BIOETHICAL

CONCEPTS, PRINCIPLES
AND THEORIES
 QUICK ■ JOURNAL
RECAP
CRISPR-Cas9 gene editing concept
– Shenzhen, China
– Used CRISPR-Cas9
• Uses artificial 20-base guide RNA
(gRNA) that binds to Cas9 => breaks
modification of embryo =>
the DNA => disruptive mutations implant => Lulu and Nana
(nonhomologous for random and – CCR5
homologous recombination for specific
■ CCR5d32
mutations) => product will be
introduced to a cell => remodel cancer ■ Goal: create HIV resistant
or other disease babies
■ Ethical concern: germline
• Edit mutations
gene editing
• Eliminate “less” desirable traits
 ■ CCR5d32
– NOT the only variant of CCR5
■ PROBLEM:
– Nana

MUTATIONS ■ 2x Frameshift mutations (1-base

pair insertion ; 4-base pare

DURING
insertion)
– Lulu
THE ■ 1x 15-base pair deletion
– No effort to fully understand the
EXPERIMEN effect of alterations made.
T – Embryos should NOT be
implanted if the scientists are
unsure of the effects
 ■ His team did not test the cells of
the girls therefore it is possible
that the experiment failed to
produce HIV resistant babies
■ CCR5
– Immune response
PROBLEMS – More symptomatic infection
and higher mortality rates
(esp. in patients with west
nile virus, inlfuenza A and
tick-borne encephalitis)
■ Engage in riskier sexual practices
 ■ CLINICAL RESEARCH
ETHICS
– The researcher only registered the trial
AFTER the twins had already been
born
– Significant ambiguity as to the
ETHICAL informed consent process in the study

ISSUES ■ Couched as “HIV vaccine trial”

■ Parents did not fully understand the
concept of mosaicism or increased
susceptibility to infections because
it was not in the manuscript of the
researcher
– Inclusion criterion
■ HIV+ father
■ HIV- mother
 ■ CLINICAL RESEARCH
ETHICS
– Study participants should be able to
voluntarily withdraw
■ Reimburse everything prevented
them to withdraw
ETHICAL – Unclear whether the research
ISSUES underwent an ethics review
– Shenzhen Harmonicare Women’s
and Children’s Hospital denied that
the study was approved
– A number of regulations were
violated
– The researcher’s background was in
physics and has NO medical training
 ■ SOCIOECONOMIC
DISPARITIES
– MAJORITY of people opposed genetic
engineering for ENHANCEMENT
“playing God”
– For medical needs => more expensive
ETHICAL ■ Should rich people be the ONLY ones

ISSUES protected from suffering chronic

diseases
■ POSSIBLE STIGMA
– backlash
■ INSURANCE
– Will those who have had their genes edited
pay more because of possible off target risk
or negative consequences of gene editing
 ■ Change basic building blocks of
humanity
■ Open market for human eggs
=> exploitation of
OTHER disadvantaged women
PERSPECTIV ■ Embryos should not be used for
E research
■ Um-implanted embryos should
not be destroyed
■ Biohackers