We will vote on June 14 next on preimplantation diagnosis. This is to amend the Constitution so that it becomes possible, as part of an assisted reproduction procedure, select the embryo that is implanted in the uterus of the mother on the basis of a diagnosis Preimplantation. Currently, the Constitution does not produce enough embryos nor to keep them long enough for such an analysis can be done.
If this vote is quite special since the implementing legislation related to the constitutional amendment has already been debated and approved by parliament. Opponents have announced they would fight the referendum. We will vote twice. On 14 June, only the constitutional amendment we will be subject, namely the decision in principle to authorize the preimplantation diagnosis. If that vote is positive, we will vote in a second time, because the outcome of the referendum is little doubt, on the implementing legislation. We can then say if we accept the way Parliament wanted to apply the new constitutional provision, or whether it should revise the law to make the application of more restrictive constitutional article.
Preimplantation diagnosis relieves bearers of serious genetic diseases
If the subject raises very emotional discussions, it is in reality few people as direct employees. Preimplantation genetic diagnosis is possible that as part of an assisted reproduction procedure. These procedures are subject, according to the Assisted Human Reproduction Act, to strict criteria and are available only to couples with infertility problems. Currently, this corresponds to about 2,000 births over 80,000 per year.
Preimplantation diagnosis is mainly aimed at couples who are capable of transmitting a serious and incurable genetic disease. Embryos are created through in vitro fertilization. While they comprise only ten cells, they are analyzed and are implanted in the uterus of the future mother an embryo which has been able to verify that it is not reached by the genetic disease which his parents are carriers. Prospective parents are therefore freed from anxiety to transmit to their descendants the terrible disease from which they suffer themselves or they are sometimes only healthy carriers. Assessing the number of cases concerned to 50 to 100 per year.
Pathologies detected by preimplantation diagnosis are already detectable, so legally entitled, as part of prenatal diagnosis carried out on a developing embryo in the womb. If the prospective parents and learn that they have passed on their genetic disease to their unborn child, they still have the choice of abortion. If necessary, it is an intrusive and violent intervention for both parents and especially of course for women. Achieving a diagnosis before the start of pregnancy, an embryo of a few cells, and implantation of an embryo which is known to not be carrying the disease, is therefore a much more approach simple and much less traumatic for parents. From an ethical standpoint, it is also less shocking to choose at this very early stage in the laboratory and a Non-embryo of the disease, rather than eliminating an embryo of weeks or a fetus, which s' is already developed in the womb.
Recall that the realization of a preimplantation diagnosis is an absolutely free choice on the part of carrier couples from serious and incurable genetic diseases, in the same way that prenatal diagnosis is not imposed. This is simply, for those of them who do not want to transmit the genetic disease they carry is able to achieve earlier diagnosis, to avoid a subsequent abortion.
Preimplantation diagnosis is practiced around the world for twenty years. A dozen European countries permits, such as Spain, the Netherlands or Belgium. Currently, Swiss couples can transmit a serious genetic disorder and have sufficient resources are likely to move to Europe to access the pre-implantation diagnosis, due to the impossibility of achieving it in Switzerland. This obviously constitutes unequal treatment with couples who can not afford it. Medically assisted procreation is very expensive and is not reimbursed by insurance, despite the great suffering that can arise regarding fertility problems within a couple. The situation would remain unchanged with the authorization of preimplantation diagnosis, which would not financed by insurance.
Open PGD other couples in assisted reproductive procedure?
Access to pre-implantation diagnosis for couples that can transmit a serious genetic disease is relatively contested. Initially, the Federal Council had not open this practice to other cases. However, the Parliament decided otherwise under law. Indeed, it would provide access to preimplantation diagnosis to all couples eligible for assisted reproduction procedure, namely to all couples with infertility problems, not just those at risk of transmitting serious genetic disease to their child. Preimplantation diagnosis then would detect potential chromosomal abnormalities, including trisomy 21 is the most known example. Today many couples suffering from infertility problems - and thus resorting to assisted reproduction - in relation to their age. These couples have a much higher risk of having a child with chromosomal abnormalities, since these increase dramatically with age of parents and, in particular, that of the mother.
Those among these couples do not feel ready to take on a child with disabilities may, at present already make a prenatal diagnosis and, if necessary, decide to terminate the pregnancy. The situation is similar to that of couples capable of transmitting a serious genetic disease: the authorization of pre-implantation diagnosis only enables those who wish to avoid abortion by selecting an embryo having no chromosomal abnormality. In addition, the ability to select an embryo free of chromosomal abnormality reduces the risk of miscarriage and therefore increases the chances for the women, to carry their pregnancies, which often happens after many arduous and unsuccessful attempts to assisted reproduction.
It should be noted again that this option would not be available to all couples, but only to those who use an assisted reproduction procedure, that is to say to couples with infertility problems. It is pertinent to maintain this limitation. First, the AHR is a long procedure, uncertain, painful and difficult, especially for the future mother. It must remain reserved to cases of infertility, as currently required by law. Then there is all the more important for those of those couples who do not feel ready to raise a disabled child and already going through serious difficulties to achieve a pregnancy, to avoid abortion, which in addition to the trauma it is directly related mean returning to a new procedure of medically assisted procreation and painful no guarantee of success.
