Preimplantation genetic testing: Comparative analysis of jurisprudential regulations

Preimplantation genetic testing (PGT) is used to screen for genetic diseases or chromosomal abnormalities in couples at risk of transmission to the offspring. It can be applied also to determine the gender or phenotypical features of the unborn and to type the Human Leucocyte Antigen (HLA), in order to search for future potential stem cell or bone marrow donors. Aim of this review is to provide a comprehensive description of Italian jurisprudential approach on PGT, and in addition, to compare the jurisprudential orientation of other nations of West Europe and USA. PGT is allowed for almost any indication in some countries (United Kingdom and USA), but is forbidden in others (Austria). In the majority of countries PGT is authorized to prevent the transmission of genetic diseases, being considered unacceptable for gender selection for non-medical reasons. Less frequently, PGT is allowed to provide therapeutic options for an already born sibling. In some cases, prior authorization from a health authority or a healthcare provider is requested. Social, healthcare and ethical issues underpin the request for PGT. Given the difficulty to identify a list of genetic diseases for which could be authorized the access to PGT, the European Society of Human Reproduction and Embriology (ESHRE) proposes to limit such test to cases characterized by a “high risk of a serious condition”. In such a framework, it has been proposed that the access to PGT is allowed through a prior in-depth meeting between the couple and a multidisciplinary equipe of healthcare professionals (obstetrician, geneticist, psychologist, expert in bioethics, legal-medicine specialist) to evaluate the medical, but also juridical and ethical acceptability of the request.