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Reproductive Genetics and the Law.

Reproductive Genetics and the Law

Prenatal diagnosis, initiated in the sixties to detect fetuses with gross chromosomal defects, now includes the routine use of DNA probes to apprise couples of their risk of bearing children with Mendelian disorders. A decade ago, the world hailed the birth of Louise Brown, the first baby born after conception outside the womb. Today, the litigious battles between surrogate mothers and genetic parents river our attention. As the first low resolution maps of the human genome are compiled we learn that a complete sequence of the three billion nucleotides that code for a human being can be available for a sum that Pentagon officials consider little more than a rounding error.

These developments raise fundamental questions about how human beings love, marry, and have (or avoid having) their babies. Should young people be screened for genetic traits so that they may avoid marriages that could include a high risk of bearing a child with a severe genetic disorder? What obligation should be placed upon an obstetrician to warn a woman about her chances of bearing a defective child? Will stunning advances in fetal and perinatal medicine compromise a woman's constitutional right to terminate a pregnancy? May a child born with congenital anomalies to a woman who worked around chemicals sue his or her mother's employer? Should the gestational mother have the preeminent legal claim to a child that she conceived under contractual obligation to give up? These are a few of the perplexing questions that Sherman Elias and George J. Annas confront in Reproductive Genetics and the Law.

Unique to the fairly substantial body of literature that explores ethical, legal, and societal problems raised by advances in reproductive genetics, this volume benefits from the individual expertise of each author. It is a strongly synergistic collaboration. Elias is director of the Division of Reproductive Genetics at the College of Medicine of the University of Tennessee. Annas, Edward Utley Professor of Health Law at Boston University's School of Public Health, is a prominent analyst of legal problems raised by the new biology.

Their book is primarily addressed to "medical practitioners, genetic counselors, and their patients, as well as those interested in public policy and legal regulation." Throughout, the discussions of legal issues and subjects, far from being ponderous, are clearly written and will be highly informative to those outside the legal profession. For example, there is an excellent summary of a critically important line of Supreme Court cases on reproductive liberty stretching from Griswold v. Connecticut (the 1965 case that overturned restrictions on contraceptive use by married persons) through Thornburgh v. American College of Obstetricians and Gynecologists (a 1986 decision that invalidated a Pennsylvania statute that sought to narrowly interpret Roe v. Wade). A recapitulation of the legal controversy and political debate over the treatment of handicapped newborns and a brief discussion on the legal aspects of genetic screening are each clear, concise, and helpful, as is an informative essay explaining wrongful birth and wrongful life litigation.

In addition, the authors develop an engaging discussion on the subject of noncoital reproduction. A fine, if brief, overview of the societal issues raised by in vitro fertilization (IVF) and artificial insemination by donor (AID), and an instructive case study of surrogate embryo transfer (SET) contribute to the debate on reproductive technologies. Elias and Annas also summarize the three major commission reports on these technologies and offer several sensible proposals for legislation in the United States.

When the authors begin to address issues in genetics and prenatal diagnosis, however, the analysis reveals several inadequacies. The introductory chapter on human genetics will be ignored by most medical readers, but is too technical for the lay person. Their examination of genetic screening and genetic counseling adds little of significance to the current literature; for example, the bulk of the discussion on newborn and carrier screening is devoted to a synopsis of the target disorders. Moreover, most of the references in the relevant chapters are quite dated.

In other respects, the analysis provided by the authors is suggestive but incomplete. A section devoted to the screening of pregnant women for genetic risks furnishes a good description of the controversy over the introduction of maternal serum alpha-fetoprotein (MSAFO) testing in our society. Unfortunately, only passing reference is made to what has unquestionably been the major development in mass genetic screening over the last two years; the recognition that low MSAFP levels are associated with an age-independent risk of bearing a child with Down syndrome. Similarly, a helpful description of chorionic villus sampling (CVS) would have been enriched by considered reflection on the problem of how our society "decides" that a new medical technique has crossed the line that differentiates experimentation from therapy. Finally, Elias and Annas develop a welcome primer on the inadequately discussed promblem of "teratology," and usefully identify how deficient current legislation is with respect to the public policy issues raised by exposure to chemicals in the work place. Yet, this presentation omits discussion of the Bendectin litigation, and for that reason seems incomplete.

Perhaps the most innovative discussion in this book is to be found in its final chapter on "Fetal and Gene Therapy," in which Elias and Annas consider the maternal-fetal conflicts raised by therapy that can be rendered in utero. The authors solidly support the mother's right to refuse therapy for her fetus, but I am not completely persuaded by their argument, which assumes that a woman almost always acts in the best interests of her fetus. One need only reflect on the prevalence of fetal alcohol syndrome to challenge this conclusion.

Even though several chapters could be more up to date, Reproductive Genetics and the Law, is a welcome addition. It brings together a variety of interesting materials that is summarized clearly and accurately. Most important, it gives the medical genetics community a source from which to review the early legal and policy responses to the fascinating activities of this revolutionary field.

Sherman Elias and George J. Annas. Chicago: Year Book Medical Publishers, 1987. xvi + 323 pp. cloth, $38.50.
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Author:Reilly, Philip
Publication:The Hastings Center Report
Article Type:Book Review
Date:Apr 1, 1988
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