More about gene therapy and human gene editing

To my post of last week, add the case of a 44 year-old man who has received gene therapy for an inherited metabolic disease called Hunter’s syndrome. This is another example of a form of gene editing as true therapy.  That is, an existing individual is given a construct intended to edit his genes to introduce a gene that makes an enzyme that is lacking in the disease, and that causes terrible problems.  In this case, as part of a clinical trial, the construct, using a so-called “zinc finger” technique, is intended to introduce the gene into only about 1% of the patient’s liver cells.   If successful, the damage already done by the disease won’t be affected, but it’s progress may be arrested, with the potential to avoid having to have repeated, costly treatment with the missing enzyme protein itself.

Cool idea–and well within the current regulatory ethical regime.  The edit would not be inherited, and unborn humans don’t have to be sacrificed to develop the technique.  The adult patients are capable of giving informed consent.  Trials in children would come later, controlled by accepted ethical experimentation on children in clinical trials.

In a separate note, on a separate topic, Nature Biotechnology is editorializing that inherited gene editing is way behind mitochondrial replacement therapy (MRT), the “3-parent baby” approach to treating genetic problems, and will likely have limited use in the future.  Why?  Because it is likely that preimplantation genetic diagnosis (PGD) after in vitro fertilization (IVF) will be preferred to identify and give birth to babies unaffected by serious genetic disorders.  The journal editors argue that gene editing would be preferred only in those few cases where PGD cannot avoid passing on a disease–for example, in cases where it is known that all embryos from a fertilizing couple would be affected. Otherwise, the gene editing would not be worth the trouble.

MRT, on the other hand, has been studied more and is closer to being used to treat unborn humans who have diseases that MRT could treat.  Thing is, those diseases are also rare, on the order of 1000 cases per year in the US, and technically, gene editing would probably not be too useful for those.

There is a lot of talk about using a mix of gene editing and PGD to eliminate certain genetic disease from the human prospect.  I recently wrote about the Chinese government working on this.  To achieve the goal absolutely, every born human would have to be a product of IVF.

And the risk of some of the disorders is low enough that the absolute risk in any one “natural” pregnancy would be low.  So why go to the trouble of trying to eliminate the risks utterly?  (I think that’s a rhetorical question.)

The title of the editorial in question is “Humans 2.0.”  Indeed.

There’s gene therapy and there’s gene therapy

I’ve seen a number of different things described in the general press as “gene therapy.” But they are indeed different.  It’s important to be specific.

For one, there’s the situation where a set of mature human cells are obtained from the person to be treated and genetically altered outside the body to make them into a potentially useful treatment, then re-administered (by vein) to the patient.  Such is the case with so-called “CAR-T” therapy, which is well handled by current regulatory structures.  Main ethical issues: common human subject research concerns, regulation of the quality of the cells, and whether the treatment, which can be dramatically effective, is worth the high price.

Then there are situations where a diseased tissue is altered to make it normal, like the recent report of how a mutation in the skin of a boy was altered, and the repaired skin grafted back on, to spread over most of his body and replace the defective skin.  Again, way cool, well dealt with by current ethical and regulatory structures.

Or, similarly, Spark Therapeutics’ LUXTERNA, which is a gene injected into the eye to repair a defective gene causing blindness, literally restoring some sight, recently recommended for approval by an advisory committee to FDA.   Truly a gene made into a therapy.

Where the ethical issues get thorny is when one speaks of possibly editing a gene in a person–likely an unborn person very early in development; i.e., and embryo–in a way that can be inherited over generations.  I and others have discussed this recently on this blog.  See for example my post of last month (October 5).  Adherents say that there are serious diseases demanding cures, and that those who would counsel caution are obstructionists who fret too much about enhanced Olympic athletes.  (Example here, but subscription required.)  But the ethical issues are several: How safe and reliable will the technique be, and how much testing should be required before trying to birth “edited” babies?  How many embryos will have to be destroyed to perfect the approach?  How can we know whether there will be unforeseen long-term effects, after several generations?  How much should we care about that?  How will discrimination be avoided?  What are the implications for control of human reproduction–no more babies from sex? And who will decide and control that?

And–where, short of the Olympics, will it all end?  Should we try to edit genes that are known to increase cancer risk, to eliminate them from the human race?

