininess”.
As described in Theme 1, the possibility of reviving eugenics was seen as a major concern. However, some argued that from a societal point of view, improving humanity is not necessarily a frightening prospect: we might take control of our evolution by curtailing some of the genetic diversity and thus lowering the incidence of the disease.
Theme 4: Deliberate Choice
Different authors suggested that PGT-P could benefit reproductive liberty, as it would enable individuals to make informed decisions about the pregnancy. This theme was present in almost half (45.8%) of articles. If one is already performing PGT-M for embryo selection, polygenic risk scores screening could be added without the need for an additional biopsy. Also, PGT-P could potentially help prospective parents going through IVF treatment to prioritize embryos for transfer, based on these genetic scores (Q1-Q2, Supp. Table S5). At the same time, freedom of choice could also lead to existential questions, such as what lives are worth choosing and what would be the impact of such decisions (Q3, Supp. Table S5).
According to others, the technique might contradictorily lead to less reproductive liberty, because it might become the parents’ moral duty to select the best possible embryo (Q4, Supp. Table S5). Similarly, doctors might have an ethical responsibility to report possible negative outliers (Q5, Supp. Table S5). Couples may also face a dilemma, if they have only one available embryo for transfer and that embryo has undesirable scores. In that case, reproductive liberty could decrease.
Theme 5: Societal Readiness
Another significant issue raised by media sources concerns premature availability of the test on the market. About two-thirds (67,8%) of articles referred to societal readiness for the technology. Many emphasized the need for a broad ethical debate, stressing the urge for regulation to protect against the use of uncertain and debatable PGT applications (Q1-3, Supp. Table S6). According to different articles, variable PGT regulation between countries could lead to medical tourism, if one country would allow something another does not.
Various authors also questioned scientific evidence underlying PGT-P. First, the test would not be reliable enough due to moderate accuracy of PRS calculation in embryos, considering the limited starting DNA material (Q4, Supp. Table S6). Second, polygenic traits can be determined by many different genes and selecting for few individual genes, associated with a certain trait, would be too limited to use them in predictions (Q5, Supp. Table S6). In addition, upbringing, lifestyle and environmental factors play a major role in determining a trait (Q6, Supp. Table S6). Third, PRS calculations operate on a population level, but they cannot be extrapolated to an individual for direct risk assessment and current statistical predictors are not valid for people of non-European descent (Q7-Q8, Supp. Table S6). This drawback could be especially relevant to the equity concerns addressed in Theme 3. Finally, the causal relationship between genes and a trait often remains obscure. For example, genes associated with higher intelligence can overlap with genes for autism, hence selecting for high IQ could lead to adverse consequences (Q9, Supp. Table S6). This led to concerns about genetic diversity and unforeseen negative impacts when we would try to promote certain traits.