Bioethics And Biosafety.docx

Current status of Bioethics Education in Pakistan The Aga Khan University at Karachi was the first institution to introduce bioethics in the undergraduate medical curriculum in the mid 1980s. Initially taught informally, the curriculum has since then been formally integrated into the various courses of the university. The subject is primarily being taught by healthcare professionals who have a personal interest in bioethics. The trend towards formal bioethics education also started from the same institution with several faculty members taking sabbatical time abroad for formal training through various bioethics programs.6 The first formal institutional framework for bioethics appeared in 2004, with the establishment of the Centre of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. This centre remains the only example of institutional support for bioethics in the country since all activities of the CBEC are funded by its parent institute, the SIUT. In addition to organizing short courses and workshops on various bioethics related themes, in 2006 this centre initiated Pakistan’s first formal bioethics training program, a one year Postgraduate Diploma in Biomedical Ethics. . In 2009 the CBEC initiated a two year Masters in the Bioethics program for a smaller number of people who will form the bioethics leadership of the country in the years to come. Both these programs continue to be Pakistan’s only indigenously funded bioethics programs. A Masters in Bioethics program was also initiated at the Aga Khan University in 2008, funded by a grant from the US National Institutes of Health. The program continued till 2012 when external funding ceased, and had trained about 70 individuals. Considering the increasing numbers of people with formal bioethics training, it comes as no surprise that there has also been an increase in bioethics conferences and thematic workshops in recent years across the country. Whereas up till 2006, bioethics related academic meetings had been organized only in Karachi, and that too at one institution, several institutions across Pakistan have now held workshops. These include not only major cities like Islamabad, Lahore and Peshawar but also institutions in smaller towns like Swat, Nawabshah and Jamshoro. Clinical Ethics Clinical ethics deal with ethical issues that emerge during the medical care of a patient. One of the major contributions of contemporary bioethics has been to increase the awareness of the patients about their rights. This has brought into question the archaic practice of paternalistic medical practice, where the physician decided, and the patient complied, unquestioningly. There are certain core values that are central to ethical patient management, respecting the wishes of the patient being one of them. Respect for Privacy and Confidentiality Issues of privacy and confidentiality also form part of the spectrum of respect for the patient. Privacy pertains to the control of sharing access to oneself with others either physically, behaviourally or intellectually. For instance, the availability of a private space for consultation and examination of the patient is an essential requirement in medical practice. It is the responsibility of healthcare institutions to provide such space like examination rooms or a curtained enclosure. Hospital Ethics Committee As can be expected, ethical questions frequently arise in healthcare delivery. The concept of creating Hospital Ethics Committees to provide assistance and advice for the resolution of such issues has evolved over the recent years and modern hospitals across the world are creating such bodies. These

committees are mandated to receive consultations on ethical issues from hospital personnel, patients and their families. Research ethics Research Ethics The development of research ethics as a distinct area of interest within bioethics can be linked to historical events in which human subjects were exploited for scientific purposes. Experimentation is essential for scientific progress, and experimentation on human participants is imperative for medical science to progress. However, the history of human experimentation is replete with examples when participants were exploited, deceived and harmed in the process of such experimentation. Awareness of such abuse and attempts to keep it in check is also evident from historic times, reflecting the concern for the welfare of the human subjects. However, WHO acts through individual governments and 194 countries are signatories of the International Health Regulations to enforce public health security globally.(t/f). In Japan, flu vaccination had once been made mandatory for school children so that the elderly may be protected from exposure, since they are more likely to suffer greater morbidity of the seasonal outbreak .(t/f). Ethical Challenges in Organ Transplantation Challenges that have been under debate ever since it became possible to replace failed organs in desperately sick individuals with working organs from either healthy, living donors or recently deceased ones. Ethical issues around organ transplantation are heavily influenced by religious, cultural and social values when the process of organ donation is considered, whether from the living or the deceased. In the following passage, some of the ethical debates specifically around kidney donation will be highlighted since kidney transplantation programs are the only ones established in Pakistan at the moment. Living Kidney Donations Surgery for organ donation is a unique operation. There is no other example of a healthy person willingly undergoing a surgical procedure that has no conceivable medical benefit for himself or herself, and readily accepting the inevitable pain and also the small but established short and long term risks associated with nephrectomy. Yet kidneys from living donors form a major share of transplanted organs in Pakistan. Since kidneys are paired organs, and a healthy donor can be expected to have a normal lifespan even after donating one kidney, taking a kidney for transplantation from a willing adult donor raises no ethical concerns. The motivation of people to donate an organ for the sake of restoring to health a seriously sick relative or spouse is quite understandable. True altruism, in which a person is willing to donate a kidney to a complete stranger to help him or her recover is also possible but is probably much less common. More common, especially in the Pakistani context, at least up till a few years ago was complete strangers ‘willingly’ donating their organs to total strangers, often foreigners. This was brought about by a wellestablished commercial process whereby the poorest of the poor were coerced to sell their kidneys in order to buy their way out of debt. The recipients were always affluent people, often from other countries. In this process of buying and selling of kidneys, the real benefit was in the form of money made by middlemen, hospitals and doctors. Studies have shown that the organ vendor, the poor peasant who sold his or her kidney, would still remain in debt and would be left financially as well as medically worse off than before.42,43 This problem of organ trade grew to such a level in the country that at the turn of the century Pakistan was regarded as the ‘kidney bazaar’ of the world with private hospitals in Punjab catering specifically to this business. Not only did this bring a bad name to the country, this practice was also causing a major health issue for the ‘donors’ who were selling their kidneys since there was no follow up offered by these commercial transplant centres.