The Hastings Center recently convened journalists to discuss some of the ethical issues with gene editing.  But even then, they are more concerned about whether there is a parental duty to “edit” the next generation.  Precautionary deliberations appeared to be limited to environmental concerns from the use of “gene drive” to spread genetic modifications rapidly through entire plant or animal species.  (Fair enough, but I’d extend the precautions to humans, where “gene drive” is not an issue.)  And, helpfully, the Hastings symposium did ask, will general press coverage necessarily be biased because reporters’ sources are the very scientists who tend to be enthusiasts?  In any event, the Center should not only do more public education events, but should make much more of the detailed content from such symposia available to the public for free, online, much as the Presidential bioethics commissions do.  As it is, we are left with their brief press releases, usually.  Thin gruel, IMHO.

Selective data collection – what do we know about the risks of IVF?

A recent article in Newsweek reports on a physician, Dr. Jennifer Snyder, who is calling for the formation of a registry of egg donors to help determine the risks to women who “donate” eggs to other women undergoing IVF for monetary compensation. Her motivation in calling for this registry was the death of her daughter at age 31 from cancer after donated eggs on three occasions. She points out that egg donors are commonly told that there are no known long-term risks of egg donation, but that the reason that there are no known long-term risks is that the risks of egg donation have never been studied.

The article reports that Alan Penzias, chair of the practice committee at the American Society of Reproductive Medicine, agrees that such a registry is needed, and states that “national reporting on IVF, including data on both mothers and babies, is required by law.” It is good that this representative of those who practice reproductive medicine is in favor of a registry to assess the risks of egg donation, but there is a problem with his statement about the current reporting that is done on IVF in the United States.

That reporting on IVF is done under the authority of the CDC by the National Assisted Reproductive Technology Surveillance System. According to their National ART Surveillance website what they measure to comply with the Fertility Clinic Success Rate and Certification Act is data about patient demographics, patient stature: medical history, parental infertility diagnosis, clinical parameters of the ART procedure, and information regarding resultant pregnancies and births. The outcomes data is limited to information about the percentage of IVF cycles that achieve pregnancy and achieve live birth and information on how many of those pregnancies are single or multiple gestations and how many are delivered prematurely or at term. No data is collected on the complications or ill effects that women who undergo IVF may experience, and no data is collected on either birth defects or any other adverse consequences other than prematurity, birth weight, and plurality for the infants born by way of IVF.

Dr. Snyder’s call for a registry for data on adverse effects experienced by women who donate eggs is absolutely necessary to be able to give women the information needed to be able to make an informed decision about being an egg donor. There is an urgent need for the same type of registry of adverse outcomes for women who undergo IVF and the children produced by IVF. It is inexcusable to expect women to consent to these procedures without knowing the risks because those who perform the procedures have failed to collect data about those risks.

Human gene editing marches on

Nature has recently carried two new reports of human gene editing.  In one, embryos donated from an IVF clinic had a gene critical to very early development altered, to study what happens when you do that, and try to understand early human development more than we now do.  In the other, scientists studied editing of an abnormal recessive gene, specifically the one causing a type of blood disorder called thalassemia, by using cloning to create a new embryonic version of an adult with the disease.  (This made it technically easier to start in the laboratory with an embryo that has the disease, because it is genetically recessive, meaning that both copies of the gene are abnormal.)  This follows earlier publication of similar work to edit dominant mutation-causing genes, in which the embryos arose because of new IVF, done in the lab, by the scientists, using donated eggs fertilized with sperm from a male donor who carried the abnormal gene.

In all three cases, the main biologic approach, and the main ethical issues, are the same.  The main differences were which genes were being edited, and how the embryos were obtained.

This prompted Nature to run an editorial to say that it is “time to take stock” of the ethics of this research.  Read the editorial here.  The key points:  This is important work that should be undertaken thoughtfully.  Accordingly, donors of any embryos or cells should be fully informed of the planned research.  Only as many embryos should be created as are necessary to do the research.  Work on embryos should be preceded by work on pluripotent, or “reprogrammed,” stem cells, and if questions can be fully answered by work with those cells, then it may not be necessary to repeat the studies on whole, intact human embryos, and if that is not necessary, perhaps it should not be done.  Finally, everything should be peer reviewed.

I agree that editing work in non-totipotent cells should be at all times favored over work on intact embryos, but if one holds that an embryo is a human being that should have the benefits of protections afforded human research subjects, then Nature’s ethical principles are rather thin, little more than an extension of animal use provisions for studies in which early humans are the raw materials for the development of new medical treatments.

