SCIENTIST: “You’ve already specified blue eyes, dark hair and fair skin. I have taken the liberty of eradicating any potentially prejudicial conditions – premature baldness, myopia, alcoholism and addictive susceptibility . . .”
MOTHER: “We didn’t want diseases, yes.”
FATHER: “We were wondering if we should leave some things to chance.”
SCIENTIST: “You want to give your child the best possible start. Believe me, we have enough imperfection built-in already. Your child doesn’t need any additional burdens.”
When Gattaca was released in 1997, Sony promoted the film with advertisements for a ‘Gattaca’ company with the tagline “Children made to order.” Within days, the toll-free number for the made-up company received tens of thousands of calls, indicating surprising demand from potential parents for genetic engineering.
Twenty years ago, the prospect of parents choosing the genes of their children was still science fiction; today, the plot of Gattaca is becoming a little more plausible.
Last fall, Chinese scientist He Jiankui claimed to have edited the genes of two newborn twin babies. As reported late last year, He recruited couples for an “AIDS vaccine development project” at a university in Shenzhen, China. After creating embryos from the eggs and sperm of the couples, He used a technique called CRISPR to attempt to delete part of a gene named CCR5. Scientists have discovered that a broken CCR5 gene conveys resistance to HIV infection, and so in theory intentionally damaging the gene could provide the same resistance. However, the use of CRISPR on human embryos that will be born is untested and almost certainly unsafe, which is why He’s work was immediately condemned by scientists and ethicists around the world.
Yet while He’s work was unprecedented, it was not unexpected. Since the development of CRISPR in 2012, there has been growing interest in the potential of this novel technique for modifying human genes. CRISPR is a gene editing technology where short genetic sequences called “Clustered Regularly Interspaced Short Palindromic Repeats” guide associated CRISPR proteins to cut DNA. In nature, these sequences exist in bacteria to defend against invading viruses. In the laboratory, this system can be used to modify genes in all sorts of ways.
In January 2013, two different teams of scientists announced that they had used CRISPR to cut genes in human cells, which were then repaired into a different form. Since then, research into the application of CRISPR to treat human diseases has become a burgeoning field.
There is, however, a critical difference between most research into human gene editing and He’s work. The aim of mainstream scientists has been to edit the genes of somatic cells, cells which are not involved in reproduction, meaning that any altered genes would not be inherited by future generations. This means that the positive and negative effects of the editing will be limited to the individuals directly treated. For example, a clinical trial in Germany is looking at treating beta thalassemia by extracting blood cells from patients, editing a gene in those cells to increase hemoglobin production, and then re-injecting the modified blood cells.
In contrast, manipulating human embryos means that genetic sequences in potentially every cell are affected, including the germline cells involved in reproduction. Thus, if the twins He has modified eventually have children of their own, they may pass on genetic changes to their descendants.
A Case Against
In theory, inheriting a cure for a genetic disease like cystic fibrosis or beta thalassemia seems like a good idea, as it would avoid the need for costly treatments to be repeated every generation. Nevertheless, in 2015 two groups of scientists, including some of the leaders in CRISPR development, penned editorials for the journals Nature and Science calling for a moratorium on germline genetic modification. They gave several reasons for caution in using CRISPR on embryos, including a lack of necessity: “we cannot imagine a situation in which its use in human embryos would offer a therapeutic benefit over existing and developing methods.” They also voiced concerns about the reliability of CRISPR, and its potential to alter genes other than those intended.
Confirming these fears, initial data from He’s experiment indicates at least one of the twins has both edited and unedited versions of the gene, which would make them just as susceptible to HIV as the general population. It is also unclear if genes other than CCR5 have been damaged by the process, a serious risk that could lead to introducing genetic diseases that weren’t present before, or even creating new ones. Finally, studies have shown that individuals with a broken CCR5 gene are also more susceptible to being killed by influenza, a very common disease. Thus, even if it had worked, He’s purported “AIDS vaccine” would carry significant drawbacks.
The fact that He’s research was unsafe, unnecessary, unethical and will have life-long consequences for those involved has reinvigorated calls for a global ban on germline genetic editing. Indeed, the genetic manipulation of human embryos is already illegal in 40 countries, including Canada. However, it is not yet outlawed in China, the United States, or many other countries, and if CRISPR research progresses to a point where scientists are able to demonstrate human gene editing is safe and reliable, regulations may be loosened.
Some Considerations for Christians
Regardless of what governments do to regulate this new technology, it is worth considering the interest in human genetic engineering recorded by the 1997 Gattaca hotline, and how we should respond. In particular, if gene editing becomes commonplace, should Christians avail themselves of it? Is research into gene editing a continuation of long-standing Christian commitments to care for the sick? Or an unnatural form of ‘playing God’?
