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in the genes and chromosomes rather than in their phenotypic effects and, further, to control and produce at will new combinations of genetic traits in offspring. 1. Sexual Selection: To determine the sex of the fetus by selecting sperm that do or do not have the Y chromosome that determines maleness and then using selected sperm for artificial insemination or in vitro fertilization and implantation. 2. Splicing genes and influencing the genotype of lower forms of life, must also be subjected to the same ethical norms as other research protocols. Superior Human Beings: Recombine genes in the nucleus of a zygote, probably by using viruses that can incorporate a section of a chromosome derived from one nucleus and fixing it in a chromosome of another (transduction). Unethical, on the grounds that it would be usurpation of God’s creative power (principle of stewardship).
HUMAN GENE THERAPY AND GENETIC ENGINEERING Types of Genetic Intervention:
Cure of disease Enhancement of capabilities 3 4
I. Cure of Disease: Type 1 - aims to cure a condition that is generally acknowledged to be a disease by genetically altering the non-reproductive cells of a patient. Done thru “bone marrow transplantation with an extra step.” Examples of diseases that can possibly be cured: 1) the bone-marrow cells of a patient suffering from sickle cell anemia may be able to be treated and the patient cured of his or her disease. However, this cure would not be transmitted to the patient’s descendant. 2) adenosine deaminase (ADA) deficiency, which causes the total collapse of children’s immune systems. Type 2 - both somatic (nonreproductive) and reproductive cells would be treated, so that the changes of the genetic “cure” would be passed on to the patient’s descendant. (Depending on the type of genetic alteration
and the stage of development at which it were performed, it is possible that only some of the patient’s descendants would be cured.) Studies of this have been done in mice.
Enhancement of capabilities: Type 3 - doubling the efficiency of an individual’s long-term memory based on somatic cells alterations. Type 4 - if enhancement of individual’s long-term memory is based on both the somatic & reproductive cells, the long-term memory efficiency would also be passed on to at least some of the subject’s descendants.
APPLICATION OF ETHICAL THEORIES Pope John Paul II - “a strictly therapeutic intervention whose explicit objective is the healing of various maladies such as those stemming from chromosomal defects will, in principle, be considered desirable, provided it is directed to the true promotion of the personal well-being of the individual without doing harm to his integrity or worsening his conditions of life. Such intervention would indeed fall within the logic of the Christian moral tradition.”
ETHICAL CONSIDERATIONS Type 1 proposed for use with human patients. Technique will be qualitatively similar to other biochemical innovations, like kidney transplants. the probable benefit/harm ratio is not Proportional to Possible benefits (rationale):
Type 2 -
cells in some parts of the body can only be reached and effectively treated if gene therapy is administered very early (embryonic stage of development). This can treat otherwise unreachable brain cells, thus preventing the brain-based disease from occurring in the future person. Principle of efficiency: - it is more reasonable to correct a defect once, through germ-line gene therapy, and to have that correction passed on to the subject’s descendants than to repeat somatic-cell gene therapy, generation after generation, in a family afflicted by a genetic disease. (Only some of the subject’s descendants would receive the properly-functioning added gene, while others would receive only the malfunctioning gene).
Possible risks: a) Major obstacle is technical. Large majority of embryos into which added DNA is microinjected, either do not survive the injection procedure, do not implant, do not survive because of a new lethal mutation, or do not express the added gene or genes. Therapeutic interventions during the embryonic stage, one would not know in most cases whether a particular embryo were destined to be afflicted with a genetic disease. the “touch down” of the retroviral vectors is not possible to control. Vectors may disrupt properly-functioning genes and therefore kill some cells; vectors may activate some previously dormant cancer-causing genes; the domesticated retroviral vectors may recombine with other DNA or other viruses and so recapture their native capacity to produce more retroviruses and to infect large number of cells;
Types 3 & 4 - Ethically unacceptable a) b) a manifestation of hubris (an attempt to play God). Such a program would inevitably lead to eugenics, an attempt by society to coerce everyone to participate in the genetic improvement program. Such a program would be utopian; it would attempt to develop a perfect human being or a perfect society. Different culture have different ideals and that therefore human beings would not be able to agree on which traits are better or worse for them.
GENETIC INTERVENTION: 1. Genetic therapy 2. Genetic surgery 3. Genetic splicing To use human embryos or fetuses as the object or instrument of experimentation constitutes a crime against their dignity as human beings having a right to the same respect that is due to the child already born and to every human person. (Shannon 1987: 599-600).
