Ethical and conceptual aspects of mitochondrial replacement techniques ("three-parent child")

Definition of the problemAlthough mitochondrial replacement techniques have been performed in humans and have been legalized in the UK, three crucial conceptual questions are yet unanswered: (1)Are mitochondrial replacement techniques agermline intervention? (2)Are mitochondrial replacement techniques amedically indicated therapy or an elective procedure of assisted reproduction? (3)What are the concepts of parenthood and identity behind mitochondrial replacement techniques? In our paper, we show that the ethical assessment of the procedure depends on the conceptual framing.ArgumentsThe procedure is an intervention in the germline, which makes it necessary to include future generations in the risk assessment. The procedure has to be regarded as an elective assisted reproduction technique since there is no medical necessity for its application. This is especially important when it comes to public funding for the clinical application. The term three-parent child is incorrect and misleading. It implies an outdated concept of parenthood that relies solely on genetic relatedness. Hence, the negative consequences for the future child's psychosocial development as well as for family dynamics that are stated by some commentators are unfounded.ConclusionThe clarification of the three conceptual issues allows asound ethical assessment. We conclude that the clinical implementation of mitochondrial replacement techniques is ethically acceptable as long as the safety of the procedure is further improved and it is implemented as an elective procedure of assisted reproduction without entitlement to public funding.