Medical science at its core aims to preserve health and eliminate disease, but a common theme in scientific discovery is the application of findings in ways that were not the primary intent. The development of diagnostic modalities to predict the health of resulting children has been a fundamental aim underpinning research into prenatal and preimplantation diagnostic modalities; however, the knowledge gained has in some cases been utilized for nonmedical purposes. As an example, amniocentesis developed to determine whether the pregnancy is (...) chromosomally normal also provides information about the sex of the fetus, which normally does not affect health. The emerging gene‐editing technologies that could be used to repair mutated disease‐causing genes in an embryo will presumably also be able to be used to alter traits unrelated to disease. And yet, I will argue, the desire to preserve the mystery of reproduction remains a central value in humans’ quest to reproduce. This yearning to maintain the mysteries will likely temper the development of strategies to alter our genome and affect the genetic identities of our offspring. In my experience as an obstetrician and reproductive endocrinology and infertility subspecialist, people want to have, not the best possible baby, but rather their own baby. (shrink)

In the engaging and thought-provoking book The Gene Machine: How Genetic Technologies Are Changing the Way We Have Kids and the Kids We Have, Bonnie Rochman addresses the question of choice in human reproduction through the lens of knowledge. Asserting that the desire for knowledge is the central theme of modern-day reproduction, she asks, “Is genetic knowledge empowering or fear-inducing or both?” Yet the question at the heart of the book goes beyond knowledge. Rochman delves into whether genetic information is (...) actionable and then examines the corollary question of whether individuals should make decisions based on this data. Do parents want to choose the kinds of kids they have? Certainly, most parents would do what they could to prevent their child from having a painful, life-limiting disease. But that is the extreme. And while genetic technologies generally start by targeting the extreme, the inevitable byproduct is the ability to know about and affect the fringe. It is at the borders that the critical questions lie. Taking advantage of reproductive choices has potentially life-altering and permanent consequences not only for the chooser but also for the resulting child, the family unit, and society. (shrink)