Next-Gen Reproduction

Reading Room: Robert Klitzman ’80

By Jennifer Altmann

Published Feb. 6, 2020

3 min read

“Choosing socially desirable genes constitutes eugenics.” — Robert Klitzman ’80

Amelia Panico Photography

In the last 40 years, technology has transformed the way many couples have babies. Recent innovations have made it possible for prospective parents to avoid passing on to their children certain genes, such as those for breast cancer and other diseases. It’s probable that at some point in the not-too-distant future, couples will be able to select genes for traits such as height and eye color, says Robert Klitzman ’80, a Columbia University professor of psychiatry who specializes in bioethics. In his new book, Designing Babies: How Technology Is Changing the Ways We Create Children (Oxford University Press), he explores many facets of assisted reproductive technologies (ARTs), from egg donation to gene editing, and says the United States needs to better address their ethical, legal, and social implications.

Since the birth in 1978 of the first “test-tube” baby, more than 8 million children worldwide have been born thanks to reproductive technologies. In 2017, the last year for which there is published data, there were 284,385 ART cycles, primarily IVF cycles, in the United States, resulting in 78,052 live infants. The technologies carry medical risks and raise ethical questions, but the industry is much less regulated in the U.S. than in other industrialized nations, Klitzman says.

Klitzman began exploring these issues after a friend asked him to donate sperm so she could have a child: “I would be the biological father, but would or should I also take on the social role of being one? ... What if I disagreed with her about how to raise our child?” He wondered how others made decisions about questions like this.

In his book, Klitzman zeroes in on recent technologies that allow patients and doctors to select and transfer embryos with the traits they desire. Doctors who perform IVF have begun testing embryos for dozens of genes through preimplantation genetic testing. While most of those procedures are done to prevent disease by allowing physicians to select mutation-free embryos, many U.S. clinics have used the technology to enable parents to select their child’s gender, assuming a successful pregnancy resulted.

How about purposely selecting for traits such as deafness and dwarfism — viewed as diseases or disabilities by some parents and clinicians, but as normal by others? Klitzman doesn’t attempt to answer that question, but writes: “In helping to create a child, [physicians] arguably have a degree of moral responsibility and thus need to consider the child’s best interests, which at times may outweigh the prospective parents’ rights” to choose these traits for their future children.

A new gene-editing technique, known as CRISPR, goes further, allowing labs to insert or remove various genes. “The problem is the technology could be used for many socially desirable traits — you could put in genes for height or perfect pitch,” he says. That worries Klitzman: “Choosing socially desirable genes constitutes eugenics, which led to horrific outcomes in Nazi Germany,” he says.

Klitzman notes the potential for other inequalities as well. The price tag for the technologies — he says IVF treatments cost more than $24,000 on average — typically makes them unaffordable for all but the affluent. He writes: “Wealthy individuals are eliminating certain lethal mutations from their offspring while the poor cannot. ... Resources and research to battle these conditions may then fall, while stigma rises.”

Klitzman says there is insufficient data to adequately monitor these advances and calls for greater mandatory data collection and better education and guidelines. “We need to proceed with great caution,” he says, “and instead we are racing ahead.”

Klitzman ultimately declined to donate his sperm; he felt he was not ready to take on the commitments that would be required. “I have often wondered if I made the right decision,” he writes. “But the choice helped me understand the predicaments that countless potential parents confront.”

Published in Feb 2020, Issue

1980

2 Responses

Robert Klitzman, M.D. ’80

4 Years Ago

Robert Cooper *12, in responding to the PAW article about my new book, Designing Babies: How Technology is Changing the Ways We Create Children, appreciates the complexities that the book raises, but criticizes the comment that “choosing socially desirable genes constitutes eugenics.” He writes that “assisted reproductive technologies are in no way of a kind with the genocides and forced sterilizations of the eugenics movement. Eugenics was about taking away personal choice … the two are polar opposites.”

But his letter suggests only a partial understanding of the eugenics movement, which in fact had many different forms. As the historian of science, Daniel Kevles, writes in In the Name of Eugenics: Genetics and the Uses of Human Heredity, Charles Darwin’s cousin, Francis Galton, coined the term “eugenics” (from the Greek, “good in birth”) in 1883. Galton used the phrase to describe efforts to give “more suitable races … a better chance of prevailing” over others.

In the early 20th Century, the eugenics movement spread in the U.S., as waves of Catholic and Jewish immigrants from Southern and Eastern Europe arrived. In 1904, Charles Davenport established the Cold Spring Harbor Lab, collecting family pedigrees, and arguing that “feeblemindedness,” “pauperism” as well as various diseases were all hereditary. In his 1923 book, A Study of American Intelligence, Princeton professor Carl Brigham, a member of the Advisory Council of the American Eugenics Society, asserted that “Nordic races” were intellectually superior to others (though Brigham later recognized his errors, and helped develop the SAT test). In the 1920s, the American Eugenics Society began sponsoring dozens of Fitter Family Contests in Kansas and elsewhere, awarding trophies. Unfortunately, Hitler adapted his ideas about eugenics from the U.S., and took them to horrific ends.

As I expand on in the book itself, eugenics therefore took on various manifestations. Cooper’s statement that “eugenics was about taking away personal choice” refers to some, but hardly all of this movement’s unfortunate outputs. Eugenics also produced biased writings, disseminated misinformation, and promoted social inequalities, discrimination, racism, social stigma and other injustices.

I nowhere say that using new technologies for choosing traits seen as socially desirable — whether selecting male over female embryos, or genes associated with IQ, height, blond hair, blue eyes, certain kinds of athletic prowess, etc. — constitutes a Holocaust. Rather, as we use these rapidly evolving technologies to alter our descendants’ genes for non-medical purposes, we should proceed with great caution, given the many past ways our society has, alas, viewed and pursued traits perceived as socially desirable.

Robert Cooper *12

4 Years Ago

Kudos to Robert Klitzman ’80 for exploring the complex ethical implications raised by “next-gen reproduction” technologies (Princetonians, Feb. 12), which promise to allow parents to prevent inherited diseases, or even select traits, for their children. However, the pull quote — “choosing socially desirable genes constitutes eugenics” — invokes the wrong supercharged bogeyman, which detracts from the discussion.

Assisted reproductive technologies are in no way of a kind with the genocides and forced sterilizations of the eugenics movement. Eugenics was about taking away personal choice — the ability to reproduce, or even to remain alive — whereas selecting genes for your offspring provides more. In treatment of personal agency, the two are polar opposites. (The baby, of course, never gets a say in any scenario.)

There are myriad moral quandaries in deciding whether and what genes parents should be able to choose, some of which are raised in the article. But the Holocaust is not an appropriate frame from which to view these technologies, and raising the specter of Nazis is not the most helpful way to analyze the issues.

Editor’s note: Author Robert Klitzman ’80 responded to this letter with an explanation of various manifestations of eugenics in the 19th and 20th centuries.