COMMENTARY

Ethical Issues That Keep Him Up at Night -- Dr. James Grifo

Arthur L. Caplan, PhD; James A. Grifo, MD, PhD

Disclosures

December 11, 2013

In This Article

The Future of Infertility Treatment

Dr. Grifo: With next-generation sequencing, we are learning more about genes. We are learning more about disease-causing genes. Should we select against that embryo? Should we not? Who should decide? Should the parents decide? They have to raise the child. I think they should decide, but we are going to learn a lot.

Dr. Caplan: Looking forward, is the future of infertility treatment going to be treating the infertile or is it going to shift over to trying to make better babies?

Dr. Grifo: "Better" is a funny word, because there has always been this criticism about designer babies, whatever they are. We don't know the genes for intelligence and hair color and eye color, so we can't select for those that easily. On top of that, you may not get the embryo that has all the things you want, and then what? Most of my patients don't care about that anyway; they just want to have a baby.

Dr. Caplan: They just want a baby.

Dr. Grifo: They are so desperate. We are going to be able to screen out a lot of things, and that is going to cause ethical dilemmas. In general it is good because the goal is a healthy baby, and what is very clear is that most embryos are unhealthy. Most embryos don't make babies. We are getting smarter about being able to determine which embryo will make the baby; that's where this technology is headed, and that's good. When you put back 1 embryo, you get a single term pregnancy; you don't get a preterm delivery, you screen out a lot of the miscarriages, you don't get to 15 weeks with a Down syndrome baby and have to face that ethical dilemma. So it's all positive.

Dr. Caplan: It seems to me, despite all of the inclinations to meddle by religious leaders, ethicists, lawyers, government officials, and the entire range of the peanut gallery that the take-home message that you have learned over your career is that there is a lot of wisdom in those doctor-patient conversations. Well-informed patients are pretty trustworthy patients, whether they are older, younger, single, or whatever their characteristics might be. That is a pretty valuable insight.

Dr. Grifo: You have hit the nail right on the head. That is really the key insight, and it's one that the general public needs to know because there is so much fear and anxiety around something new, and this is new technology in a brave new world. We should embrace it. A lot of good comes out of it. It's always good to have the voice of reason from the ethicists and the regulators keeping us honest. We take that very seriously.

Dr. Caplan: I want to thank you. This was very illuminating about a very cutting-edge area, but it has implications for everybody practicing healthcare, and certainly for people who are patients and for citizens just trying to understand this rapidly evolving area within medical technology.

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