When doctors announced that a baby carrying the genetic material of three people was born in Mexico earlier this year, Christians were divided on the ethical questions the procedure raised. Did the American doctor who performed the procedure in Mexico embrace morally dubious means to produce a baby for a couple that could have adopted? Or was he fulfilling the mandate of believers and Hippocrates — to ameliorate suffering whenever possible?
Fazale Rana argued the latter, telling Tyler O'Neil of PJ Media it would be "inherently sinful" if scientists and doctors did not pursue all means to alleviate suffering, which, in this case, would mean the chronic illness and premature death of a child born with a genetic disease.
"Our mandate as Christians is not only to preserve the dignity and sanctity of human life, to make sure that we're not producing human life and discarding it. To not do things to alleviate human suffering is just as bad in my mind," said Rana, a scientist and vice president of research and apologetics at Reasons to Believe, a California nonprofit.
Rana's argument — and the poignant reasons the baby's parents sought the procedure — may sway some people of faith to accept the procedure that results in a three-parent baby. Called mitochondrial replacement, it's a cutting-edge reproductive technique that's been approved in the United Kingdom, but not in the U.S.
Less-defensible procedures, however, are on the horizon, including manmade eggs created with stem cells, an advance announced by Japanese researchers this week. These initiatives and others challenge believers to think deeply about what lengths science should go to in order to enable life.
When baby makes four
Dr. Alejandro Chavez, director of New Hope Fertility Center, talks during an interview with The Associated Press in Mexico City, on Sept. 28, 2016. The first baby born from a controversial new technique that combines DNA from three people the mother, the father and an egg donor was born five months ago to Jordanian parents. They were treated in Mexico by a team led by Dr. John Zhang of the New Hope Fertility Center. | Eduardo Verdugo, AP Images
Although the baby born in Mexico five months ago was widely hailed as the first three-parent baby, that wasn't correct. The child was, however, apparently the first three-parent baby born using this specific procedure.
The doctor responsible, fertility specialist Dr. John Zhang of New York City, has published an abstract detailing the case, and is scheduled to speak Wednesday at the annual meeting of the American Society for Reproductive Medicine this week in Salt Lake City.
As Nidhi Subbaraman reported for BuzzFeed, before Zhang's team made the news, there were a dozen babies born in the U.S. with genetic material from three people before the Food and Drug Administration stepped in and put a stop to the procedure in the 1990s.
In those cases, and the recent one, doctors sought to replace damaged DNA from a woman with mitochondrial disease with healthy DNA from a donor. Mitrochondria generate energy for cells, and when they are diseased, a child may have neurological and organ problems. Some children with the disease do not survive past adolescence.
There are two main ways to circumvent the problem using in vitro fertilization. As Liat Clark explained in Wired magazine, in one method the doctor uses two embryos that are a day old — one created from the parents' sperm and egg, one from the father's sperm and a donor egg. The nucleus of the donor's embryo is removed and substituted for the nucleus in the parents' embryo.
In the other method, called maternal spindle transfer, the mother's nucleus is replaced with the donor's nucleus before fertilization.
That was the procedure used in Mexico because the parents, who are observant Muslims from Jordan, did not want an embryo destroyed. The couple has been trying to have a family for more than two decades, experiencing four miscarriages and giving birth to two children who died — one at 8 months of age, one at 6 years.
The couple sought help from a New York fertility clinic, New Hope, but had the procedure done in Mexico where there is no prohibition against the method. Zhang said on his blog, "I believe this technique will revolutionize and change human reproduction."
That's exactly what many people of faith are worried about. And some scientists, too.
For one thing, reproductive health experts acknowledge that mitochondrial transfer improves the chances of having a child that doesn't have the disease, but doesn't guarantee it.
A study published in the journal Nature in June examined 500 eggs from 64 donors and found that most developed normally. But a co-author, Dr. Douglass Turnbull, told the BBC, "Our studies on stem cells do express a cautionary note that it might not be 100 percent efficient in preventing transmission, but for many women who carry these mutations the risk is far less than conceiving naturally."
For some women, even a decreased risk resembles a miracle. Anywhere from 1,000 to 4,000 children are born with mitochondrial disease in the U.S. each year, according to the United Mitochondrial Disease Foundation.
During the U.K. debate over three-parent babies last year, the BBC interviewed one mother who lost seven children to mitochondrial disease. The woman said she so desperately wanted a family that she kept getting pregnant in the hopes that one of her babies would be free from disease.
How adoption figures in
The lengths that parents — and science — will go to enable the birth of healthy children raises questions, not just about the genetic manipulation of embryos, sometimes called "designer babies," but also about whether the most moral choice would be to simply adopt.
In an essay in Wired magazine, Dr. Travis Rieder argues, "Don't make a three-parent baby. Adopt instead." Rieder notes that women who have mitochondrial disease have two uncomplicated options: not bringing a child into the world, or having IVF with the father's sperm and a donor egg.
"Not procreating does not equal not starting a family; one could adopt one of the millions of orphans in the world who need a family. However, adoption is often seen as a last-resort option," Rieder said. He says this is because many people wrongly categorize adoption as less of a societal "good" than creating a family of their own lineage. But prizing a genetic family over a family built through adoption, he writes, is "a kind of moral distortion.
"Families are good, and familial relationships are among the greatest goods in life; but creating a genetic child isn’t necessary for these goods. Inviting a non-genetic child into one’s family isn’t less good, or less desirable, and there is a massive need for it," Rieder said.
Rieder, however, is a crusader for smaller families in general, and has argued that people should have fewer children because of climate change.
Others decried the procedure for more traditional reasons. A representative of the Christian Action Research and Education group in the U.K. noted on the website Christiantoday.com that four embryos died during the process of creating the one that lived.
"It is immoral to label this a success," CARE official Dan Boucher said. "While we are thankful that the baby has been born healthy, we are deeply concerned by the risky, harmful and most definitely unethical science behind it."
And some scientists said it was troubling that an American doctor dodged his country's laws by going to Mexico, where there is no prohibition, and that the clinic erred by proceeding while there are still questions about the long-term effects on the child.
“They just went ahead and did it. The number of issues that are still unresolved — it’s just staggering," Dr. David Clancy, of Lancaster University in the U.K., said in Scientific American.
Regardless of reservations, the technology may be headed for the U.S.
In February, a committee organized by the U.S. National Academies of Sciences, Engineering and Medicine released a report commissioned by the FDA. It recommended that American doctors be allowed to proceed cautiously.
But even that report was not without controversy. It said only male embryos should be brought to term because of the risk that female embryos could still carry the defective genes.
At any rate, the controversy about mitochondrial transfer may soon be dwarfed by another ethically challenging development in medicine.
New Scientist, the magazine that first broke the news of three-parent baby, reported this week that "eggs made from skin cells in lab could herald end of infertility."
While so far scientists have only created eggs from skin cells of mice, the article said, "The feat suggests it is only a matter of time before the same is achieved in humans, opening up the possibility of new fertility treatments, and the potential for two men to genetically father a baby together."