The struggle to bring the menace of organ trade to an end in Pakistan spans more than two decades. This effort was spearheaded by the SIUT, aided by national nephrology and urology societies, the media and members of the general public. It was in response to a suo moto notice taken by the Supreme Court of Pakistan that an ordinance was finally promulgated in 2007 banning organ trade, criminalizing transplantation of organs from Pakistanis to foreigners, and supporting living, related donations. The ordinance, called ‘Transplantation of Organs and Tissue Ordinance 2007’ also ordered the creation of a regulatory and oversight organization called the Human Organ and Transplantation Authority (HOTA).44 The ordinance was unanimously ratified by the parliament to become law in 2010. After the 18th constitutional amendment, the provinces have been directed to establish such committees and take over the role of HOTA. Deceased Organ Donation In major transplant centres across the world, it is the deceased donor programs that are being developed to meet the ever increasing needs for organ transplantation. This is because the deceased is obviously not going to be harmed by the removal of organ/s and even in death, can help restore the life of a severely sick person. In Pakistan however, to date only 4 Pakistanis have been deceased donors. This is primarily because of lack of awareness among the public as well as among medical professionals about the various aspects of deceased organ donation. Although there are numerous fatawas from ulema belonging to different Islamic schools of thought declaring deceased organ donation permissible in order to save the life of another human being, according to a study conducted by the author, ambiguity still remains in the minds of the general public.45 This study also highlighted many social and cultural aspects of deceased organ donation which need to be addressed before any such program can be started in Pakistan to contribute meaningfully towards organ transplantation activity. For instance, even if an individual has willed his or her organs to be donated after death, this study showed that the family can intervene after the death and refuse to honor this pledge. This is by no means unique to the Pakistani context, but a formal role for the family will have to be considered while getting pledges for deceased organ donations so that the possibility of a veto from the family after death can be minimized. Genomics and Its Challenges (rest from copy) Sharia Law and Organ Transplantation: Through the Lens of Muslim Jurists14 Farhat Moazam A common error made by non-Muslim and Muslim analysts alike is to depict Islam as monolithic and static and Sharia Law or fiqh (Muslim jurisprudence) as uniform and frozen in time. The reality is that there is great diversity in the way Muslims live their lives and a plurality of positions Muslim jurists hold on ethical and legal issues. This article begins with a brief overview of the evolution of Sharia Law and the classical usul al-fiqh (roots of jurisprudence), and the tradition of ikhtilaf (differences, disagreements) that exists within Muslim jurisprudence.2 It discusses how the latter is exemplified in juristic positions on organ transplantation and brain death which range from consensus to dissent based on particular interpretation of the Sharia. The second half of the article consists of a “case report” from Pakistan beginning with a brief narrative of events around the passage of the national Transplantation of Organs and Tissues Ordinance, 2007 in order to stem kidney commerce in the country. It describes a petition against it in the Federal Shariat Court (FSC) of Pakistan arguing that specific clauses of the Ordinance were contrary to Sharia, and discusses arguments offered by jurists and lawyers appearing on behalf of the petitioner and the respondents, the role of physicians, and the

