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

Germ-line Genetic Therapy Germ- -line Genetic Therapy line Genetic Therapy Germ Munson- -Davis Look Bravely at a Davis Look Bravely at a Munson Brave New World Brave New World Genetic Treatment Genetic Treatment Curing Disease Enhancement Curing Disease Enhancement Somatic cell Somatic cell Easiest to justify? Easiest to justify? Germ- Germ -line line Hardest to justify? Hardest to justify? • 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) Arguments against it: it Arguments against it: it tampers tampers with with ► (Overview) ► � 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” ” ► Medical Ethics 1

Germ-line Genetic Therapy 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 inherently inherently wrong (why?) wrong (why?) ► It is ► � Even if we could be totally assured that benefits Even if we could be totally assured that benefits � outweigh risks, it’ outweigh 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, of 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 of rich/poor for access. of rich/poor for access. Munson/Davis : these problems and conflicts : these problems and conflicts “ “no no ► Munson/Davis ► 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. Medical Ethics 2

Germ-line Genetic Therapy 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- -modifying system. modifying system.” ” himself a self ► Which kind of objection is this: Which kind of objection is this: ► consequentialist or inherent wrongness? consequentialist or inherent wrongness? Munson Responds – – Eugenics Eugenics Munson Responds (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. (Are you reassured?) technology we will use it. (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. Medical Ethics 3

Germ-line Genetic Therapy 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 � other humans have known it. other humans have known it. � Leenen Leenen: We may create : We may create animal animal- -human human or plant or plant- -human human � creatures. “ “When scientists When scientists transgress transgress [my emphasis] [my emphasis] creatures. the boundaries of what is human, they place themselves the boundaries of what is human, they place themselves outside human society. outside 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 human human survival. survival. reason to favor ► Would it be a good or bad thing if creatures Would it be a good or bad thing if creatures ► develop that are superior superior to humans? to humans? develop that are (Munson/Davis) Unlikely in any case; we shouldn Unlikely in any case; we shouldn’ ’t worry t worry ► (Munson/Davis) ► 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” ” guided by guided by “ “a good and wise Being a good and wise Being” ”; ; evolution 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? ► Medical Ethics 4