The gene therapy market is showing steep rise, with the largest pharmaceutical companies continuing to snap up biotechnology startups. However, in their pursuit of profit, businesses sometimes forget that creating new forms of life and playing God is not always a virtue. Molecular genetics and related research and engineering methods enable changes to living bodies that scientists of the past could not even imagine – cloning, innovative treatment, therapeutic and germline gene therapy, embryo selection by genotype, creation of microorganisms with predetermined features, plants with human or animal genes and more.
The possibility of modifying the genome has predictably raised several ethical issues.
Human reproductive cloning
One of the first issues in human cloning has to do with the high death toll of embryos. Chinese scientists at Sun Yat-sen University in Guangzhou have experimented with modifying the gene responsible for beta-thalassemia (a potentially life-threatening blood disorder) using the gene editing technique known as CRISPR/Cas9. However, only 28 of 86 embryos survived, and only a few surviving embryos tested to a successful replacement of the specific base in their genetic code.
In addition to the large percentage of dead embryos, the scientists also found a large number of non-targeted mutations that unpredictably affected other parts of the genome. Scientists are now experimenting with another genome editing technology, TALEN, which promises greater accuracy and lesser side effects.
The prospect of finding a cure for serious or lethal diseases through gene therapy can indeed be of great benefit to many patients. Scientists are also considering the possibility of producing ‘spare parts’ for the body or its organs, such as replacement kidneys or hearts. In some countries, such as the United States, a cloned embryo’s development can be legally interrupted in the first 14 days to obtain stem cells. Russia recently adopted a number of restrictions on such activities.
Actions including “creating a human embryo for the production of biomedical cell products” and “the use of biological material obtained by interrupting the development of a human embryo or fetus or disrupting such a process for the development, production and use of biomedical cell products” were made illegal in 2018.
Moreover, the temporary ban on human cloning adopted in 2002 is still in force.
Prenatal screening and discrimination
Examples of differences in applying moral theories to genetics can be found in discussions of prenatal tests and possibility of abortion for medical reasons. If a fetus is stricken with a severe disorder that will condemn the child to lifelong suffering, this medical reason is beyond argument. The unresolved question is whether it is justified to abort a pregnancy because the fetus carries a gene predisposing the future baby to a disease but not yet revealing itself. From the moral perspective, depriving an embryo of its right to become a human only based on any probabilistic assumption is a typical case of genetic discrimination.
But from the standpoint of ethics, the laws protecting embryos will continue to exist only until American, British or Chinese scientists, who are not subject to their countries’ legislative bans on embryo experiments, will succeed in treating first hereditary diseases. Germline therapy is likely to become commonly permitted if the accuracy of embryo genome editing is significantly higher and the consequences are thoroughly studied and present less of an issue than the disease itself. With an effective germline therapy, the need for an abortion due to genetic reasons will no longer be relevant.
As utilitarian as it may sound, the idea of having a super baby for several tens of thousands of dollars seems to be an excellent investment even if there is no place in kindergartens for your future baby and parents live cooped up in a tiny rental apartment. Technically, the possibility of editing a human genome already exists but in many countries planting a “manipulated” egg into a woman’s body is a criminal offense. The legislative ban on upgrading human embryos seems to be ethically correct as well, especially considering the huge amount of embryonal “waste” produced in the course of editing.
Environmental consequences
Just like availability and unlimited use of antibiotics resulted in the emergence of resilient infectious agents 50 years later, gene therapy may turn our planet into a lifeless desert just as easily as a nuclear war. Vectors pose a particular danger as these viruses, modified for the purposes of genetic engineering, usually do not trigger an immune response from the infected organism.
Viruses are already highly prone to uncontrolled mutation and DNA exchange with carrier cells. The outcome of mutations in modified viruses is absolutely impossible to predict.
The successes of modern virology do not mean that scientists will be able to outrun new fast-moving deadly virus strains that cannot be recognized by the immune system.