final FSC judgement dismissing the petition. This case illustrates that religious positions and rulings are not fashioned in a vacuum but shaped by interplay of perceived boundaries of authority within political and legal systems and existing societal norms. Sharia Law and Ikhtilaf-al-Fiqh One of the factors that has played a crucial role in the development and moulding of Muslim ethical and legal thought is the nature of the early Muslim community, and the particular historical circumstances including the varied geographical, political, and administrative backgrounds within which Islam evolved. Unlike Christianity that remained a religious community for its first three centuries, Islam was a religiouspolitical force from its inception.3 Its rapid spread beyond the Arabian Peninsula and interface with nonArab cultures and societies, and political schisms within the growing Muslim community itself, resulted in early challenges for Muslims in the realms of the sacred as well as the profane. Efforts in the attempt to protect the early religious ethos and guard against fragmentation of an expanding empire included the development of Sharia Law, or Islamic Law as it is sometimes referred to. Over time, Sharia Law came to be accepted as a guide for not only religious duties and rituals such as prayers and fasting but also interpersonal and worldly dealings, thus subsuming within it the legal and the ethical pertaining to all aspects of Muslim lives (Hodgson 1977). Ethics therefore became an integral part of Sharia Law with scholars of fiqh (jurisprudence), the fuqaha, becoming the locus for ethical discourse and what constitutes right and wrong acts. According to Kevin Reinhart and others, “Islamic Law is the central domain of Islamic ethical thought”, and is “not merely law but also an ethical and epistemological system” (Reinhart 1983; Hourani 1985; Sachedina 2009). Most Muslims accept that interpreting and ascertaining the “meaning” of Sharia as related to ethics and law is the domain of fuqaha (jurists) rather than of theologians and philosophers. Sharia Law is religious by nature and considered to flow from the guidance found within a divine Sharia. Difficulties arise however in the ambiguous, and sometimes misleading, usage of connected but not identical terms such as Sharia, Sharia Law or Islamic Law, and the discipline of fiqh (from the Arabic word meaning “discernment”). The word Shara’a as it appears in the Qur’an (Sura 45: Ayah 18), and from which the term Sharia is derived, is an overarching concept referring to God’s appointed way for Muslims to follow in life in order to gain salvation in the hereafter; it is a path that is divinely ordained and therefore immutable (Rahman 1979).4 But comprehending what God “wants” from humans and fashioning this into moral principles and legal edicts require human reasoning and discernment. Unlike Sharia therefore, Sharia Law is not a human, social construct undertaken by fuqaha (jurists) that is neither divine nor can it be uniform and static through time. Accordingly, whereas Muslims agree that Sharia is divine and immutable, one finds consensus but also diversity in the opinions of fuqaha in its interpretation and translation into law. This occurs even though jurists employ “classical” sources, usul al-fiqh (roots or fundamental principles of fiqh), as their framework for reasoning and subsequent opinions. Problems arise however when the terms (divine) “Sharia” and (manmade) “Sharia Law” derived through fiqh are used interchangeably, giving a sense of divinity and immutability to the latter (Kamali 2008; Masud 1995). Muslim Jurists, Organ Transplantation and Brain Death A recent challenge for Muslim jurists has been to address moral issues that surface with the advances in biomedical science and technology. Accepted as the locus for moral guidance by many lay and professional Muslims alike, jurists are being questioned about the “permissibility”, or not, in Sharia of clinical practices including donation and transplantation of human organs and brain death criteria to establish death. To arrive at opinions on medical and scientific issues too, Muslim jurists employ derivative reasoning from the classical roots of fiqh and utilise secondary juristic principles and maxims such as “necessity makes lawful that which is prohibited”, and “where it is inevitable the lesser of two harms should be chosen” (Haleem 1993; Kamali 2008: 144–5). An important point to note, however, is that in the absence of a central doctrinal

