Born and Made: An Ethnography of Preimplantation Genetic Diagnosis (review)

Preimplantation Genetic Diagnosis is a procedure used to prevent serious genetic disease, through the screening and selection of embryos in the laboratory before their implantation into the uterus. The embryos for PGD are created through IVF, with a similar failure rate to IVF for infertility (75 percent), so babies born through the use of PGD are rare success stories. Beyond the procedures and statistics, however, PGD is also a deeply symbolic technology. Mainstream representations portray it as a technology out of control and unaccountable, and the means through which those with the available resources can create designer babies.

Sarah Franklin and Celia Roberts' book represents a careful, insightful and scholarly attempt to unpick this technology from this pervasive frame. Instead, using interviews with practitioners, recipients and regulators of PGD, alongside media and policy analysis, the authors explore its daily practice from a sociological perspective.

The result is a book which works on two levels. Firstly, it describes, through a two-year long ethnographic study, and in sensitive and rigorous detail, the experiences of couples seeking and undergoing PGD. Through their accounts, the journeys of these couples are traced from their initial discovery of the possibility of PGD, through to their contact with practitioners and the outcome of the process. For many couples, of course, the outcome is more uncertainty, given the low success rate of PGD.

Those personally involved with PGD, either as practitioners or recipients, are keen to present it through a different frame to that which pervades the media- as a way of preventing illness. In contrast to the desire to create a designer baby, couples undergoing PGD present themselves as steering a socially responsible course away from the certain pain and death that the genetic conditions of which they are carriers will inevitably bring about to affected children. They describe a deliberate, and much deliberated, choice to use a technology fraught with failure to avoid an affected pregnancy in the first place, rather than conceiving naturally and being prepared to undergo a termination based on the results of genetic testing. Franklin and Roberts ably demonstrate how patients' accounts, and their cautious optimism, show the depth of engagement and subtlety of lay understandings of genetics and genetic decision making.

Secondly, the book begins to lay out a framework for the sociology of PGD. It does this through examining the social forces within PGD that influence the form of its practice and application, as well as the external forces, such as patient demand, in terms of how PGD protocols are adjusted and revised. As the authors highlight, this approach emphasises exchange and interaction. At the same time hangs the issue of how is PGD called to account, or made accountable to wider society. Of course, there are no easy "right" answers to these questions, nor do the authors attempt to provide any, noting instead that best practice can only be determined on the basis of the quality of the decision making practice itself.

Despite the mainstream depictions of PGD as essentially unaccountable, a runaway technology, the authors show how the regulation of PGD over the past 15 years provides an example of precaution and social restraint. They conclude that in fact PGD is actually an example of how social desires often race far ahead of technology. For some families, PGD provides a means to circumvent "avoidable harm," in the form of the births of children with profound and fatal disabilities. For others, it opens up the possibility of the birth of "saviour siblings," who can donate biological material to save the life of an existing child. As Franklin and Roberts identify, social efforts to limit technology will inevitably be weakest at the point where they conflict with the moral imperative to save lives where it is technologically possible to do so.

For this reader, the book was compelling, illuminating and intellectually stimulating. There are some minor quibbles: why, for example, was it thought necessary to clean up...