Alex Tang
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Medical Students /Paediatric notes
The Ethics of Genome Editing
A Christian Perspective
This lecture was delivered at this international conference
Christian Biomedical Ethics Theological Framework
We need a framework to look at the rapidly advancing challenges of emerging new technologies. Technologies such a genome science, Big Data, Artificial Intelligence, and the Digital Person will redefine the structure and nature of our civilization within the next few years. Are these technology helpful or harmful? What should be the Christian faith communities’ respond to them? These new technologies would not be found in the Bible, a text that was written more than two thousand years ago. Where then are Christian to seek guidance for their discernment? A framework to guide our thinking is needed.
I suggest that a Christian biomedical ethics framework should include these four pillars.
1. The Sovereignty of God
2. The Sanctity of Human Life
3. The Stewardship of Man
4. The Way of Love
The Sovereignty of God
1 Chronicles 29:11 (NIV)
Yours, LORD, is the greatness and the power and the glory and the majesty and the splendor, for everything in heaven and earth is yours. Yours, LORD, is the kingdom; you are exalted as head over all.
Our foundational belief is that God created everything and he is in control of everything. Any scientific experiment will only succeed with His permission. Since it is his creation, we cannot bend the rules of physics and biology without his allowing it.
The Sanctity of Human Life
Genesis 1:27 (NIV)
So God created mankind in his own image, in the image of God he created them; male and female he created them.
Exodus 20:13 (NIV)
“You shall not murder.
Human life is sacred because we are made in his image. In certain circumstances, we are allowed to kill other human beings. Just War is argued by Augustine and other church fathers that is ia llowed to kill enemy soldiers in a war. Even Bonhoeffer reasoned that it is justified to kill Hilter during the Second World War. He was caught and executed. Murder, however is condemned.
The Stewardship of Man
Genesis 1:28 (NIV)
God blessed them and said to them, “Be fruitful and increase in number; fill the earth and subdue it. Rule over the fish in the sea and the birds in the sky and over every living creature that moves on the ground.”
Also called the Cultural Mandate, mankind is to reproduce and populate the then empty earth. The second part is that we have dominion over God’s creation. This means that we are allowed to improved and manipulated God’s creation for the good of mankind. Scientific and technological advances have improved the quality of living and living standards of mankind.
The Way of Love
Matthew 22:37–40 (NIV)
Jesus replied: “ ‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbor as yourself.’
All the Law and the Prophets hang on these two commandments.”
The Parable of the Good Samaritan is a beautiful illustration of this principle by Jesus. A Jewish man was mugged and left for dead by robbers. His fellow tribal people step aside and refused to help him. It was finally a Samaritan, an outsider and outcast who helped the injured man out of altruistic reasons. The guiding principle for bioethics is the way of love. It is not to do harm but do good to others.
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A Pastoral -Theological Approach to Christian Biomedical Ethics
As we look at genome editing through the lens of the Christian framework, there is much support for it. However it need to be regulated. This need for regulation is also an ethical consensus among scientists who suggests the following:
(1) Promoting well‐being
(2) Transparency
(3) Due care
(4) Responsible science
(5) Respect for persons
(6) Fairness
(7) Transnational cooperation
This is comparable to the Christian framework. It is unfortunately that ‘rogue’ scientists for whatever reasons failed to abide by these guidelines.
Genome editing research
Genome editing is recent and research was carefully regulated. It is only recently that certain human applications were allowed:
1. (2015) Treatment of CD19+ acute lymphoblastic leukemia in an 11-month old child. Modified donor T cells
2. (2015) remove gene, Beta-thalassemia, China
3. (2017) remove gene, Hypertrophic Cardiomyopathy, USA
4. (Feb 2019) in vivo with Hunter Syndrome, California
In December 2018, there was a public outcry when a ‘rogue’ scientists revealed that he had enabled the birth of a set of twins, Lulu and Nana, on whom he had disabled their gene for CCR5, a protein vital in preventing HIV infection.
Genetic Engineering
1. Animal husbandry
Humans have been cross breading their animal stocks or cross fertilizing their crops for better and healthier stocks or crops.
2. Genetic Modified Organism (GMO)
Where there were some initial reaction to GMOs, these seem to have died down when there is more acceptance of them. In 2009, Atryn, an anticoagulant which reduces the probability of blood clots during surgery or childbirth was extracted from the goat's milk. Human alpha-1-antitrypsin is another protein that is used in treating humans with this deficiency
3. Genetic Modified Animals
Creating pigs with greater capacity for human organ transplants (xenotransplantation)
Ethics of Genome Editing
What does the ethics of genome editing covers?
1. Modifying the human genome –genetic correction and enhancement
2. Safety and effectiveness
3. Existence of alternative approaches
4. Off-target results
5. Epigenetics
6. Future generations
Each point is important but the key is in the difference between genetic correction and genetic enhance.
Genetic Correction
By genetic correction, we mean editing a rare mutation that has a high probability (penetrance) of causing a severe single-gene disease, with the aim of converting the mutation into the DNA sequence carried by most people. Assuming that it can be done without errors or off-target effects, genetic correction could have a predictable and beneficial effect.
Genetic Enhancement
Genetic enhancement, by contrast, encompasses much broader efforts to ‘improve’ individuals and the species. Possibilities range from attempting to modify the risk of a common disease by replacing particular genetic variants with alternative ones that occur in the human population, to incorporating new instructions into a person’s genome to enhance, say, their memory or muscles, or even to confer entirely new biological functions, such as the ability to see infrared light or break down certain toxins.
Genetic correction is lifesaving as most genetic diseases are lethal. It is also localized to certain abnormal genes so editing them should not have much effect on other areas. Genetic enhancement are often option. The danger is germline modification in which and editing down is passed onto future generations. In other ways, we could be creating a inheritable disease.
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A Christian Perspective on Genome Editing
My perspective at this moment is
1. Research and clinical studies on genetic correction should continue with adequate oversight
2. A moratorium on genetic enhancement (includes germline editing)
A moratorium maybe for 5 years and a review whether the issues of safety and effectiveness; existence of alternative approaches; off-target results; epigenetics; and consequences on future generations have been settled with future improvement in technologies.
16 April 2019
