Abstract
Recent development in genetics research and the elaboration of a number of new testing techniques have once again triggered debate about the legitimacy of medical practices that aim at detecting and preventing hereditary and/or genetically determined disease.1 Testing techniques do, in fact, furnish information concerning the genetic makeup of an individual, including the unborn. Used in the context of clinical genetics, they make available to the person (or persons) consulting more precise data about hereditary conditions in the family, permitting that person to make informed decisions for immediate or long-term action, in particular with regard to reproductive choices.
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Notes and References
As we will see later in this paper, both detection and prevention are problematic notions in genetics. Detection may sometimes only mean establishing a statistical probability that a condition will or will not occur. Prevention may simply entail abstinence from procreating or selective abortion, as there are as yet no successful remedies for many genetically determined conditions. Fundamentally, prevention involves making choices about risk taking, on the basis of a statistical probability.
It must be noted that the distinction between physicians and genetic counselors is not pertinent in France, where genetic counseling is done exclusively by physicians.
This familial dimension of genetics is often absent in studies that deal with the more technical aspects of laboratory work in molecular biology.
In French, I usually distinguish procreation, which is a social process, from reproduction, which is a biological process. Procreation is, in other words, the social organization of biological reproduction. Thus the term “medically assisted procreation” translates quite well the idea of a socially organized solution to the absence of descendants. Nevertheless, I have chosen, in this article, to respect the terminology familiar to English-speaking readers: reproductive technology and reproductive choices.
Centre d’Étude et de Conservation des Oeufs et du Sperme Humain, in other words, Center for the Study and Preservation of Human Eggs and Sperm. For an extended sociological analysis of the ethical, institutional, and technical dimensions of semen banking and donor insemination in France, see Simone Novaes, Les Passeurs de Gamètes, op. cit.
J. Selva et al., “Genetic Screening for Artificial Insemination by Donor (AID): Results of a Study on 676 Semen Donors,” Clinical Genetics, 29 (1986), pp. 389–396.
P. Jalbert and G. David, “Problèmes génétiques liés à la procréation artificielle par don de gamètes: solutions adoptées par les CECOS,” Journal de gynécologie obstétrique et de biologie de la reproduction, 16 (1987), p. 548.
The most common examples of cumulative risk factors are allergies and cardiovascular disease. For more detail on these guidelines for the genetic screening of donors, see P. Jalbert et al., “Genetic Aspects of Artificial Insemination with Donor Semen: the French CECOS Federation Guidelines,” American Journal of Medical Genetics, 33 (1989) pp. 69–275.
I believe that a definition of infertility, not just as an incapacity to conceive (and bear) a child but as an incapacity to produce a healthy child, will play a major role in the way both reproductive technology and genetic diagnosis and therapy will evolve as medical practices in the future.
Here I am using the term coined by Barbara K. Rothman in her book The Tentative Pregnancy (New York: Viking, 1986), an excellent analysis of prenatal diagnosis, both as a psychologically trying experience and as a practice that has consequences on the social attitudes toward handicaps. In her conclusion, she recommends that prenatal diagnosis be replaced more frequently by donor insemination because it is less traumatic for the woman and, as a practice, would have fewer long-term consequences in terms of discrimination. She seems to disregard the complexity of the problems raised by donor insemination, however, which, as we will see, lead in a different manner to similar consequences in social attitudes.
In French, the physician has an “obligation de moyens” but not an “obligation de résultat.”
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© 1999 Springer Science+Business Media Dordrecht
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Novaes, S.B. (1999). Making Decisions about Someone Else’s Offspring. In: Fortun, M., Mendelsohn, E. (eds) The Practices of Human Genetics. Sociology of the Sciences, vol 21. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4718-7_8
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DOI: https://doi.org/10.1007/978-94-011-4718-7_8
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