Citizens who do not wish to allow PGD to all couples with infertility problems, but nevertheless want the bearers of serious and incurable genetic disease can benefit, can express it by accepting the constitutional article 14 next June, but refusing law giving effect during the vote in the referendum.
A matter of responsibility to our children and not entitled to a perfect child
For my part, I consider that as the constitutional article that implementing legislation should be supported:
- It does not authorize everything and anything, and those who cry to eugenics show a guilty exaggeration. Preimplantation diagnosis remains linked to medically assisted procreation, which concerns only a limited number of couples, according to strict criteria of the law on medically assisted procreation. Only serious and incurable genetic diseases and in case of acceptance of the law, chromosomal abnormalities can also be detected. This does by no means select embryos on criteria of gender or any other characteristic. Both the Constitution and the law prohibit. Finally, this approach remains completely voluntary, as is currently the prenatal diagnosis.
- The purpose of preimplantation diagnosis is not to produce perfect children, but to alleviate the legitimate anxieties of couples who do not want to convey a serious and incurable disease to their children and, if the implementing legislation is accepted, the couples forced into an assisted reproduction procedure and do not feel ready to take a disabled child. These future parents can already use today to prenatal diagnosis that can lead, in the case of transmission of a serious genetic disorder or a chromosomal abnormality on abortion. I will always fight for women who wish to have the right to abort. However, I consider that this is an act heavy that one should try to avoid as far as possible. Preimplantation diagnosis allows to do so in a number of cases. The present system is absurd, because you can not select an embryo of a few cells, so that we can terminate a pregnancy, which means destroying an embryo or a fetus several weeks. This must change.
- The achievement of pre-implantation diagnostics, even if they would also be applied to chromosomal abnormalities, does not mean that there will be more different children or will have less respect for the disabled. First, PGD only a limited number of serious genetic diseases or, in the case of a wider application of chromosomal abnormalities. Then, it is accessible only to a limited number of couples (remember, only 2,000 out of 80,000 births per year are related to medically assisted procreation) and all these couples are will not use, since it is their free choice. Finally, couples who already today do not want to give birth to a child which they would have passed a serious genetic disease or suffering from a genetic defect, can benefit from prenatal diagnosis and terminate the pregnancy. Moreover, the fact that there is more or less different and disabled has no role in relation to our responsibility to make them all and to all a dignified life and to show them the same respect to a person healthy. This is a fundamental ethical duty, which remains valid at all times and would still even if only one person in the world was affected by disability.
To conclude, I would like to quote my colleague Luc Recordon, himself disabled but favorable both constitutional article to the law:
"There can be no question of a right to a healthy child. However, there is an obligation to society to allow people to exercise their responsibility with the greatest possible elements in hand vis-à-vis the potential future child. For what you say and what shall I say, I am severely disabled, if I had a child for whom I would not have taken all the precautions to be born in the best possible condition, or made, if necessary with full knowledge of the facts, the choice to accept or to refuse to have a child? What then can I answer the child who would tell me "You let me come into the world as you know, given your own genetic history, that I might have this or that? "I can not imagine that I could have taken this responsibility without any fact, knowingly, to assume my responsibility facing a potential child. It is not a right to history, it is a responsibility of history in front of him, including the responsibility to tell her "I knew there was a disability and, for reasons that belong to me and I can explain, in full knowledge, I chose you to come to the world. "
IVF: How to avoid as possible the risk of mistaken identity
Paris, Tuesday, April 15, 2014 - The revelation by the Stampa of an error at the time of implantation of IVF embryos in an Italian woman of forty years on 4 December in Rome raised an important wave of emotion. Within the institution obviously where medical assistance service procreation was closed, but in the whole Italian society puts this matter on the front of the scene of many ethical debates around abortion and IVF that remain very sensitive in this country. But this emotion regard beyond all the teams that carry the world to IVF. This case has just remind them that the inversion of gametes or embryos remains their "obsession", explains Professor Jean-Luc Pouly, obstetrician gynecologist at the University Hospital of Clermont-Ferrand, told the Nouvel Observateur.
No two patients bearing a name close on the same day in the French centers
In France, the accidents they concern an error at the time of insemination, IVF or the location can be reported (without obligation) at the Biomedicine Agency. "We realized that there was every year in France, a dozen embryo transfer errors which one could see immediately," says Jean-Luc Pouly. Upon detection of the error, a treatment for preventing pregnancy is administered to the patient. To minimize the risk of poor transfer, procedures were recommended in 2008, which are followed by the majority of institutions. These include a quadruple check on transfer of the embryo: first by two biologists, then by the nurse and the doctor. These actors undertake a strict verification of the identity of the patient expressly requested his name not only asking him to confirm it. "In such an event, patients can be so stressed that they would be able to answer" yes "while one is mistaken name. The question surprised them, but they are told that this is a security measure, "said Jean-Luc Pouly. Other precautions: two patients with the same name or close family names are never received the same day. "This may happen more often grows only" still finds the practitioner.
Remained unknown errors?
Thanks to such measures, errors are rare in France but also in the world. Over the last thirty years the revelations of inversion at the time of birth were rare: two or three cases have been reported. But some have gone unnoticed, while findings during pregnancy as was the case in Italy on the occasion of a CVS appear extremely unlikely.