When Careful Becomes the Problem

A friend of mine had her second child last year through IVF. Standard process — hormone treatment, egg retrieval, fertilisation, transfer. But somewhere between retrieval and transfer, a step had been added that didn't exist ten years ago. The clinic offered polygenic screening. Not for diseases. For traits.

She could see estimated cognitive ranges. Predisposition to anxiety. Cardiac risk. Emotional regulation scores. All framed as information, not as a choice. But of course it was a choice, because once you've seen the spreadsheet, not choosing is also choosing.

She picked the embryo with the best profile. She used exactly that word — best — and then corrected herself immediately. "Healthiest," she said. "I mean healthiest."

I didn't push it. But I've been thinking about that correction ever since.

We're not good at distinguishing between care and control. They feel identical from the inside. You screen for a cardiac defect because you love your child. You screen for anxiety predisposition because you love your child. You screen for higher estimated cognitive range because you love your child. At no point does the feeling change. The motivation is consistent. The logic is airtight. And somewhere along the way, you've crossed a line that you can't see because you were looking at a spreadsheet.

This is the territory I'm writing about in The Careful Ones, the story I'm serialising here. Tuesday's chapter — "The Argument" — is about what happens when someone on the other side of that spreadsheet does the maths. When the person who has the trait you screened out is sitting across the table from you, and they're family, and they're not angry, exactly. Just precise.

I won't say more than that. You should read it cold.

The polygenic screening industry is real and growing. Companies like Genomic Prediction and Orchid already offer embryo scoring for IVF patients. The science is probabilistic — these are risk estimates, not guarantees — but the interface is a ranked list. You see your embryos in rows. Each row has scores. One row is better than the others. The clinic tells you it's your choice. They're right. That's the problem.

Because "your choice" assumes you can make it neutrally. That seeing the scores doesn't change you. That knowing Embryo D has a higher anxiety predisposition and a lower cognitive estimate doesn't make you see Embryo B differently. But it does. It has to. That's what information does — it reorganises your preferences before you've noticed them shifting.

Nobody is being coerced. Nobody is being lied to. The process is voluntary, transparent, and wrapped in careful language about health and wellbeing. Every single person involved is being reasonable.

That's the thing about systems that work as designed. The problem isn't malice. It's the compound effect of a thousand reasonable decisions made by people who love their children.

The information isn't going away. It's going to get better — more markers, tighter estimates, cleaner interfaces. And every improvement will make the choice feel more responsible, more careful, more like the obviously right thing to do.

What I wonder about is whether some kinds of creativity depend on the traits we'd screen out. Not all creativity — not the disciplined, structured kind that looks good on a profile. But the restless, uncomfortable kind. The kind that comes from a mind that won't settle, that notices the wrong things, that can't stop pulling at a thread everyone else has agreed to leave alone. Anxiety is a clinical word for something that, in the right context, is also a kind of vigilance. Sensitivity is a risk factor on a spreadsheet and a prerequisite for a certain type of art.

Maybe that's too neat. Maybe the link between discomfort and insight is romanticised, and screening for emotional regulation just produces calmer, happier people who are creative in different ways. I don't know. But I notice that the uncertainty only runs in one direction — the clinics are very sure about what they're selecting for, and very quiet about what might be lost.

The careful ones may not be wrong. That's what unsettles me. They may just be making a trade they can't fully see, in a currency nobody has learned to count yet.

The Careful Ones is serialising weekly on this newsletter. Chapter 2, "The Argument," goes out on Tuesday. If you haven't read Chapter 1, you can start here.

My debut collection Surfaced explores similar territory — seven stories about people living inside systems built to help them.