With the adoption of the German Federal Law regulating pre-implant diagnostics, ethical, moral and medical debate on human beings and theme of the value of life returned at the centre of a hot debate in Germany. Again and again, theoretical analyses on man’s intervention on the regulations on the development and the study of the embryo, on the consequences of mechanistic selection and fertility management, along with questions linked to the scientific use of the embryos in vitro, met with the opposition of doctors of different religious confessions, as well as non believers. SIR Europe delved into the issue with the help of Professor Emeritus of forensic medicine, Hans-Bernhard Wuermeling, member of the governing board of the Katholische Ärztearbeit Deutschland, the Association of Catholic doctors in Germany. German legislation has studied and delved into the problem of pre-natal (PND) and pre-implant (PID) diagnostics. What are the evaluations of the process that have led to the present legislation? “The German law of 1990 for the protection of embryos (Embryonenschutzgesetz) stipulated the prohibition of the artificial insemination of an egg for purposes unrelated to the pregnancy of the woman from which the egg had been taken. It was assumed therefore that pre-implant diagnosis was forbidden. In fact, when artificial insemination was first practised it served merely to eliminate unwanted embryos. When an appeal was filed against the law in 2010, the Federal Court of Justice ruled that PID could be unpunished under certain conditions. The decisive reflection was based on a contradiction in the assumption whereby if pregnancy interruption following prenatal diagnostics – worse still – is not subject to sanction, then similarly the much less invasive PID with embryo selection could not be forbidden, an equation that did not take into account the fact that pregnancy interruption pursuant to prenatal diagnostics had been considered non subjected to sanction owing to the specific situation of the expectant mother, a situation that is never present in the case of PID”. What have been the consequences of the re-evaluation of the 1990 law? “In 2011, lawmakers drew the consequences of the 2010 ruling by expressly prohibiting – with only two exceptions – all forms of PID practice. Exceptions are applied first of all in the case of parents with genetic defects implying a high risk of hereditary disease for the child; and then in case of serious risks for the embryo, with high chances of causing an abortion, of the birth of a dead fetus. The existence of one of the two exceptions must be ascertained and confirmed by an ethics committee. Only a few numbers of centers are allowed to perform PID: details are regulated via a governmental decree. Such decree was adopted in 2013, ensuing approval by the Bundesrat (Germany’s lower chamber). It came into force on February 1st. Since then, PID is legal in Germany, provided it is performed in compliance with the above-mentioned conditions. What are the medical and ethical contradictions of the law that came into force past February 1st? “German legislation on the protection of the embryo forbids the transfer of more than three embryos per cycle as it may result in extreme multiple births. It is equally forbidden to fertilize more than three eggs at a time, to prevent a surplus of embryos. This latter limitation makes illegal the fertilization of all eggs available with the purpose of increasing the chances of identifying those embryos likely to have genetic diseases or lethal pathologies and select those chosen for fertilization. Thus a consistent potential for increasing the effectiveness of in vitro fertilization and PID is not used. From the perspective of reproductive medicine, it is an intolerable situation. Thus the political realm put forward a request to eliminate the limit of three eggs per fertilization. However, such procedure would entail the production of an excessive number of embryos, which would eventually have to be used or ‘disposed of’: a serious violation of the respect for the life of the human person since the moment of conception”. To what extent will PID influence the respect of the human person and his/her intangible value? “This situation has been ongoing for a long time, owing to tolerance of abortion at juridical level. Moreover, the practice of in vitro fertilization led an increasing number of people to assume that human beings could be ‘manufactured’ just like any product undergoing quality checks, which in specific cases can be eliminated. PID, similarly to euthanasia, is the logical consequence of this change in mentality. In the long term a peaceful coexistence with people holding this position will be no longer possible. It won’t be enough to oppose this mindset with general remarks. In fact, it will be necessary to proclaim and reaffirm the value and the intangibility of human life, making people understand that a child is not a customised product, but an undeserved gift, on which no claim can be made. Doctors have the responsibility of clarifying this concept. If not, information – however necessary – regarding the poor effectiveness of in vitro fertilization along with physical, psychological – and sometimes even moral – discomfort will be secondary issues. But in the near future these efforts will be useless. Evidently, humanity must learn from their own mistakes before they have a change of heart”.
A new law on pre-implant diagnostics. Reflections on the value of life