It is entirely speculative at this point whether technologies to alter the human germ line will develop to the point where they are deemed safe and effective enough to be made available to prospective parents, much less considered ethically acceptable. But even the possibility that such profound technologies might be used has prompted intense debate. The scientific, ethical, moral, and social issues raised by these technologies have been debated in this volume and elsewhere. Missing in the discussion thus far, however, have been the perspectives of the couples or individuals who might consider the use of such technologies, consideration of the clinical or research setting in which these technologies might be offered, and the impact of that setting on couples, or the perspectives and concerns of the health professionals and researchers who may be in the position of counseling the families and providing the services. Additionally, the public has not yet been invited into the discussion in any meaningful way. In the interest of extending the debate, this discussion will try to anticipate some of the patient, genetic counseling, and application aspects of technologies developed to alter the human germ line and articulate the need to include many more voices and perspectives in the debate. Some may consider this discussion premature, perhaps even inappropriate at this point in time, but given the speed with which scientific progress is made, it seems prudent to at least introduce these issues into the debate.