"There are incredible new choices out there," says Dr. Dick Stouffer, a scientist at the Oregon Regional Primate Research Center in Beaverton, "along with a new set of problems." Consider this scenario suggested in Harper's magazine last month by author David Shenk: Your pregnant daughter and husband have fertilized her eggs in vitro (in a test tube) intending to implant the one with the best chance of surviving. A genetic screening reveals that of six eggs, two possess traits of extraordinary intelligence but are prone to manic-depression; two are disease-free but substandard in intelligence; and two are ordinary in intelligence but susceptible to colon cancer. What does your daughter do? Now add this to the equation. Her HMO advises her that if she chooses the manic-depressive or colon-cancer fetus, the treatment for those illnesses will never be covered by health insurance. The illness is on the record--it gives new meaning to "preexisting condition." New choices, indeed. "That's what all the angst is about," says Dr. Jeff Jensen, an obstetrician/gynecologist at Oregon Health Sciences University. "People want to push that scientific envelope, yet we're running the risk of not being able to keep up with the ethical dilemmas that exist." For the first 15 years of legal abortion, women had little genetic information about their developing fetuses. In the early 1980s, four new tests became widely available--ultrasound, amniocentesis, maternal serum testing and chorionic villus sampling--allowing parents to find out not only the gender of the fetus, but also whether it had any of 20 severe diseases. Now, science is on the brink of creating an even wider array of tests. When the federal government's $3 billion Human Genome Project is completed in 2005, it's expected that all 100,000 human genes will be decoded and mapped. Doctors most likely will be able to scan fetal cells for genes related to all kinds of characteristics: Alzheimer's, manic-depression, cancer, obesity, even sexual orientation. Just how far off is it? Scientists and doctors disagree. Some say five to 10 years; others say longer. Still others, like Dr. Susan Olson, a genetics expert at OHSU, say that even when elaborate new genetic tests are available, they'll be too expensive for widespread use. Dr. Don Wolf, a scientist who heads OHSU's in vitro fertilization lab, agrees. "The technology involved is not trivial," he says. "It's not the kind of thing I ever expect to be common. It simply won't be affordable." Other medical experts disagree, pointing out that our knowledge about which genes do what is improving daily, and the cost of DNA mapping is declining. "People who have the resources will purchase things if the technologies are available," says Jensen. At that point, when we can look at a fetus and determine whether it will have the musical aptitude of a Mozart, or the physical skills of a Michael Jordan, the ethical decisions about abortion will get very tricky. Consider, for instance, fertility treatments, like those used by the McCaugheys in Iowa to produce their famous septuplets. It's rare, but not unheard of, for such fertility treatments to produce three or more fetuses at once. Every year, two or three women experience such pregnancies at OHSU's fertilization lab, according to Dr. Paul Kirk, chairman of the obstetrics and gynecology department at OHSU. In those cases, parents are faced with the decision of "selective reduction"--a euphemism for aborting some of the fetuses, even though they may be healthy--because a higher number of babies increases the chance of prenatal complications. The next step, some scientists say, is the decision to "selectively reduce" based on information about what kind of people those fetuses will become. Other dilemmas loom: How will we regulate future genetic tests? Who will have access to the information? Is there an obligation to eliminate certain defects from the population? If a Darwinian march toward weeding out imperfections starts, how will we keep it from a Hitlerian ending? It's no wonder the federal government is spending $100 million to study the genethical issues raised by its Human Genome Project. Kirk expects the new scientific advances to bring new restrictions on abortion rights. "My personal bias is that society should continue to support a woman's right to choose," he says. "But there are some areas where people will be less tolerant." Abortion-rights activist Horowitz agrees that "numerous questions are going to be raised by medical advances." She says she'll answer all of them in the same way. "For me, the fundamental question remains the same," Horowitz says. "Whose decision is it? Our answer remains consistent: It is a woman's decision in consultation with her doctor and family." Even if the decision to abort is based on, say, gender? "It's a good question, but the fundamental issue hasn't changed," she says. "I'm not in a position to make judgment calls for somebody else, and I don't want somebody else making the decisions for me...certainly not the likes of Newt Gingrich or Trent Lott." OHSU genetics expert Olson says she's optimistic about the choices women and their doctors will make in the future. "Even for those of us right in the middle it is overwhelming," she concedes. "We can't hide from it. What keeps a sane perspective is dealing with the patients and seeing how most of them are so thoughtful and mature in the approach...and that scientists are trying to think ahead and set up structures to deal with all the ethical issues." Horowitz is more pessimistic. Technology for women's reproductive health has always been bogged down in politics, she says. Consider RU-486, a pill that induces abortion, eliminating the need for surgical abortion and thereby de-fusing some of the protests and politics. Though clinical tests of RU-486 were successfully completed at OHSU and 16 other locations in the country almost two years ago, a manufacturer has still not been found to make the drug in America--in part because no company wants to face the political fallout. "On one hand, we talk about a brave new world, and on the other, look at how little advancement there's been in birth control," Horowitz says. "We have virtually the same options as 30 years ago. I don't see the future spinning radically out of control." |