authority like a Church in Islam and the presence of the ikhtilaf tradition, rulings and fatawa (religious opinions) on any matter delivered by jurists from one part of the world or a particular madhhab, while carrying authority, are not considered binding on those who dissent (Kozlowski 1996). This section provides a brief summary of existing juristic opinions on these two issues and highlights areas of consensus and disagreements. Solid Organ Donation and Transplantation: The moral and legal dimensions of organ donation and transplantation have been a subject of debate among Muslim jurists and scholars for a number of years, a fact little known to the international bioethics community. One reason for this may be because Arabic remains the dominant language for such discussions and related publications, a language in which few are conversant, including Muslims of whom a majority are not citizens of Middle Eastern countries. What, however, should also not be discounted is that the dominant model of contemporary bio-medical ethics which has gained international currency is of a “resolutely secular orientation” utilising AngloAmerican analytic philosophical traditions and focuses on a search for universals in which religion plays no part (Fox and Swazey 2008; Jafarey and Moazam 2010). Juristic debates on this issue began in the 1980s, and due to the unfamiliarity of most jurists with the complexity of the science involved, Muslim physicians played a key role as “experts” through direct participation in discussions and by providing written submissions. In 1982, following a meeting in Jeddah, the Saudi Grand Ulema sanctioned (a “majority” not unanimous ruling) both living and deceased organ donation. This was followed by a similar ruling by the Academy of Islamic Jurisprudence in its 8thsession in their meeting in 1985, by the Conference of Islamic Jurists held in Amman, Jordan in 1986, and subsequently by other jurists in Kuwait and Egypt. Conditions for permissibility of transplantation included voluntary consent of the donor and a medical opinion that no other measure was available to save the patient’s life. In 1988, the 4th International Conference of Islamic Jurists held in Jeddah endorsed all previous fatawa about the permissibility of organ donation and transplantation, prohibited organ trading and trafficking as counter to the spirit of Sharia, and emphasised altruistic donation (Albar 1995; Yaseen 1995). On the other hand, jurists opposing brain death tended to use the “literal meaning of the verses of the Qur’an or inferences drawn from it” and rationalised that there was no justification to emphasise one organ (the brain) as the locus for the soul rather than another such as the heart. Moreover, Islamic Law requires that death be ascertained with yaqin (certainty) and not through zann (legal probability), and death cannot be said to have occurred with yaqin “if the body is still pulsating [with a beating heart]”. Concerns were also expressed that the primary objective of brain death was to obtain organs for transplantation, and a day may come when an unconscious or insane person would be included in the category of the dead for this purpose. It is of historical interest that these concerns echo those expressed by Christian theologian Paul Ramsey and philosopher Hans Jonas in the 1970s (Moazam 2006). Jonas in particular worried that “we do not know the exact borderline between life and death”, and that legitimising brain death would “open the road” to a rush for harvesting organs (Jonas 1970). Kidney Transplantation in Pakistan: A Case Study This section moves from theoretical debates among Muslim muftis and jurists to jurist arguments in an actual case filed in the Federal Shariat Court of Pakistan challenging clauses of the organ transplantation Ordinance as being contrary to Sharia. It begins with a brief account of events leading up to the promulgation of the “Transplantation of Organs and Tissues Ordinance, 2007” in Pakistan which criminalised all commercial transactions related to human organs, and the subsequent petition filed in the Pakistan Federal Shariat Court (FSC) challenging certain clauses of the Ordinance as being “repugnant to the injunctions of Islam.” An analysis of different arguments offered by Muslim jurists appearing for the petitioner and the