Included was a link to the journal’s policies for considering for publication any reports of experimentation on living organisms.  Those policies include this paragraph regarding modification of the human germline:

“In deciding whether to publish papers describing modifications of the human germline, we will be guided by safety considerations, compliance with applicable regulations, as well as the status of the societal debate on the implications of such modifications for future generations. We have established an editorial monitoring group to oversee the consideration of these concerns. (The monitoring group includes the Editor-in-Chief of Nature publications, the Nature Editorial Director, the Head of Editorial Policy, Nature Journals and the Executive Editor, Life Sciences.) This group will also seek advice from regulatory experts to ensure that the study was conducted according to the relevant local and national regulations. In this evaluation, we will be strongly guided by the guidance issued by the International Society for Stem Cell Research: Guidelines for the Conduct of Human Embryonic Stem Cell Research (http://www.isscr.org/home/publications/guide-clintrans ).”

I want to be reassured by their invoking “the status of the societal debate on the implications of such modifications for future generations,” but the weaknesses are first, that debate is just not very robust, and “society” is generally in a position of accepting, more or less uncritically, the ongoing technical push; and second, that the ones considering the status of the issues will more or less naturally view them through the relatively narrow researchers’ scope I describe above.  To be sure, the goals at a minimum appear to be to ensure that the research is not reckless, that it meets technical standards, that obtaining and creation of embryos is relatively limited in scope, and that nobody, for now, is trying to bring gene-edited embryos to human pregnancy, much less birth.  At least, not until the scientists and regulators tell us they think it’s time to try that.

Is Obfuscation Ever Helpful in Science or Ethics?

Obfuscation and science would seem to be polar opposites. The scientific method hinges upon correctly identifying what one starts with, making a single known alteration in that starting point, and then accurately determining what one ends up with. Scientific knowledge results from this process. Accidental obfuscation in that three-step process necessarily limits the knowledge that could potentially be gleaned from the method. Peer review normally identifies and corrects any obfuscation. That is its job. Such peer review can be ruthless in the case of intentional obfuscation. It should be. There is never any place for intentionally misrepresenting the starting point, the methods or the results.

Until now?

In an excellent article in Technology Review, Antonio Regalado describes the current status of research where human embryonic stem cells “can be coaxed to self-assemble into structures resembling human embryos.” The gist of the article is that the scientists involved are excited and amazed by the stem cells’ ability to self-organize into structures that closely resemble many features of the human embryo. Perhaps more importantly, per Regalado:

“…research on real human embryos is dogged by abortion politics, restricted by funding laws, and limited to supplies from IVF clinics. Now, by growing embryoids instead, scientists see a way around such limits. They are already unleashing the full suite of modern laboratory tools—gene editing, optogenetics, high-speed microscopes—in ways that let them repeat an experiment hundreds of times or, with genetic wizardry, ask a thousand questions at once.”

This blog has reported on Synthetic Human Entities with Embryo-like Features (SHEEFs) before (see HERE and HERE for starters). The problem from a bioethical standpoint is this: is what we are experimenting upon human, and thus deserving protections as to the type of research permitted that we presently give to other human embryos? Answering that ethical question honestly and openly seems to be a necessary starting point.

Enter the obfuscation. Consider just the following three comments from some of the researchers in the article:

When the team published its findings in early August, they went mostly unnoticed. That is perhaps because the scientists carefully picked their words, straining to avoid comparisons to embryos. [One researcher] even took to using the term ‘asymmetric cyst’ to describe the [amniotic cavity-like structure] that had so surprised the team. “We have to be careful using the term synthetic human embryo, because some people are not happy about it,” says [University of Michigan professor and lab director Jianping] Fu.

“I think that they should design experiments to focus on specific questions, and not model everything,” says Insoo Hyun, professor and ethicist at Case Western University. “My proposal is, just don’t make the whole thing. One team can make the engine, another the wheels. The less ambiguous morally the thing is that you are making, the more likely you can do your research unimpeded.”

“When Shao presented the group’s work this year, he added to his slides an ethics statement outlined in a bright yellow box, saying the embryoids ‘do not have human organismal form or potential.’”

This last comment seems to contradict the very emphasis of the linked article. As Regalado nicely points out: “The whole point of the structures is the surprising, self-directed, even organismal way they develop.”

Honestly, at this point, most are struggling to understand whether or not the altered stem cells have human organismal form or potential. I suspect everyone thinks they must or else researchers would not be so excited to continue this research. The value of the research increases the closer a SHEEF gets to being human. If our techniques improve, at what point does a SHEEF have the right to develop as any other normal embryo? Said differently, given their potential, and particularly as our techniques improve, is it right to create a SHEEF to be just the engine or the wheel?

