A parent's dilemma

A couple undergoing IVF has multiple embryos and must choose which to implant. Their fertility clinic offers PGT-A testing to screen for Down syndrome and reveal sex. Newer companies promise to test for intelligence, height, disease risk.

The pressure to test

The parent feels torn. Genetic testing feels eugenics-like and expensive, yet they worry they must do everything possible to make their baby healthier and happier. What does a parent owe their child?

PGT-A: the older test

PGT-A has existed since the nineteen nineties. It screens for conditions like Down syndrome and reveals embryo sex. However, it does not predict what gender your child will ultimately end up identifying with.

Polygenic testing: the new frontier

Newer polygenic testing screens for complex conditions influenced by thousands of genes: breast cancer, depression, diabetes. Some companies offer screening not for disease prevention but for genetic enhancement, selecting for taller or higher IQ children.

The misleading math

Polygenic testing companies claim to predict risk reduction. But statistical geneticist Sasha Gusev warns the numbers are deceptive. A claimed twelve percent reduction in Type two diabetes risk means a child develops it later or at a milder stage, not that they avoid it entirely.

“Typical risk reduction estimates tend to exploit statistical assumptions to overstate their benefits and lead to confusion.”

Mental health is different

Polygenic scores perform poorly for psychiatric conditions. Psychologist Eric Turkheimer notes most mental health conditions exist on a spectrum from mild to severe. It is unclear we should eliminate mild or moderate manifestations.

The anxiety paradox

The author has generalized anxiety with obsessive tendencies. While painful sometimes, she would not eliminate it because the same trait driving worry also drives her creativity, curiosity, and ability to write novels and children's books.

Pleiotropy: genes do multiple jobs

Genes affect more than one trait. A gene linked to depression may also affect other things. If everyone selected embryos to avoid depression, we do not know what else we would accidentally eliminate from the human population.

The commodification risk

Treating children like consumer objects with selectable parts carries psychological harm. If polygenic testing is eighty percent accurate, twenty percent of the time it is wrong. A child may feel they failed to live up to the vision their parents pursued.

Sex selection and identity

A parent selecting for a girl may face a child who grows up transgender. That child may feel an extra sense of letting their parent down by not conforming to the gender expectations the parent went out of their way to chase.

The cost barrier

Polygenic testing is expensive. Company Orchid charges twenty five hundred dollars per screened embryo. Testing ten embryos costs twenty five thousand dollars. This raises the specter of entrenching a caste system where the rich get smarter and stronger.

Implicit coercion ahead

As more people use embryo selection, society may create pressure on everyone to do the same. Refusing selection could put a child at professional disadvantage or invite moral condemnation for making suboptimal kids when optimization is possible.

The obligation argument

Philosopher Julian Savalescu argues parents have a moral obligation to create children with the best chance of the best life. Orchid founder Noor Siddiqui tells parents the responsible decision is to protect their children from disease using language like, What if you could have stopped it but chose not to?

“What if you could have stopped it...but chose not to?”

The maximizing trap

Utilitarians believe the right action maximizes well-being. But maximizing one value can lead us to overlook other important values like diversity. Polygenic testing could lead to a less diverse world.

The impossible calculation

Choosing between embryos with different disease risks requires dizzying moral math: how much weight on longevity, patient-reported quality of life, and your own ability to cope? Nobel laureate Herbert Simon noted many problems have too many variables for maximizing to be feasible.

Satisficing: good enough

Herbert Simon coined satisficing, a portmanteau of satisfying and sufficing, to describe opting for a good enough choice rather than an optimized one. For serious conditions like Tay-Sachs or BRCA mutations, screening makes sense. For others, good enough is enough.

Social support matters too

Conditions like autism can be compatible with a happy life. Mental health suffering is heavily socially constructed. To give your child a good enough life, you do not have to achieve it by biological means. Changing the social environment can be just as important.

Where each parent draws the line

Each parent will draw the line on what counts as a good enough life in a slightly different place. This depends on how well-resourced the parent feels emotionally, socially, and financially to deal with a certain condition. What feels manageable to one parent may feel crushingly hard to another.

Resist the pressure

Genetic testing is supposed to offer parents more choice but often has the opposite effect. Language like What if you could have stopped it but chose not to preys on parents' worst fears. You are a moral agent free to weigh factors and make the choice that works well enough for your family.

“You are nobody's hostage.”