It is done with the purpose
GENETIC CONTROL: PRENATAL DIAGNOSIS: IN VITRO FERTILIZATION: EMBRYO TRANSFER: CLONING:
of aborting the fetus if it is found to be deformed, hence, it is to be condemned as a violation of the unborn child’s right to life. Constitute an offense against the respect due to human beings by manipulating them.
SURROGACY: - contrary to the unity of marriage and to the dignity of the procreation of the human person. SPLICING GENES - and influencing the genotype of lower forms of life must also be subjected to the same ethical norms as other research protocols. SUPERIOR HUMAN BEINGS: Recombine genes in the nucleus of a zygote, probably by using viruses that can incorporate a section of a chromosome derived from one nucleus and fixing it in a chromosome of another (transduction). Unethical, on the grounds that it would be usurpation of God’s creative power. (principle of stewardship). (7) CONCLUSIONS
It is more feasible, technically and ethically, to improve the human condition by improving the environment and development of the individual, that is, the phenotype, than by modifying genetic endowment, that is the genotype, and priority in research and investment of medical resources should be given to the former effort. Genetic research is extremely important, however, to understand the interactions of genotype and phenotype. Presently proposed methods of genetic reconstruction of human beings involve in vitro fertilization and other procedures that are ethically objectionable because they separate reproduction from its parental context and involve the production of human beings, of whom some will be defective because of experimental failure and who will probably be destroyed. This contravenes the basic principles of ethical experimentation with human subjects. Proposals to improve the human race by sex selection, cloning, or genetic reconstruction are ethically unacceptable in the present state of knowledge. Unless limited to very modest interventions, they would restrict the genetic variability important to human survival, and they would separate reproduction from its parental context.
If the foregoing problems can be overcome, it will be ethically desirable to develop and use genetic methods
for therapy of genetic defects in existing embryos, keeping in view the risk-benefit proportion. The principle of stewardship throws light on many of the problems of human reconstruction. Natural law should not be conceived of as a fixed pattern of human life to which human beings are forever confined. Rather, the Creator has made human beings free and intelligent, and it is precisely this intelligent freedom that is human nature and the foundation of natural moral law. Human intelligence, however, is not disembodied but depends on a brain and a body that have a specific structure. In caring for their total health, persons not only have the right but the obligation to understand their psychological and biological structure and to improve themselves even in ways that may seem novel to past generations. Such improvement is good stewardship of the share in divine creativity with which God has endowed mankind. In particular, Christians should be concerned that such innovations do not weaken the fundamental relations within the family or the sense of the child as a unique gift of God. At the same time, persons must use this creativity with profound respect for God’s existing creation and especially for their own psychological and biological mode of existence, lest by tampering with their brains or the rest of their personalities they should undermine the freedom and intelligence on which this creativity depends (principle of totality). Consequently, the use of surgery and genetic manipulation to improve their bodies is ethically good, provided that they take full account of such risks and are not carried away by a false ambition to work technical miracles without regard to their real meaning for human living. (9)
ETHICAL and PUBLIC POLICY ISSUES
1. 2. 3. 4.
Freedom and coercion in genetic testing and screening Confidentiality or disclosure of test results Access to genetic testing services Probable benefits and harms of genetic testing and screening programs
Freedom and Coercion: “ethics of genetic duty” – individuals and couples have a moral duty to learn what they can about the likelihood that they will transmit genetic conditions to their offspring and to take steps that are compatible with their other ethical convictions to avoid causing preventable harm to their descendants. Confidentiality and Disclosure: Who, besides the individual and his or her health provider, should have the access to the information about the genetic condition? Two contexts: 1. Extended family context – Individuals or couple who learn that they have genetic disease or carry a genetic trait may face decisions about whether to inform their parents, their siblings, their children, and even more distant relatives.
involve either employers or insurers. “the potential for misuse as well as unintended social or economic injury, information about genetic conditions should be disclosed to insurers or employers only with the explicit consent of the person tested”. POSSIBLE BENEFITS AND HARMS: A. Principal benefits: 1. knowledge 2. the ability to avoid transmitting genetic disease to offspring 3. the ability to secure timely treatment for a genetic condition. 4. may help to “democratize” genetic disease - it may become clearer that visible and invisible genetic problems are simply an omnipresent aspect of the human condition Possible harms: 1. through coercion 2. through leading to exclusion from the work force or the health care system 3. through providing incomplete information or partial services. 4. a positive genetic test may result in the stigmatization of the individual tested.
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