In considering the ethics of genetic editing and engineering, two distinctions are crucial. One we’ve already made is between somatic (or non-reproductive) changes and germline (or inherited) alterations. Because germline modifications would affect future generations, most scientists and ethicists believe they are harder to justify than somatic changes. However, there are also ethical questions about somatic alterations, especially those that do not address a clear medical need.
Asking about the goals of genetic modification leads into a second major distinction between genetic therapies, genetic enhancements, and genetic experiments. A genetic therapy aims to cure a disease such as Tay-Sachs or Huntington’s disease, while efforts to guarantee blue eyes, dark hair or fair skin would be genetic enhancements. The line between therapy and enhancement can be blurry in some cases; for example, we may ask if premature baldness is a true threat to health or more of a cosmetic concern. Still, the distinction is widely used in bioethics and healthcare, including whenever dentists, doctors or insurers differentiate between medically necessary and elective treatments.
Finally, changes that are neither curative nor cosmetic are best classified as genetic experiments, done solely for the purpose of expanding human knowledge. Despite He’s claims to be helping children, his clear carelessness and the drawbacks even if he had succeeded suggest he was engaged in genetic experiments, not therapies. Combining these two distinctions provides us with six categories that cover the spectrum of human genetic modifications, ranging from germline genetic experiments to somatic genetic therapies.
Rules For Playing God
How then should Christians assess these different forms of genetic alteration? Like the late Reformed theologian Allen Verhey, I believe there is considerable potential in taking the idea of “playing God” seriously. In his reflections on this phrase, Verhey quotes Eleanor Graham in Should Doctors Play God?
“If I were an actress who was going to play, let’s say, Joan of Arc, I would learn all there is to learn about Joan of Arc. And, if I were a doctor or anyone else trying to play God, I would learn all I could about God.”
In a contribution to On Moral Medicine: Theological Perspectives in Medical Ethics, Verhey selects three images of God as relevant to new genetic technologies: God as creator, God as healer, and God as the one who takes the side of the poor. In terms of God as creator, Verhey suggests Christians should start by praising God for the wonder of creation, including the structure of DNA. Next, he agrees that human beings are given creativity and dominion by God – but immediately cautions that this should be done “in response to God, in imitation of God’s ways, and in service to God’s cause.”
What does the faithful exercise of these gifts look like? In Reading the Bible in the Strange World of Medicine, Verhey argues we can know God’s character through Jesus; so because Jesus was a healer, we can be confident that God is a healer. Certainly, Jesus’ healing ministry has inspired generations of Christians to set up hospitals, train as doctors and nurses, and contribute to medical research. However, Verhey contends we should always treat people as ends in themselves, rather than merely tools to be used for advancing knowledge or the human race as a whole. Thus, while Verhey believes genetic therapies should be celebrated, he holds genetic enhancements should be refused, as should genetic experiments on children which provide no clear benefits to them, and sees no justification for germline modifications of any sort.
Initially, Verhey’s analysis suggests somatic genetic therapy is the only acceptable form of genetic editing for Christians, but a common challenge to his position is that the line between therapy and enhancement is constantly moving. For example, if we discover genes that improve height, reflexes, and strength to be above average, could not their absence be considered a disorder? However, an important rejoinder is improvements to these features primarily provide a competitive advantage for certain activities, rather than an intrinsic benefit for all areas of life. Indeed, in many ways being taller is an advantage only if other people are shorter, which suggests that such alterations should not be considered the moral equivalent of a cure for sickle cell anemia.
The question of the social effects of enhancement brings Verhey to his third image, of God as the one who takes the side of the poor. In a world with growing inequality, should we devote scarce resources to genetically producing stronger, smarter and better-looking children? The usual solution, of giving access to those who can pay for it, risks the creation of a permanent divide between a wealthy, genetically enhanced upper class and a poor, genetically unenhanced lower class – not unlike that envisioned in Gattaca. Thus, Verhey argues we must guard against the temptation to seek perfection through genetic technologies, and leave medicine to promoting health, while we “work on becoming the kind of society that practices hospitality to those who are different from us.”
Although safe and practical human genetic engineering is not yet a reality, the advent of CRISPR technology and the willingness of scientists like He to break ethical boundaries suggests such a future may arrive faster than anticipated. Still, the distinctions and arguments developed by theologians like Allen Verhey provide valuable tools to guide Christians as they approach this brave new world. In particular, Verhey challenges the church to continue its age-old practices of healing the sick and providing hospitality for the poor and outcast, without being distracted by the prospect of “children made to order.”
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