In 2015, the United Kingdom legalised a form of in vitro fertilisation (IVF) therapy known as ‘three-parent IVF’ and, less colloquially, mitochondrial replacement therapy (MRT). This IVF procedure is aimed at enabling women who have mitochondrial diseases that would normally be passed down to their offspring to have a healthy child instead. The technique involves removing faulty mitochondria from the intended mother’s egg and replacing them with mitochondria from a generically unrelated woman (by transferring the intended mother's nucleus to the donor woman's enucleated egg), or removing the pro-nuclei from the intended mother's newly fertilised egg and transferring them to a donated embryo with its own pronuclei removed. Australia and the USA have not yet legalised this procedure, and a considerable amount of debate about whether it is ethical remains. One issue that requires investigation is whether the technique can genuinely be called a form of treatment in respect of the child who would be born. Some ethicists and legal scholars argue that MRT does not treat a child, but replaces one child (who would otherwise be born without MRT) with another (who would be born with MRT). This raises two related issues:
- Can we really claim that, by not allowing MRT, children born with mitochondrial disease are harmed by our refusal to use this technology? (If we used it, a different child would exist instead of them, so it is not clear on what ground they could complain about inheriting mitochondrial disease);
- Should we be investing public funds and other resources to develop this technology if, effectively, it is treating no one other than the mother who has the disease (ie, it is not treating the child)?
Neither of these questions have yet been sufficiently addressed, let alone answered, and would form a great PhD topic. A third issue concerns what is known as the slippery slope worry: since MRT is a form of germline therapy, does it pave the way for more radical genetic manipulations of the germline to change human nature? Or can it be argued that MRT is not a form of genetic manipulation at all but only replaces one person’s mitochondrial DNA with another’s?
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