Eugenics and medicalized reproduction Conceptual, historical, medical, and ethical considerations

Bernard Baertschi (1, 2) , Pierre Jouannet (1, 3) , Bertrand Bed’hom (4, 1) , Christine Dosquet (1, 5) , Anne Dubart-Kupperschmitt (1, 6) , Christine Lemaitre (1) , Israel Nisand (1, 7) , Isabelle Rémy Jouet (1, 8)

1 CEI - IEC - Comité d'éthique de l'Inserm = The Inserm Ethics Committee
2 UNIGE - Université de Genève = University of Geneva
3 Fertilité et reproduction humaines- Université Paris 5
4 ISYEB - Institut de Systématique, Evolution, Biodiversité
5 AP -Comité d'évaluation éthique de l'Inserm
6 Physiopathologie et traitement des maladies du foie
7 Biologie de la reproduction
8 Inserm - Assurance qualité, technologies pour la santé

The classic eugenics of the late 19th century sought to improve the human race by relying on the coercive power of the state. This practice has been discredited, but it is sometimes argued that “liberal” or “private” eugenics has outlived it, particularly in the context of medically assisted reproduction (MAR). Indeed couples can resort to in vitro fertilization (IVF) when they wish to have a child who does not have certain serious genetic diseases in the name of reproductive freedom and the interest of the unborn child. “Liberal” or “private” eugenics is currently the subject of much debate. The main arguments underlying the current thinking are as follows: (a) even if the aim (not having a child with a serious genetic disease) is laudable, not all means of achieving it are necessarily so; (b) by choosing which embryo(s) to transfer, a choice is made as to the people who deserve to exist; (c) there is a risk of applying arbitrary or even immoral selection criteria; (d) some MAR practices involve the transmission of genetic mutations or chromosomal abnormalities (dysgenics); (e) the practice of genetic testing with the aim of choosing embryos without genetic diseases expresses a stigmatizing attitude towards people with disabilities (expressivist argument); (f) couples and the medical institution have a moral duty not to transfer an embryo carrying a deleterious gene; (g) couples are under a great deal of pressure to undergo testing, a pressure that could undermine their autonomy and their ability to choose freely; (h) the good of the child, a cardinal ethical and legal consideration, could be threatened by “private” eugenics; and (i) an alternative to embryo selection could be germline gene therapy, which is currently prohibited. Today, genetic testing and criteria can be used in a wide variety of ways when reproduction is medicalized. These may include genetic factors sought in gamete and embryo donors to avoid the transmission to the child of a genetic pathology when the risk is known; chromosomal analysis of embryos to avoid transferring into the uterus those that will not develop to term; a preimplantation diagnosis on the embryos to avoid transmitting to the offspring genetic characteristics of the future parents that are likely to seriously harm the health of the unborn child; selection of embryos on the basis of polygenic scores to detect those less at risk of developing a pathology after birth; and selection of the child’s sex without any medical indication. Male sterility, for example, may be due to a chromosomal factor (Y-chromosome microdeletion) or a genic factor (mutations of the CFTR gene or genes involved in spermatogenesis). When spermatozoa can be used in ICSI, sterility can be bypassed, but chromosomal or genic modifications can be transmitted to offspring and cause sterility in boys. If no spermatozoa are available, an in vitro correction of the defective gene by genomic engineering in germ cells could be considered for the treatment of male infertility. As classical eugenics has been unanimously discredited, labeling a practice as eugenist is tantamount to condemning it. The law is currently doing the same. However, this was not always the case: before World War II, it was often viewed positively. The notion of eugenics was therefore devised at a time when genetics, in the sense of determinism and the process of transmitting inheritable traits, was not yet understood. Nowadays, a return to “genetic determinism” or “genetic program” sometimes resurfaces, often simplistically or erroneously based on the most recent data from knowledge acquired in genetics. The cumulative effect of couples’ decisions has some effect on the composition of future generations, albeit quantitatively minimal. However, there is no eugenist intention as such. A distinction must therefore be made between eugenics as a consequence and intentional eugenics. The first is not truly eugenics, so the term “eugenist” should be used only for interventions that promote the deliberate, intentional transmission of genetic traits or characteristics to offspring.

Mots clés: IEC; Note Inserm Ethics Committee

Domaines: Ethique

Bernard Baertschi, Pierre Jouannet, Bertrand Bed’hom, Christine Dosquet, Anne Dubart-Kupperschmitt, et al.. Eugenics and medicalized reproduction Conceptual, historical, medical, and ethical considerations. 2024. ⟨inserm-04434380⟩