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    Children and Families

    Human beings have long sought to control their reproduction and shape their children’s futures. Our power to do this is greater than ever before, and prompts difficult questions about the obligations of individuals, families, and society. What is responsible procreation?

    Using assisted reproductive technologies, people who not long ago could only dream of having biologically related children are doing so. There is also a growing global aspect to procreation with a sperm donor from one continent, an egg donor from another and a surrogate mother in still another. People can time and plan their families to a degree unimaginable a generation ago. Egg freezing, until recently an experimental procedure, allows women to preserve their eggs until they are ready to start families.

    A growing array of tests identifies medical and nonmedical traits in embryos created through in vitro fertilization, affecting parents’ decisions about which embryos to implant. Doctors screen fetuses early in pregnancy for Down syndrome, other conditions, and for sex, potentially influencing judgments about whether to continue a pregnancy. In the near future, prenatal whole genome sequencing is expected to be less expensive and more available, dramatically increasing the amount of genetic information, ranging from disease risk to indicators of intelligence. How should these changes affect parenting? How should they impact the long-standing tension between parents’ interests in learning as much as possible about their children and children’s interests in shaping their own futures?

    Complicating these questions is the reality that the meaning of much genetic information is unclear. Doctors may determine a child has a chance of developing a particular disease later in life, but they may not know with any certainty this will happen or which environmental factors will have an impact. Even in rare cases when doctors know a child will fall ill with a particular condition, there is often no cure or effective treatments, raising questions about the value of having such information.

    Most of society agrees that parents have broad discretion in making decisions for their children. Some decisions are straightforward, and others are agonizing with long-term consequences. When should very premature infants or sick children be allowed to die? Which moods and behaviors in children are problematic and warrant altering with drugs or other interventions? What atypical or unwanted physical characteristics justify using surgery to change them? What role should children have in making their own medical decisions and at what age?

    We know children’s environments—the foods they eat, the air they breathe, their neighborhoods, and their schools—dramatically influence their mental and physical health. Beginning before they are born, their environments may be as influential as their genes, often more. As we learn about the importance of these environments, we may ask whether all the responsibilities for raising healthy children should fall to parents alone. What is the role of society—on the local, national, or global level—in setting and implementing standards?

    Reproduction and child rearing are fundamental human activities, and they have long been contested. New reproductive and genetic technologies, as well as new knowledge about genetic and environmental influences, intensify the need for reasoned analysis of the challenges posed by creating and caring for children in the 21st century.

    Activities

    Current Projects

    Goals and Practices for Next-Generation Prenatal Testing

    Sequencing of Newborn Blood Spot DNA to Improve and Expand Newborn Screening

    Recent Past Projects

    Multiple Births Following Fertility Treatment

    Pharmacological Treatment of Emotional and Behavioral Disturbances in Children

    In the News

    Josephine Johnston on surrogate pregnancies (Dallas Morning News)

    Josephine Johnston on egg freezing parties (ABC’s “Nightline”)

    Josephine Johnston on fertility treatments and multiple births (Wall Street Journal)

    Selected Publications

    Josephine Johnston and Miriam Zoll, “Is Freezing Your Eggs Dangerous? A Primer,” The New Republic

    Josephine Johnston, Michael K. Gusmano, and Pasquale Patrizio, “Preterm Births, Multiples, and Fertility Treatment: Recommendations for Changes to Policy and Clinical Practices,” Fertility & Sterility.