A representative example is the current outbreak of 2019-nCov coronavirus in China. According to virologists, the new strain appeared as a result of DNA recombination of viruses that are known to infect bats, snakes and humans. Some publications also suggested that the virus could not appear the natural way. In any case, despite the unprecedented measures taken by the Chinese government and global community, the virus continues to spread, the vaccine has not been developed yet, and the only preventive measures include imposing a quarantine and decontaminating commonly touched surfaces.
Public control
The adoption of the Universal Declaration on the Human Genome and Human Rights by UNESCO in 1997 prohibited any form of discrimination of people due to their genome, but global community is still deeply concerned about genocide wars. Unfortunately, discrimination is still common on the basis of race, ethnicity, sex or gender identity. The identification of certain genetic markers of these groups of people will provide new opportunities for eugenics programs, ethnic cleansings and genetically directed biological wars or terrorist attacks.
The legal prohibition of experiments with human genome does not always work. For instance, in 2019, a Chinese scientist was sentenced for three years in prison for editing two embryos’ genes in an attempt to confer genetic resistance to HIV, which led to the birth of genetically modified babies. In fact, there are currently no obstacles except ethical ones to the use of ‘new genetics’ for malicious purposes, while the cheapening technology and the accessibility of instructions on how to do it will make gene editing accessible to everyone.
Religion and gene editing
From a Buddhist point of view, most technologies are neither good nor bad in themselves. Since Buddhism does not romanticize nature or ‘being natural,’ it is open and ready to adapt to any changes, which means that progress, any new technology or social changes are not a problem. On the other hand, a very close interdependence between all things makes Buddhists think of how to avoid negative consequences of the use of technology and believe that progress should be aimed at general improvement in all areas, such as social, economic, environmental and others.
In the Islamic community, there is no consensus on this issue. On the one hand, according to the Quran, any action that changes creations of Allah is considered Shaitan’s instigation (4:118-119) and is therefore forbidden; on the other hand, even the most avid Muslims agree that there should be natural exceptions to the rule – for instance, for medicine, pharmaceutics and agriculture. Balancing these viewpoints still remains a matter of blazing debates among Muslim theologians (which we cannot give the links to due to Russia’s anti-extremism laws).
Christians have differing views as well, ranging from a relatively neutral stance, which argues that the DNA is far from being a sacred thing that cannot be messed with, to an ardent opinion which claims that “the road to medical fascism is paved with good intentions.” Yet, due to the fact that genetic engineering is not directly mentioned in the Bible but there are numerous mentions of unusual creatures such as unicorns (Numbers 23:22), talking serpents and giants (Genesis 6:2-4), cherubs (Ezekiel 1:5-24) and other creatures, believers only have to go with the clergy’s opinions that they are most comfortable with.
Judaism has a pragmatic approach to genetic engineering: followers of this religion believe that genetic manipulation does not imply a forbidden merge of two living organisms and is not breeding in the halakhic sense – and thus, genetic modification is rather acceptable.
The future of gene therapy
Scientists still seek ways to use gene therapy with great caution by preferring modifications that are not inherited. This seems reasonable because as soon as all hereditary diseases are cured there are no reasons for genes to be passed on to the next generation.
Researchers have high hopes for transfection, a process of deliberately introducing naked or purified nucleic acids into eukaryotic cells – but its efficiency is questionable, if only because one-time transfections cannot result in long-time recovery effects and its repeated application poses a higher risk of allergic reactions. Long-time improvement is possible only with DNA constructs integrated into cell genome, which poses a risk of degeneration and cancer.
We should not expect miracles from gene therapy; it will possibly have the reverse effect in the long run. Since mutations occur independently but never disappear on their own, minor and serious hereditary diseases may someday become as common as defective vision is today.
It is yet unknown whether people will ultimately be able to derive benefit from this technology.
By Christina Firsova