respondents will be presented as will salient features from the FSC ruling in which the petition was dismissed. Organs and Tissue Transplantation Ordinance 2007, Pakistan Systematic transplantation of kidneys in Pakistan began in the 1980s in the absence of any national and institutional oversight and regulatory bodies. Similar to other developing countries, as the country did not have deceased organ donor program, all transplants were undertaken with kidneys obtained from living donors (Groth 2003). The early pattern of family members donating kidneys for kin was gradually replaced by one in which the major source became impoverished individuals willing to sell a kidney. This shift was driven by private sector physicians and hospitals in the major cities of Punjab increasingly willing to offer transplants to affluent citizens from other countries with kidneys bought from poor, often debt-ridden villagers. By the end of the 20th century, Pakistan had achieved notoriety as a “kidney bazaar” with a handful of physicians and private hospitals running a lucrative business of kidney tourism worth millions of dollars. At the turn of this century, the Sindh Institute of Urology and Transplantation (SIUT), the busiest public transplant centre in the country, renewed its longstanding struggle for a national law to curb kidney commerce. As reports of exploitation of kidney vendors by hospitals began to rise, the campaign against such practices was taken up by the press and the media, other health- care professionals and associations, and representatives of civil society.7 The faculty of the recently inaugurated Center of Biomedical Ethics and Culture in SIUT contributed through publication of ethnographic studies on the repercussions on Pakistani vendors and their families (Moazam, Zaman, and Jafarey 2009), and by submitting letters and articles to the local press for public awareness.8 Publications about medical and economic ill effects on kidney vendors, and collaboration with international organisations including the WHO, also served to advance this cause (Naqvi, Ali, and Mazhar 2007). The push for a national law against kidney trade and tourism was met with active opposition from a handful of influential, politically well connected physicians and hospital owners known to be at the forefront of these practices. In 2006, the Chief Justice of the Supreme Court of Pakistan took suo moto notice of the kidney trade adding to the pressure on the government to act, and in September 2007, the “Transplantation of Organs and Tissues Ordinance, 2007” was finally promulgated through Presidential decree by Parvez Musharraf (Syed 2007). The Ordinance prohibited unrelated living organ donation (exceptional cases are permitted following review by an Evaluation Committee), and criminalised transplantation of organs from Pakistanis into foreigners with stiff fines and imprisonment for those, including physicians, convicted of these offences. It recommended the setting up of a national registry and an oversight body (HOTA — Human Organ Transplantation Authority) and initiation of deceased donor programmes in Pakistan. (The Ordinance was ratified as law unanimously, by both the Pakistan National Assembly and the Senate in 2010.)9 Several attempts were made by the organ trade lobby to amend the Ordinance and relax restrictions against non-related donors and payments to those providing kidneys.10 One of the most significant challenges to it occurred on 26 January 2008 through a petition filed in the Federal Shariat Court of Pakistan claiming that specific clauses of the Ordinance were contrary to the Sharia and therefore should be removed. Federal Shariat Court (FSC) of Pakistan Article 203-D of the Constitution of the Islamic Republic of Pakistan stipulates that all laws in the country must conform to “the injunctions of Islam as laid down by the Holy Qur’an and Sunna”

(www.pakistani.org/Pakistan/constitution). The FSC of Pakistan was established in 1980 under Chapter 3A of the Constitution by a Presidential Order of General Zia ul Haq, and given the authority “to examine and decide the question whether or not any law or provision of law is repugnant to the injunctions of Islam,” and refer those it considered to be against the Sharia to the Parliament for amendment. TRANSPLANTATION ( Definition ) : 1--Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. 2--What is organ transplantation? Organ transplantation is a surgical procedure to replace a failing, diseased organ with a healthier donor organ, such as a heart, liver, kidney, or lung. Donor organs can come from deceased donors, which is always the case in heart transplants, or from living donors, which can happen in kidney, liver, and, rarely, lung transplants. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source. TYPES OF TRANSPLANTATION / TYPES OF ORGAN TRANSPLANT : Organs that have been successfully transplanted include the heart, kidneys, brain, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), corneae, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart.

1. Heart transplant A healthy heart from a donor who has suffered brain death is used to replace a patient’s damaged or diseased heart. Due to the complexity of this procedure, strict medical criteria is imposed in assessing whether a donor’s heart is suitable for transplant, and whether a potential recipient is suitable to receive the transplant .

2. Lung transplant One lung or both lungs from a recently deceased donor are used to replace a patient’s diseased lung or lungs.

3. Liver transplant A patient’s diseased liver is replaced with a healthy liver graft from a donor. Donor livers can be obtained from deceased donors, or a family member may choose to donate a portion of his liver to the patient.

