Germ- -line Genetic Therapy line Genetic Therapy Germ Munson- - - PDF document

Germ-line Genetic Therapy Medical Ethics 1

Germ Germ-

• line Genetic Therapy

line Genetic Therapy

Munson Munson-

• Davis Look Bravely at a

Davis Look Bravely at a Brave New World Brave New World

Genetic Treatment Genetic Treatment

Hardest to justify? Hardest to justify?

Germ Germ-

• line

line

Easiest to justify? Easiest to justify?

Somatic cell Somatic cell Enhancement Enhancement Curing Disease Curing Disease

• Is there a clear distinction between treating disease and enhancement?
• Should we regard genetic intervention differently from other medical

interventions; e.g., psychiatric medications or psychosurgery?

• See http://www.bioethics.gov/reports/beyondtherapy/index.html

Germ Germ-

• line Genetic Therapy

line Genetic Therapy

► ► A revolutionary possibility: change the genetic

A revolutionary possibility: change the genetic endowment of individuals endowment of individuals and descendents and descendents

► ► (Overview)

(Overview) Arguments against it: it

Arguments against it: it tampers tampers with with

• Individual rights

Individual rights

• The social order

The social order

• The order of nature /

The order of nature / “ “playing god playing god” ”

► ► It

It’ ’s a prelude to positive eugenics s a prelude to positive eugenics

► ► It may cause unpredictable genetic losses

It may cause unpredictable genetic losses

► ► It threatens

It threatens “ “humanity humanity” ”

Germ-line Genetic Therapy Medical Ethics 2

Distinguish Different Kinds of Opposition Distinguish Different Kinds of Opposition

► ►Consequentialist form of objection

Consequentialist form of objection

• We don

We don’ ’t know enough; we t know enough; we’ ’ll mess it up ll mess it up

• Risks outweigh benefits

Risks outweigh benefits

► ►It is

It is inherently inherently wrong (why?) wrong (why?)

• Even if we could be totally assured that benefits

Even if we could be totally assured that benefits

• utweigh risks, it
• utweigh risks, it’

’s still wrong s still wrong

• “

“Tampering Tampering” ”? ?

• Is this a purely religious objection?

Is this a purely religious objection?

Tampers with Individual Rights Tampers with Individual Rights

► ► Violates human dignity, the right to a

Violates human dignity, the right to a “ “pristine pristine genetic inheritance genetic inheritance” ”

► ► Tampers with body, but so does all therapy

Tampers with body, but so does all therapy

► ► Cannot obtain

Cannot obtain “ “informed consent informed consent” ” of descendents,

• f descendents,

but ( but (Munson/Davis

Munson/Davis) not

) not-

• yet

yet-

• existing people have no

existing people have no right of autonomy or informed consent right of autonomy or informed consent

► ► Right not to be harmed. Not absolute and the

Right not to be harmed. Not absolute and the small risk of harm is outweighed by the promise of small risk of harm is outweighed by the promise of very good consequences (freedom from horrible very good consequences (freedom from horrible genetic illness). genetic illness).

Tampering with Social Order Tampering with Social Order

► ►Many potential conflicts; e.g., demanding

Many potential conflicts; e.g., demanding therapy as condition of insurance or conflict therapy as condition of insurance or conflict

• f rich/poor for access.
• f rich/poor for access.

► ► Munson/Davis

Munson/Davis: these problems and conflicts

: these problems and conflicts “ “no no different in kind from those we already face. different in kind from those we already face.

► ►Crucial to consider whether

Crucial to consider whether genetics genetics and in and in particular particular germ germ-

• line

line therapy introduces therapy introduces something fundamentally new. something fundamentally new.

Germ-line Genetic Therapy Medical Ethics 3

Conflict with the Natural Order or Conflict with the Natural Order or “ “Playing God Playing God” ”

► ►Playing God

Playing God” ”

( Is it an objection worth raising? What does it mean?) ( Is it an objection worth raising? What does it mean?)

► ► Munson

Munson-

• Davis:

Davis: “ “what what’ ’s wrong with playing God? s wrong with playing God?” ” (p. 355)

(p. 355)

► ►It is a prelude to positive eugenics, but

It is a prelude to positive eugenics, but (Ramsey): (Ramsey): “ “man is not wise enough to make man is not wise enough to make himself a self himself a self-

• modifying system.

modifying system.” ”

► ►Which kind of objection is this:

Which kind of objection is this: consequentialist or inherent wrongness? consequentialist or inherent wrongness?

Munson Responds Munson Responds – – Eugenics Eugenics

(p. 355) (p. 355)

► ► No evidence negative eugenics will lead to

No evidence negative eugenics will lead to positive eugenics. positive eugenics.

► ► No reason to think just because we have a

No reason to think just because we have a technology we will use it. technology we will use it. (Are you reassured?)

(Are you reassured?)

