Questions still open

After a limited allowance of pre-implantation diagnostics by the Bundestag, many details are now still to be clarified. It will be decided how far the limitation – on which many deputies made their approval dependent – will actually reach.

The Federal Ministry of Health is currently in charge of drafting a decree on this subject. As an "objection bill," the law on PGD is expected to become law on 23. September dealt with in the Federal Council. After the Federal President Christian Wulff has ied the law, it is expected to be published in the Federal Law Gazette in October.

The patient representative of the Federal Government, Wolfgang Zoller (CSU), called the regulation already a "toothless tiger". In order to be able to make clear guidelines, it would have been necessary to regulate by law what is worth living and what is not, Zoller told the newspapers of the Essen-based WAZ media group on Monday. PGD is controversial because doctors test artificially created embryos in the Petri dish for hereditary diseases and destroy them if necessary.

And the "supernumerary embryos"?
For the time being, it is not clear which form of PGD will be used in Germany in the future. According to the ruling of the Federal Supreme Court, which first set the legislative process in motion, "PGD on totipotent cells" is "clearly prohibited and punishable" under the Embryo Protection Act. This would only allow diagnosis with pluripotent cells, from which, in contrast to totipotent cells, no human being can develop. However, the wording of the PGD law allows the use of totipotent cells.

It is also unclear what will happen to the "supernumerary embryos" of PGD. The method requires at least eight embryos. Currently, however, the law only allows the production of three embryos, all of which must also be implanted. Zoller therefore demands that the embryo protection law be revised.

The president of the German Medical Association, Frank-Ulrich Montgomery, also wants to limit the scope of PGD: PGD should not become a "routine procedure of in vitro fertilization" and should only apply to "a few and very specific indications". But the law does not specify a list of diseases. The only requirement is the "high probability of a serious hereditary disease". The vague terminology opens up wide scope for discretion: what about diseases that only break out in mid-life, for example??

And the handling of incidental findings?
Ethics committees, the composition of which is also still to be decided, are to decide on this. Who are the members: only physicians or also ethicists, lawyers or representatives of life rights and disability associations? Drawing a line becomes difficult for yet another reason. PGD is also to be permitted if there is a "serious injury" which, in turn, is "highly likely to lead to a stillbirth or miscarriage.". All women over the age of 35 can potentially invoke this legal right. They are also the main clientele of artificial insemination. This is why critics speak of a breach of the dam, which is inherent in the law itself.

The handling of incidental findings also remains unclear. In prenatal diagnostics, for example, the law prohibits the determination of sex. But what happens in practice when PGD diagnoses Down syndrome – a genetic change that does not meet either specification? One of the main reasons given by many members of parliament for allowing PGD was that it would prevent abortions at a later date. And the disability known as "mongoloism" is often considered a reason for abortion.

A narrow limitation of the PID will be hardly possible therefore. However, this was already clear before the decision. Finally, the rights of the Father are completely unregulated. So far, only the mother's written consent is required, although the intervention is performed on the embryo. Finally, the question of who will finance PGD is likely to cause controversy.

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