Genetic Engineering (Part3)
Reply by Jack P. Freer, MD
JFreer@ubmedb.buffalo.edu
as416@freenet.buffalo.edu
In this final message, I will attempt to provide an overview of the ethical issues surrounding (germ line) genetic research and intervention. The first type of problem concerns the preliminary work of investigating the human genome. The first step in treating genetic disorders is to identify exactly what genetic sequence is responsible for the trait. Currently available technology has permitted scientists to rapidly "crack the code" in the DNA molecules of our genes and chromosomes. While this is certainly a necessary first step toward *TREATING* genetic disorders, it is usually quite a while later that treatment/prevention is available (if ever). That means that there will always be a period of time in which we can identify individuals who will later develop illness, but have no treatment or prevention available for them.
Knowing that one is genetically determined to develop an illness, and yet be unable to do anything with that knowledge is troublesome to many people. Furthermore, as suggested in an earlier discussion, this will also apply to many illnesses *NOT* usually thought of as genetic (such as Alzheimer's, alcoholism, and many if not all cancers). This is because the susceptibility to many diseases is also genetically determined. As our knowledge of the human genome grows, so will the list of diseases which can be predicted years in advance, with no hope of prevention.
As troubling as that may be to some people, there are more serious consequences that will almost certainly occur. If a test becomes available which will predict an individual's tendencies toward certain illnesses, that will likely be exploited by insurance companies and employers. Just as life and disability insurers now require blood tests and physical exams to assure optimal health (or determine the cost of the insurance if "rated"), they will certainly wish to use the developing technology to determine if the applicant is at risk for diseases which will cost them money in the future. Similarly, employers would want such information to reduce absenteeism from alcoholism, etc.
The second type of problem relates to the other side of the process, the actual genetic manipulation of germ line therapy. As we have suggested, somatic cell therapy is not terribly controversial because it does not alter the patient's germ cells. Any modification in somatic cells, ends with the death of that patient. Germ cell therapy however, alters the genetic make up of countless future generations. The sheer enormity of that impact is so awesome that it demands serious attention before we meddle with the very essence of what determines who we are. Thoughtful scientists have for some time, been concerned about the consequences of selective breeding livestock, and crops to meet our perceived needs. Invariably, there are surprises that could never have been predicted, since we never know ALL the different variety of traits and characteristics that derive from a given bit of genetic material. This unknowable information (ALL the future consequences of genetic manipulation) is a serious deterrent to germ line therapy in humans, since it will almost certainly be irrevocable once the change spreads through the population.
Another aspect of this dilemma is the problem of "genetic enhancement." If we can alter genes to prevent illness, why not do it to enhance our offspring to make them "more desirable." They could be made stronger, smarter and more attractive if we choose. This is another frightening thought, since it raises serious issues about eugenics and how we treat people in our society who are "less desirable."
I would like to stop at this point and invite readers to submit further questions or comments in regard to this issue. I have only given a brief overview and would be happy to pursue this further if anyone has specific thoughts on any of this. I will attempt to put together a reading list, but for now a good overview (although somewhat technical) is the issue of Journal of Medicine and Philosophy, vol. 16; no. 6 (1991).
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Jack P. Freer, MD
JFreer@ubmedb.buffalo.edu
as416@freenet.buffalo.edu
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