4. Pancreas transplant This type of transplant is commonly done on type 1 diabetics whose pancreas don’t work properly.

5. Cornea transplant Corneal donation restores vision to those blinded by corneal disease. A damaged or cloudy cornea can be replaced surgically with a healthy, normal cornea, donated by another individual , during a corneal

transplantation. 6. Trachea transplant The windpipe or trachea is a cartilaginous tube descending from the larynx to the bronchi and into the lungs. A trachea transplant can help patients who suffer from hardening and narrowing of their windpipe.

7. Kidney transplant A kidney for transplant can be taken from a living or dead donor. 8. Skin transplant Donor skin has been found to be an effective treatment option for patients suffering from severe burn injuries, acting as a temporary dressing and allowing and promote healing until a patient is ready for grafting using his own skin.

9. Vascular tissues transplant Transplanting vascular tissues that circulate blood around the body can help relieve symptoms of breathlessness, tiredness and dizzy spells in patients with severe cardiovascular conditions. Vascular tissues can be donated up to 24 hours after death. 10. Hair Transplant : Hair transplantation is a surgical technique that removes hair follicles from one part of the body, called the 'donor site', to a bald or balding part of the body known as the 'recipient site'. The technique is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding (like the back of the head) are transplanted to the bald scalp. Hair transplantation can also be used to restore eyelashes, eyebrows, beard hair, chest hair, pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin. Since hair naturally grows in groupings of 1 to 4 hairs, current techniques harvest and transplant hair "follicular units" in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking original hair orientation. This hair transplant procedure is called follicular unit transplantation (FUT). Donor hair can be harvested in two different ways: strip harvesting, and follicular unit extraction (FUE). EUGENICS : Introduction to Eugenics 1. Eugenics is a movement that is aimed at improving the genetic composition of the human race. Historically, eugenicists advocated selective breeding to achieve these goals. Today we have technologies that make it possible to more directly alter the genetic composition of an individual. However, people differ in their views on how to best (and ethically) use this technology.

2. Eugenics (/juːˈdʒɛnɪks/; from Greek εὐγενής eugenes 'well-born' from εὖ eu, 'good, well' and γένος genos, 'race, stock, kin')[2][3] is a set of beliefs and practices that aims at improving the genetic quality of a human population.[4][5] The exact definition of eugenics has been a matter of debate Brief History of Eugenics : (Initial/Ancient) In 1883, Sir Francis Galton, a respected British scholar and cousin of Charles Darwin, first used the term eugenics, meaning “well-born.” Galton believed that the human race could help direct its future by selectively breeding individuals who have “desired” traits. This idea was based on Galton’s study of upper class Britain. Following these studies, Galton concluded that an elite position in society was due to a good genetic makeup. While Galton’s plans to improve the human race through selective breeding never came to fruition in Britain, they eventually took sinister turns in other countries. Is Eugenics Happening Today? As research continues to uncover new disease-causing mutations, it becomes increasingly possible to stop the transmission of certain heritable diseases. In the long term, this may lead to complete eradication of diseases like Down Syndrome, cystic fibrosis, and hemophilia. However, some wonder if modern day attempts to eradicate hereditary disorders equate to eugenics. EXAMPLE : 1. One complication of genetic testing for the purpose of disease eradication is that, in practice, a particular ethnic group will likely be involved due to shared ancestry. For instance, Tay-Sachs disease is significantly more common in certain Jewish communities. Tay-Sachs is a genetic disease that causes a deterioration of mental and physical abilities and results in death by age four. Eradicating Tay-Sachs will require screening all individuals in the affected population. 2. Using modern genetic technology, prospective parents can be prescreened to determine their carrier status for certain diseases. Preimplantation genetic diagnosis following in vitro fertilization allows parents to select embryos that are free of disease. Additionally, prenatal genetic testing can provide a lot of information to parents about their unborn child. These technologies make more informed decision-making possible, but some are concerned about a shift in the way we view family and parenting. Parents who want to have a child without pursuing genetic testing may feel guilty if the child is born with any health problems. Additionally, some are concerned about what an overemphasis on eliminating disabilities in unborn children will mean for people who already have the disability. FUTURE OF EUGENICS : Being used and will use these facts in research . The most significant difference between modern genetic technologies, that some view as eugenic, and the historical use of eugenics is consent.