Having scientists carefully picking their words and straining to avoid comparisons is not what scientists should ever be doing. Doing so obfuscates both science and ethics. Does anyone really think that is a good thing?

Search and destroy—or at least, select

This week’s issue of Nature carries a feature article on the explosion of preimplantation genetic diagnosis (PGD) in China.  Because women are having children later in life, partly because of relaxation of the old one-child policy; because Chinese culture sees it as a duty to seek to bear healthy children; because some Chinese want to try to enable their kids to exploit some features of life–reproductive technology, specifically in vitro fertilization, is exploding, and embryos are selected for the absence of certain diseases.  Embryos with genes that transmit such diseases have oblivion as their fate, but the Chinese hope that all children born there are born are free of the burdens of some truly bad diseases, and if they have those diseases, they won’t be born.  Retinoblastoma.  Huntington’s disease.  Brittle-bone disease (osteogenesis imperfecta).  (That’s the disease that Alec, the kid on the Shreiners Hospital for Children ads, has–you know, “we’ll send you this adowable wuv-to the wescue bwanket.”  I love those ads.) Polycystic kidneyShort-rib polydactyly syndrome.

Deafness.  Maybe the Chinese think that deaf people have no reason to live, kind of like Randy Newman’s short people.

The Asian gene that makes it hard to metabolize alcohol.  Without that gene, it’s possible to drink at a business lunch.  Important for career success.

The central government’s 5-year plan puts a high priority on using PGD to optimize the population.  Not too many people object.

Folks in the West wonder why the US can’t get with the program the way the Chinese do.

Chinese physician-scientists speak of eliminating all 6000 known disease-causing genes from the population.  “We just do them one-by-one until we get the whole set,” one Chinese geneticist is quoted as saying.

The article says further: “The Chinese word for eugenics, yousheng, is used explicitly as a positive in almost all conversations about PGD. Yousheng is about giving birth to children of better quality.”

The Chinese are also busily aborting babies with Down syndrome.  In this case, of course, Down syndrome is identified by prenatal diagnosis, when not only fertilization has occurred, but there is a pregnancy.  As in Iceland, as CBS recently reported.  If you abort such a baby in China, “nobody scolds you,” they say.  In Iceland, they “don’t look at abortion as murder.”  They “look at it as a thing that we ended.”  There are one or two Down syndrome births per year in Iceland, CBS reports  Abortion after 16 weeks is legal there for a “fetal deformity,” like Down syndrome.  The abortion rate in Iceland after a prenatal Down syndrome diagnosis is “nearly 100 percent,” compared with an estimated 67 percent in the US, 77 percent in France, and 98 percent in Denmark, according to CBS.  I didn’t see a rate for China in the Nature article.  But they sold over a million Down syndrome diagnosis kits last year, it says.

Follow the links and read both articles in full.

And go back and read Mark McQuain’s fine post of this past Tuesday, August 15, and the Time magazine article to which he linked.  The most telling statement of that article, in my opinion: “I worry that in our haste to make people healthy, we are in fact making the people we want.”

Precisely.  Beyond the concern of killing unborn humans lies the conceit that we know what people we want.  That those choices will always appear benign, or praiseworthy.  That we don’t have to worry about being told what people we want.  That the group of people doing the choosing won’t be very narrow indeed.

Perhaps it is time to start a society of free-range humans.

 

The goal of human embryonic gene editing is enhancement

As Jon Holmlund reported in his post last week, research on the editing of genes in human embryos is now being conducted in the United States. The door to doing this research was opened by the consensus report on Human Genome Editing published by the National Academy of Sciences earlier this year. That report encouraged the pursuit of research on gene editing in human embryos and justified that based on the potential benefit of editing human embryos to correct genes for serious human genetic disorders. The report recommended that once basic research could show the reliability of the gene editing techniques it would be reasonable to proceed with human clinical trials as long as those trials involved the correction of genes responsible for serious genetic disorders. They stated that there were significantly more moral concerns about using human genome editing for enhancement and that enhancement should not be pursued until those moral concerns were resolved. Thus, the research currently being done in Portland, Oregon by Shoukhrat Mitalipov (see article in MIT Technology Review) involves creating human embryos with a single gene genetic disorder and then editing the abnormal gene to remove the disorder.

