Reproductive Autonomy and the Limits of Embryo Selection Technologies

Abstract

Embryo selection has expanded from monogenic testing for single-gene disorders to polygenic risk scoring for complex, common conditions, and the ethical arguments built around reproductive autonomy have not kept pace. This review examines what current selection technologies can and cannot reliably predict, and weighs that technical picture against two competing currents: the disability-rights critique, which holds that selecting against a condition can devalue people already living with it, and liberal arguments for procreative beneficence, which hold that parents have some obligation to select for a child's expected wellbeing. It also examines the narrower policy question of non-medical sex selection, where professional societies have grown more permissive under specific conditions, and asks what that shift implies for broader regulation. We argue that the evidentiary weakness of polygenic embryo scores, combined with commercial incentives to overstate their predictive power, means informed consent in this domain often fails procedurally before the deeper substantive disagreements are even reached. We conclude that reproductive autonomy is necessary but insufficient justification for expanding embryo selection, and that defensible practice requires independent counseling, honest disclosure of absolute risk, and a clearer line between testing tied to a medical indication and testing sold as a stand-alone product.