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J Obstet Gynaecol Can. 2018 Oct 22. pii: S1701-2163(18)30638-8. doi: 10.1016/j.jogc.2018.08.001. [Epub ahead of print]

Pre-implantation Genetic Diagnosis: The Road Forward in Canada.

Author information

1
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC. Electronic address: vardit.ravitsky@umontreal.ca.
2
Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, QC.
3
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC.

Abstract

The use of pre-implantation genetic diagnosis (PGD) is increasing as the list of indications it can test for constantly expands. This raises new challenges for clinicians and prospective parents regarding possible uses and calls for guidance. Policy approaches towards PGD vary greatly worldwide. The 2004 Canadian Assisted Human Reproduction Act does not provide guidance, except for prohibiting non-medical sex selection. Criminal legislation is an unsuitable policy instrument to regulate human genetics and reproductive medicine. We call for professional societies to issue guidelines regarding the uses of PGD that would establish the standard of care and legal norms. Such guidelines should be based on a patient-centered approach and respect individual autonomy in reproductive decision-making. Canadian approaches to PGD should also consider issues related to equity of access. Moreover, since PGD often raises concerns about eugenic uses, guidelines should also consider its societal impact and its implementation should be accompanied by policies that maintain or increase social support for people with disabilities. Finally, public engagement could provide an evidence-base regarding Canadian societal values and concerns that should guide regulatory reform, for example, the regulation of non-medical sex selection through PGD.

KEYWORDS:

PGD; access; autonomy; guidelines; patient-centred care; regulation

PMID:
30361155
DOI:
10.1016/j.jogc.2018.08.001

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