And Baby Makes . . . Four?
Researchers have found a way to treat a rare form of human infertility, but the method has concerned some ethicists. The treatment addresses infertility in which an egg can be fertilized but the resulting embryo disintegrates before implantation in the uterus. By injecting cytoplasm from the egg of a fertile donor into the egg of an infertile woman, scientists preserve the egg's integrity so fertilization and implantation can proceed normally. Dr. Jacques Cohen and his team at the Institute for Reproductive Medicine and Science at St. Barnabas Medical Center in Livingston, N.J., pioneered the technique, known as ooplasmic transfer. According to the New York Times, they have treated thirty women who have given birth to fifteen babies—all of whom appear to be perfectly healthy.

Egg cytoplasm contains more than just proteins to nourish the embryo, however. It also contains mitochondria, tiny structures that produce energy through cellular respiration and that, more significantly, carry their own separate genetic material. Thus babies born using this technique end up with the genetic material of three people. In a British medical journal, Dr. Cohen reported on a follow-up study in which the researchers were able to detect donor mitochondrial genes in the blood cells of two of the children born using this technique. He is unconcerned about the presence of this genetic material: "There are differences [in the mitochondrial genetic material], but they are not meaningful," he said.

But ethicists are not so sure. Ooplasmic transfer results in permanent genetic alterations. The concern is that we are in no position now to predict the long-term implications of this manipulation. The U.S. government does not provide funds for this type of research; it is not permitted at all in Britain. U.S. ethicists from the Hastings Center in Garrison, N.Y., and Cleveland's Case Western Reserve University believe the federal committee that oversees gene transfer experiments would never have approved the research, but since it was privately funded it was not subject to such scrutiny. And the wholly unregulated American private sector obeys only the cynic's golden rule: whoever has the gold makes the rules.

The Latest in Sex Selection
In another dispatch from assisted reproduction's slippery slope, John Robertson, the acting head of the ethics committee of the American Society for Reproductive Medicine, has taken the stance that it can be ethical for couples to choose the sex of their child. He recently wrote a letter to a fertility specialist clarifying the Society's position, reported the New York Times, in which he used the term "gender variety" to describe an acceptable use of a technique that can be used to determine the gender of an embryo. If a couple already has a child of one sex, he wrote, they could ethically choose embryos from the opposite sex for implantation. This seemingly represents a reversal of the society's previous position, which was that sex selection "should be discouraged."

Dr. James Grifo, a reproductive endocrinologist at New York University Medical Center, takes an opposing stance: "Sex selection is sex discrimination, and I don't think that is ethical." And Dr. William Schoolcraft of the Colorado Center for Reproductive Medicine takes it further: "As we learn more about genetics, do we reject kids who do not have superior intelligence or who don't have the right color hair or eyes?"

The technique, known as preimplantation genetic diagnosis—in combination with in vitro fertilization—is used almost exclusively for couples at risk for certain genetic diseases. Because it analyzes an embryo's chromosomes, it's easy to distinguish the girls from the boys, and many fertility doctors report requests for that information. Dr. Grifo commented, "I could have financed my research from now until the day I die if I honored all the requests." But while he has refused to use this technology for sex selection, there are others who feel no such responsibility. One Chicago doctor declared: "We will offer it immediately . . . we have a list of patients who have asked for it." Like female infanticide and "therapeutic" abortions currently used in some parts of India and China, preimplantation genetic diagnosis is sure to please those who think life ought to be served to order.

Trachea Flambeau
An elderly man, diagnosed with a cancerous lesion on one of his vocal cords, went to an outpatient surgery center to have it removed via laser surgery. The surgical team failed to follow the manufacturer's instruction on use of the laser, while the anesthesia team gave him a higher-than-required concentration of oxygen. These two errors resulted in a fire in the patient's trachea hot enough to melt his endotracheal tube. The fire was considered a "complication" that led to acute respiratory distress, multiple organ failure, the patient's death, and a $2.1 million settlement.

The case was published in Healthcare Risk Management's Legal Review and Commentary. These masters of understatement helpfully included a comment section on "what this means to you," specifically: "Hospitals, surgery centers, nursing homes, and physicians offices are full of things that can and do ignite."