However, the idea that human germline genetic modification should be pursued to correct serious genetic disorders is a flawed concept. The technique used by Mitalipov does not involve treatment of a diseased human embryo, but the creation at the time of conception of a genetically altered embryo. Since the goal of this procedure is not the treatment of a diseased individual, but the creation of a child free of a particular genetic disease for parents who desire such a genetically related child, there is a much simpler and already available means to accomplish that goal. The parents can accomplish that in the large majority of cases by using preimplantation genetic diagnosis (PGD) to select an embryo that does not have the disorder. Since this method is much simpler, involves much less risk, and will undoubtedly be less expensive than gene editing, there would be very little market for embryonic gene editing for parents who are carriers of a serious genetic disorder and desire to have an unaffected child.

Some might suggest that gene editing of embryos with a genetic disorder would be morally preferred to PGD because of the destruction of the embryos who do have a genetic disorder in the process of using PGD. This is based on the human embryo having full moral status which makes the destruction of embryos inherent in the way PGD is used impermissible. However, if human embryos have full moral status, then the research being done to develop human embryonic gene editing is impermissible since it involves destruction of the embryos created for the research.

Since there will be little practical use for human embryonic gene editing in dealing with serious genetic disorders, what will human embryonic gene editing be used for? It will be used for things that cannot be done with PGD. It will be used to create children with genes that the parents do not possess. It will be used for enhancement. Those who promote research on human embryonic gene editing should be honest and admit that it will have little use in the treatment of single gene disorders and that the real reason to develop it is to do enhancement, which they admit is morally problematic.

Human genetic editing (engineering) is here

A “hat tip” again to Wesley Smith, who at the National Review Online blog, provided a link to this week’s report in the MIT Technology Review that the first editing of genes in human embryos in the US is underway—and apparently not yet formally published—at an academic center in Portland, Oregon.  Similar efforts have been undertaken in China, but US scientists have been a little more tentative about taking this step in humans.

In 2015, US scientists were clearly against trying to initiate a pregnancy with an IVF embryo whose genes had been altered in the laboratory.  They were, apparently, divided on whether experiments on early human embryos, sperm, or eggs in the laboratory were “responsible.”

This blog discussed the matter back then.

Earlier this year, the National Academies of Science, Engineering, and Medicine were more open to proceeding with changing human genes in a way that would be permanent—inherited from generation to generation—as long as the process was done as carefully as they thought it could be. 

The work still appears to be held very close to the vest.  Funded by private money—the law prohibits public expenditures for this kind of work on humans—the MIT report says the Oregon scientists changed some genes (the MIT reporters did not find out which ones) in “many dozens” of IVF embryos that were created and destroyed specifically for research.

The ultimate goal sounds laudable:  repairing genes that cause inherited disease.  The posts linked to above reviewed some of these arguments, or provided further links to those discussions. 

Fears include: 1) unknown risks to any baby born after this.  Apparently the Oregon scientists think these risks may be avoided by editing an egg at, or almost at, the moment of fertilization; 2) unknown risks to the baby, some years later, after it grows, or risks of fetal death—still unknown; 3) opening the door to broader gene editing, including enhancement efforts, popularly called “designer babies.” 

The first two may—may—be somewhat manageable.  The third will be pursued, somewhere, regardless of complaints that it should not be done.

A further future risk is that whoever pays for medical care will insist on gene editing, perhaps quite broadly, as a condition of providing medical insurance coverage for a newborn, throughout life.  Think about it: if you’re born with sickle cell anemia, federal “Medi-Health” will not pay for your care; your parents should have edited the gene out of you.

In the meantime, an unknown number of unborn embryos and fetuses—i.e., unborn human beings—will be killed in the name of research, as things stand now, when the law does not consider them human subjects worthy of human research protections.

Smith worries: are we just going to stand by and watch this?  Will there be any meaningful democratic deliberation?  It appears the answers are: yes to the first, no to the second.  Why?  Maybe you saw a news report about this—for all of 3 minutes.  Then it was back to discussions of Anthony Scaramucci’s vocabulary or the US Senate’s choreiform movements.  We simply don’t have the will, the attention span, the urgency to care.  We hear a news story, or write a blog post, and then go on.  I don’t know how to change this.  Absent a horror story that everyone can understand, the artificial engineering of children looks like it will march on.

At least the Church can think, and act, as the Church should:  this is a good time to look up, and read (or re-read) “What’s wrong with designer genes?” from the Desiring God website, posted just 2 years ago (July 21, 2015).

