Editorial

2314 www.thelancet.com Vol 379 June 23, 2012

For the report of the Nuffi eld Council on Bioethics see http://

www.nuffi eldbioethics.org/sites/default/fi les/Novel_techniques_

for_the_prevention_of_mitochondrial_DNA_disorders_

compressed.pdf

For information on the public consultation see http://www.

hfea.gov.uk/6372.html

Mitochondrial disease is an inherited disorder with no cure and few options for prevention. But now, a report by the Nuffi eld Council on Bioethics has concluded that an in-vitro fertilisation technique—which uses donated, healthy mitochondria (which have their own DNA) to replace the mother’s dysfunctional mitochondria—would be ethical, if safe and eff ective. The technique is currently illegal in the UK, which only permits eggs to be used that have not had their DNA altered. The report paves the way for reassessment of the procedure’s legality and a public consultation will start in September.

Three main ethical issues are addressed: fi rst, the safety of the technique (not yet established, but being tested). Second, the eff ect of having genes from three people (not a major ethical problem). The third is that the technique introduces germline genetic changes; the new mitochondrial DNA can be passed to the child’s off spring. Approval of the technique could set a precedent for genetic alteration and is feared to be the start of a move towards so-called designer babies. Such

concern is understandable and genetic manipulation should not be undertaken lightly.

Disagreements about the ethics of germline genetic change are inevitable. However, the most striking passages in the report are the accounts of aff ected families: all support mitochondria donation. ”Our son died...He was 2 years and 4 months old. He had very little quality of life and was very ill and suff ered greatly, as did the entire family.” Another mother writes: “Losing a child is the most devastating thing a parent can ever go through. You never get over it.”

Mitochondrial disease causes severe illness and distress to these families and the potential to prevent it exists: an eff ective treatment should not be denied solely because approval might set a precedent; the report’s conclusions should be welcomed and current legislation amended. Caution about altering a person’s genes is essential, but of all the ethical issues at play, we must not lose sight of an overriding one: to alleviate suff ering of patients and their families. The Lancet

Ethics of mitochondrial donation

Suicide prevention: steps to be takenSuicide is a devastating event for individuals, families, and communities. People who experience such a loss, the wider public, and health professionals, often struggle to understand this complex behaviour, which remains taboo in many cultures. In today’s Lancet, we publish a three-part Series to illuminate some of the issues around the causes of suicide, the treatments for suicidal ideation and self-harm, and importantly, the prevention of suicide.

The papers focus on self-harm and suicide in adolescents, suicide in young men, and means restriction for suicide prevention. Globally, 900 000 people die from suicide every year, and low-income and middle-income countries (LMICs) account for most (84%) of these suicides. Yet, as the Series highlights, data on suicide and eff ective prevention strategies for suicide in these countries are lacking. For example, emerging prevention strategies for adolescents (eg, school-based screening) are largely based on data from high-income countries, and most would be prohibitively expensive for LMICs.

As the last paper in the Series shows, suicide can be prevented by restricting access to highly lethal,

common methods of self-harm, for example, limiting gun availability in high-income countries. But the cultural context is important for prevention to work. Past research has shown, for example, that pesticide poisoning was a major method of suicide in rural areas of developing nations, especially in Asia. Safer storage of pesticides has therefore been eff ective in suicide prevention in these settings.

Improving suicide prevention globally will require a greater understanding of why and how people decide to take their own lives in diff erent settings. Additionally, the decriminalisation of suicide will help destigmatise this behaviour and help those in distress to come forward. The media also have a part to play in their coverage of suicide. To this end, Samaritans in the UK has produced a useful set of media guidelines for those reporting on suicide to discourage sensationalism, which can be harmful and lead to imitative behaviours in vulnerable people. Suicide is a major public health problem that needs to be addressed sensitively by health professionals, legislators, and the media. The Lancet

For more on the Samaritans media guidelines see http://www.samaritans.org/media_

centre/media_guidelines.aspx

See Comment pages 2316 and 2318

See Perspectives page 2333

See Articles page 2343

See Series pages 2373, 2383, and 2393

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