► ► We don

We don’ ’t know if we have the wisdom or t know if we have the wisdom or not until we try. not until we try.

Unpredictable Losses Unpredictable Losses

► ►Objection: we may lose some good things

Objection: we may lose some good things by genetic modification; e.g., sickle cell trait by genetic modification; e.g., sickle cell trait protects against malaria. Others? protects against malaria. Others?

► ►Munson/Davis: we might decide the loss is

Munson/Davis: we might decide the loss is worth it for the benefits. worth it for the benefits.

► ►Critics who point to

Critics who point to “ “unforeseen disasters unforeseen disasters” ” cannot be satisfied. Must be weighed cannot be satisfied. Must be weighed against the promise of great benefits. against the promise of great benefits.

Germ-line Genetic Therapy Medical Ethics 4

Objection: It threatens Objection: It threatens “ “humanity humanity” ”

► ► Not likely to change our essential humanity;

Not likely to change our essential humanity; mutations have occurred throughout history. mutations have occurred throughout history.

► ► But maybe it will eventually make us no longer

But maybe it will eventually make us no longer “ “human. human.” ” Is this worrisome? Is this worrisome?

• Kass

Kass: : “ “it may mark the end of it may mark the end of human life human life as we and all as we and all

• ther humans have known it.
• ther humans have known it.
• Leenen

Leenen: We may create : We may create animal animal-

• human

human or plant

• r plant-
• human

human creatures.

• creatures. “

“When scientists When scientists transgress transgress [my emphasis] [my emphasis] the boundaries of what is human, they place themselves the boundaries of what is human, they place themselves

• utside human society.
• utside human society.”

”

(Munson, pp.356 (Munson, pp.356-

• 357)

357)

Munson/Davis: So what? Munson/Davis: So what?

► ► Maybe the plant

Maybe the plant-

• human combinations will view us

human combinations will view us favorably and be helpful to us! favorably and be helpful to us!

► ► Just because we are human gives us no special

Just because we are human gives us no special reason to favor reason to favor human human survival. survival.

► ► Would it be a good or bad thing if creatures

Would it be a good or bad thing if creatures develop that are develop that are superior superior to humans? to humans?

► ► (Munson/Davis)

(Munson/Davis) Unlikely in any case; we shouldn

Unlikely in any case; we shouldn’ ’t worry t worry about it. about it.

► ► “

“Attachment to our humanity cannot be adequate Attachment to our humanity cannot be adequate grounds for opposition to germ grounds for opposition to germ-

• line therapy.

line therapy.” ”

Are All Objections Unsound? Are All Objections Unsound?

► ► Munson/Davis: yes, they

Munson/Davis: yes, they’ ’ve all been shown to be ve all been shown to be unsound unsound

► ► All objections assume that our

All objections assume that our “ “tampering tampering” ” will will produce something worse rather than better. produce something worse rather than better.

► ► Hidden possible assumption: there is

Hidden possible assumption: there is “ “wisdom of wisdom of evolution evolution” ” guided by guided by “ “a good and wise Being a good and wise Being” ”; ; therefore, we must not tamper with His handiwork. therefore, we must not tamper with His handiwork.

► ► Munson/Davis: this is about as strong as

Munson/Davis: this is about as strong as “ “if god if god wanted us to fly, he wanted us to fly, he’ ’d have given us wings. d have given us wings.” ”

► ► Agree or disagree?

Agree or disagree?

Germ-line Genetic Therapy Medical Ethics 5

Germ Germ-

• line Genetic Therapy Not Only

line Genetic Therapy Not Only Permissible Permissible but a Medical but a Medical Imperative Imperative

► ► Medical research is not value

Medical research is not value-

• neutral. It aims not
• neutral. It aims not

just for pure knowledge but to just for pure knowledge but to cure disease. cure disease.

► ► Best way to confront disease is to prevent it.

Best way to confront disease is to prevent it.

► ► Germ

Germ-

• line therapy offers promise to rid ourselves

line therapy offers promise to rid ourselves

• f serious genetic diseases for which there is no
• f serious genetic diseases for which there is no

treatment. treatment.

► ► Therefore, medical profession has a

Therefore, medical profession has a prima facie prima facie

• bligation to employ germ
• bligation to employ germ-
• line genetic therapy.

line genetic therapy.

Prevent Disease and Enhancement Prevent Disease and Enhancement

► ► Munson/Davis focus on

Munson/Davis focus on “ “negative eugenics negative eugenics” ”: : improving the species by preventing disease. improving the species by preventing disease.

► ► Some favor that but oppose

Some favor that but oppose “ “enhancement enhancement” ” (positive eugenics). (positive eugenics).

► ► Is there a clear line between the two? Do Munson

Is there a clear line between the two? Do Munson and Davis insist on one? and Davis insist on one?

► ► Should we use genetic knowledge for

Should we use genetic knowledge for enhancement as well as disease prevention? enhancement as well as disease prevention?