The need for Christians to make distinctively biblical moral decisions

I am continuing to reflect on the recent CBHD conference. One of the paper presentations I attended was related to the role of Christian faith and the church in decisions about fertility treatments. Heather Prior and an associate are doing research on how Christian couples in their community make decisions about treatments for infertility including such things as IVF. In the preliminary results she was reporting they found that many of the churches that the couples in their study attended had statements about the use of reproductive technology, but that none of the couples dealing with infertility were aware of those statements. Few had sought any counsel on their decisions from their pastors or others in their church.

I find that concerning. In my interaction with Christian students I have become very concerned that even those with strong Christian faith tend to think about ethical issues using thought patterns they have absorbed from the surrounding culture rather than using distinctively biblical ways of thinking. I don’t think this is limited to students, and this study suggests that it is not. The culture that we live in believes that people should make their own decisions about how they live based on how they feel about any decisions they need to make. It also says that those around them should affirm whatever they decide. I fear that Christians are taking on that same attitude. If we think like the world around us, we will make decisions on things such as reproductive technology based on what we desire and how we feel and expect the church to affirm whatever decision we make. When this happens there is no distinction between the church and the rest of the world.

Those who follow Jesus need to be different from the culture around us. We have access to a solid foundation for making moral decisions and living a life that is distinctive in its goodness. That foundation for making good decisions is found in the Bible and the body of the church. If we are going to be distinctive followers of Jesus we need to recognize that what we feel and desire can easily be affected by our fallenness. We need to turn to scripture and to good counsel from those in the church who have spiritual wisdom and who have thought through ethical issues well from a biblical perspective to help us live in a way that brings glory to God.

IVF and respect for the dignity of human life

This past Thursday through Saturday I was at the CBHD summer conference which was focused on genetic and reproductive technologies. One of the sessions that I found most interesting was the final session on Saturday in which representatives of the Roman Catholic, Orthodox, and Protestant traditions of the Christian church discussed how their traditions view reproductive technology with a focus on in vitro fertilization. The Roman Catholic representative expressed some of the reasons why the Roman Catholic Church takes the position that all use of IVF is impermissible because it violates things that they see as essential in how God designed human beings to come into existence within a marriage relationship. The Orthodox representative said that while some Orthodox churches such as the Roman Orthodox Church have taken a specific position on IVF, most Orthodox churches see the decision about whether to use IVF in the treatment of infertility as a decision that should be made on a case-by-case basis with the infertile couple seeking the guidance of their bishop or spiritual mentor. The Protestant representative made it clear that there is not one Protestant position and identified himself as coming from an evangelical Protestant viewpoint. He said that most who have that point of view are primarily concerned about the moral problems of such things as the use of third-party gametes, surrogacy, and the destruction of excess embryos. He stated that IVF would generally be considered permissible as a treatment for infertility as long as those more problematic things were avoided.

During the question-and-answer time the Protestant representative was given a question about whether the fact that the destruction of human embryos was a necessary part of the development of the technique for IVF made the use of IVF today morally problematic. His response was that moral concerns about how it technique was developed would not impact the decision to use that technique now since those things were all in the past. If the format had allowed I would have liked to have asked a follow-up question. It seems to me that those who did the embryo-destructive research to develop the technique of IVF did so with a lack of respect for the dignity and value of the life of human embryos and that the lack of respect for the dignity of human embryos has continued to be a characteristic of the practice of IVF. Those who perform the procedure treat human embryos as an object to be manipulated to obtain the desired objective of a successful pregnancy. They encourage infertile couples to produce multiple embryos to improve the efficiency of the process. In almost all cases they evaluate the microscopic appearance of the embryos to choose which embryo to implant, not based on the moral value of the each human embryo, but based on its likeliness to produce a successful pregnancy. For the most part they seem to have no concern that the production of multiple embryos to improve the efficiency of the process will result in many of those embryos losing their lives. The lack of respect for human life that was present in the development of the technique of IVF has persisted in the way that human embryos are treated by those who practice the technique today.

One of the things that the representatives of all three Christian traditions agreed on is that we have more areas of agreement in bioethics than we do areas of difference. The representatives from Roman Catholic, Orthodox, and evangelical Protestant traditions all agreed on the sanctity of human life from conception to natural death. This includes an understanding that human embryos are persons with high value because they have been created in the image of God. Is it morally wise for a Christian couple to put themselves and the lives of their children into the hands of those who do not show respect for the life of human embryos? Since I was the one who asked the question regarding the concern about the way in which IVF was developed, I wish I had found a way to put this broader question on the 3 x 5 card.