Health, Ethics and Society, Maastricht University, Maastricht, Netherlands; GROW School for Oncology & Developmental Biology; CAPHRI School for Public Health & Primary Care, Maastricht University, Maastricht, Netherlands.
Bioethics. 2019 Feb;33(2):294-301. doi: 10.1111/bioe.12534. Epub 2018 Nov 26.
Many European countries uphold a 'high risk of a serious condition' requirement for limiting the scope of preimplantation genetic diagnosis (PGD). This 'front door' rule should be loosened to account for forms of PGD with a divergent proportionality. This applies to both 'added PGD' (aPGD), as an add-on to in vitro fertilization (IVF), and 'combination PGD' (cPGD), for a secondary disorder in addition to the one for which the applicants have an accepted PGD indication. Thus loosening up at the front has implications at the back of PGD treatment, where a further PGD rule says that 'affected embryos' (in the sense of embryos with the targeted mutation or abnormality) should not be transferred to the womb. This 'back door' rule should be loosened to allow for transferring 'last chance' affected embryos in aPGD and cPGD cases, provided this does not entail a high risk that the child will have a seriously diminished quality of life.
许多欧洲国家坚持认为，限制植入前遗传学诊断（PGD）范围需要满足“严重疾病的高风险”要求。这种“前门”规则应该放宽，以考虑具有不同比例的 PGD 形式。这既适用于作为体外受精（IVF）附加条件的“附加 PGD”（aPGD），也适用于除申请人已接受 PGD 指征之外的另一种疾病的“联合 PGD”（cPGD）。因此，在 PGD 治疗的后端放宽限制，就需要放宽进一步的 PGD 规则，该规则规定“受影响的胚胎”（在具有靶向突变或异常的胚胎意义上）不应移植到子宫中。在 aPGD 和 cPGD 情况下，应放宽允许转移“最后机会”受影响胚胎的“后门”规则，但前提是这不会带来孩子生活质量严重下降的高风险。
