Constructing embryos, constructing politics: Connecting politics and technology in the Netherlands and Germany

Mapping ethical, legal, and social implications (ELSI) of preimplantation genetic testing (PGT)

PURPOSE

Preimplantation Genetic Testing (PGT) has attracted considerable ethical, legal, and social scrutiny, but academic debate often fails to reflect clinical realities.

METHODS

Addressing this disconnect, a review of 506 articles from 1999 to 2019 across humanities and social sciences was conducted to synthesize the Ethical, Legal, and Social Implications (ELSI) of PGT. This review mined PubMed, WoS, and Scopus databases, using both MeSH terms and keywords to map out the research terrain.

RESULTS

The findings reveal a tenfold increase in global research output on PGT's ELSI from 1999 to 2019, signifying rising interest and concern. Despite heightened theoretical discourse on selecting "optimal" offspring, such practices were scarcely reported in clinical environments. Conversely, critical issues like PGT funding and familial impacts remain underexplored. Notably, 86% of the ELSI literature originates from just 12 countries, pointing to a research concentration.

CONCLUSION

This review underscores an urgent need for ELSI research to align more closely with clinical practice, promoting collaborations among ethicists, clinicians, policymakers, and economists. Such efforts are essential for grounding debates in practical relevance, ultimately steering PGT towards ethical integrity, societal acceptance, and equitable access, aiming to harmonize PGT research with real-world clinical concerns, enhancing the relevance and impact of future ethical discussions.

Comparing Germany and Israel regarding debates on policy-making at the beginning of life: PGD, NIPT and their paths of routinization

Definition

The routinization of prenatal diagnosis is the source of bioethical and policy debates regarding choice, autonomy, access, and protection. To understand these debates in the context of cultural diversity and moral pluralism, we compare Israel and Germany, focusing on two recent repro-genetic “hot spots” of such policy-making at the beginning of life: pre-implantation genetic diagnosis (PGD) and non-invasive prenatal genetic testing (NIPT), two cutting-edge repro-genetic technologies that are regulated and viewed very differently in Germany and Israel, reflecting different medicolegal policies as well as public and bioethical considerations.

Arguments

First, we compare policy-making in the context of PGD for HLA (human leukocyte antigen) typing, used to create sibling donors, approved in Israel under specific conditions while prohibited in Germany. Second, we compare policy-making in the context of NIPT, which came under fire in Germany, while in Israel there has been little public debate about it.

Conclusion

Both countries justify their contrasting policies as reflecting a concern for the well-being and care of the embryo/child, thus highlighting different concepts of embryo/child protection, (relational) autonomy, family relations, and the impact of religion and history on the promotion/protection of life. We use the juxtaposition of PGD and NIPT to highlight some inconsistencies in policies concerning the protection of extra- and intra-corporeal embryos. We conclude by drawing on the comparison to show how national variations exist alongside co-evolution.

Saving or Subordinating Life? Popular Views in Israel and Germany of Donor Siblings Created through PGD

To explore how cultural beliefs are reflected in different popular views of pre-implantation genetic diagnosis for human leukocyte antigen match (popularly known as "savior siblings"), we compare the reception and interpretations, in Germany and Israel, of the novel/film My Sister's Keeper. Qualitative analysis of reviews, commentaries and posts is used to classify and compare normative assessments of PGD for HLA and how they reproduce, negotiate or oppose the national policy and its underlying cultural and ethical premises. Four major themes emanated from the comparison: loss of self-determination and autonomy; loss of dignity through instrumentalization; eugenics and euthanasia; and saving life. In both countries, most commentaries represented a dominant position, with a few negotiated positions. We also highlight the decoding of a relatively less explored bioethical aspect of My Sister's Keeper's narrative, namely the meaning of euthanasia. We conclude by discussing how the findings relate to attempts of providing cultural explanations for the regulation of HLA-PGD.

Contested change: how Germany came to allow PGD

Until recently, German laws protecting the human embryo from the moment of conception were some of the strictest internationally. These laws had previously prevented any manipulation of the embryo, such as in preimplantation genetic diagnosis (PGD), and continue to affect stem cell research. In 2011, however, the German parliament voted in favour of allowing PGD in specific cases. While the modification in the law in earlier analysis was interpreted as being in keeping with the usual norms in Germany, this article argues instead that the reasoning behind the partial acceptance of PGD, rather than the legal decision itself, is indicative of a sociocultural change that needs to be accredited. Demonstrating that a significant change occurred, this article analyses the arguments that led to the amendment in law: not only has the identity of the embryo been redefined towards a pragmatic concept but the notions of parenting and pregnancy have also changed. The focus on the mother and the moment of birth has given way to a focus on conception and 'genetic couplehood'. The professional discourse preceding the decision allowing PGD suggested that the rights of the not-yet-implanted embryo should be negotiated with those of the two parents-to-be, a concept that may be called 'in-vitro pregnancy'.

Technoethics and Public Reason

Public reason specifies the rules under which a political community collectively conducts ethical reasoning. Technoethics needs to incorporate an account of how the technologies it aspires to govern bear on these rules. As the case of biobanks shows, technologies have the capacity to change the exact meanings of concepts that play central roles in ethical reasoning. By consequence, a revision of the rules to which this ethical reasoning about the very same biobanks is subject, becomes inevitable. Thus, reasoning in technoethics becomes essentially reflexive, as it is to discuss its own rules at the same level at which it discusses its primary object, namely new technologies. Technoethics is thus not only about how human values are to be incorporated into technology design, but also about what kind of political world is constructed through technology.

Taming Indeterminacy: The Co-production of Biodiversity Restoration, Flood Protection and Biophysical Modelling of Rivers and Coastal Environments

In this article, I compare two accounts of how biodiversity restoration, flood protection and bio-physical models are co-produced in the Netherlands. Both are historical accounts of the interplay between research practices, policy discourse and intervention practices, one focusing on rivers and the other on the coastal environment. Three questions will be central to my comparison of the two paths of co-production. First, how have institutional conditions of research contributed to shaping the bio-physical models? Second, how has epistemic indeterminacy been tamed in the two cases? Third, how do the models of rivers and coasts perform biodiversity? I conclude by arguing that adaptive approaches to biodiversity restoration require an adaptive epistemology, which implies tolerating a certain degree of epistemic indeterminacy.