Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-29T19:17:45.501Z Has data issue: false hasContentIssue false

Altering Humans—The Case For and Against Human Gene Therapy

Published online by Cambridge University Press:  29 July 2009

Nils Holtug
Affiliation:
A research fellow in the Bioethical Research Group, Department of Education, Philosophy, and Rhetoric at the University of Copenhagen, Denmark.

Extract

The case in favor of gene therapy is quite simple. Gene therapy is likely to improve the health and well-being of some people that are among the worst off in society, namely patients with painful and life-threatening diseases. However, two types of objection have been raised.

Type
Special Section: Alpha and Omega: Ethics at the Edges of Life
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Some people believe that deontological constraints have a threshold, such that if enough is at stake, it is permissible (or obligatory) to violate a constraint. However, since I shall reject the deontological objections to gene therapy, it doesn't really matter in the present context whether constraints have a threshold.

2. Anderson, WF. Editorial: end-of-the-year potpourri—1993. Human Gene Therapy 1993;4:701–2.CrossRefGoogle Scholar

3. Anderson, WF. Human gene therapy. Science 1992;256:808–13.CrossRefGoogle ScholarPubMed

4. Danks, DM. Editorial: germ-line gene therapy: no place in treatment of genetic disease. Human Gene Therapy 1994;5:152.CrossRefGoogle ScholarPubMed

5. For an analysis of the different versions of the ‘playing God’ argument, see Chadwick, R. Playing God. Bioethics News 1990;9:3846.Google Scholar

6. For a good discussion of the relation between unnaturalness and morality, see Singer, P, Wells, D. The Reproduction Revolution: New Ways of Making Babies. Oxford: Oxford University Press, 1984:3641.Google Scholar

7. For a theological analysis to the effect that gene therapy is not unnatural in any morally problem atic sense, see Porter, J. What is morally distinctive about genetic engineering? Human Gene Therapy 1990; 1:419–24.CrossRefGoogle ScholarPubMed

8. For discussions of this objection, see Chadwick, R. The perfect baby: Introduction. In: Chadwick, R, ed. Ethics, Reproduction and Genetic Control. London: Routledge, 1992:110–1. Also see notes 9 and 10.Google Scholar

9. Glover, J. Future people, disability and screening. In: Laslett, P, Fishkin, JS, eds. Justice Between Age Groups and Generations. New Haven: Yale University Press, 1992:133–4.Google Scholar

10. Harris, J. Is gene therapy a form of eugenics? Bioethics 1993;7:180–4.CrossRefGoogle ScholarPubMed

11. Holtug, N. Human gene therapy: down the slippery slope? Bioethics 1993;7:402–19.CrossRefGoogle ScholarPubMed

12. de Wachter, MAM. Ethical aspects of human germ-line gene therapy. Bioethics 1993;7:167–9.CrossRefGoogle ScholarPubMed

13. European Medical Research Councils. Gene therapy in man. The Lancet 1988;06 4:1271.Google Scholar

14. Anderson, WF. Human gene therapy: scientific and ethical considerations. Journal of Medicine and Philosophy 1985;10:275–91.CrossRefGoogle ScholarPubMed

15. Engelhardt, HT. Human nature technologically revisited. Social Philosophy & Policy 1990;8:180–91.CrossRefGoogle ScholarPubMed

16. Fletcher, JC. Ethical issues in and beyond prospective trials of human gene therapy. Journal of Medicine and Philosophy 1985;10:293309.CrossRefGoogle ScholarPubMed

17. Glover, J. What Sort of People Should There Be? Harmondsworth: Penguin, 1984.Google Scholar

18. Harris, J. Wonderwoman and Superman: The Ethics of Human Biotechnology. Oxford: Oxford Univer sity Press, 1992.Google Scholar

19. Hoose, B. Gene therapy: where to draw the line. Human Gene Therapy 1990;1:299306.CrossRefGoogle Scholar

20. Munson, R, Davis, LH. Germ-line gene therapy and the medical imperative. Kennedy Institute of Ethics Journal 1992;2:137–58.CrossRefGoogle ScholarPubMed

21. Resnik, D. Debunking the slippery slope argument against human germ-line gene therapy. Journal of Medicine and Philosophy 1994;19:2340.CrossRefGoogle ScholarPubMed

22. Walters, L. The ethics of human gene therapy. Nature 1986;320:225–7.CrossRefGoogle ScholarPubMed

23. Wessels, U. Genetic engineering and ethics in Germany. In: Dyson, A, Harris, J, eds. Ethics and Biotechnology. London: Routledge, 1994:230–58.Google Scholar

24. Wood-Harper, J. Manipulation of the germ-line. In: Dyson, A, Harris, J, eds. Ethics and Biotechnology. London: Routledge, 1994:121–43.Google Scholar

25. Zimmerman, BK. Human germ-line therapy: the case for its development and use. Journal of Medicine and Philosophy 1991;16:593612.CrossRefGoogle Scholar

26. See note 22. Walters, 1986:227.Google Scholar

27. See note 22. Walters, 1986:227.Google Scholar

28. See note 25. Zimmerman, 1991:594.Google Scholar

29. See note 20. Munson, , Davis, 1992:140.Google Scholar

30. See note 12. de Wachter, 1993:170.Google Scholar

31. Ostling, RN. Scientists must not play God. Time 1983;06 20:37.Google Scholar

32. Commission of the European Community. Adopting a Specific Research and Technological Develop ment Programme in the Field of Health: Human Genome Analysis. Brussels, 11 1989.Google Scholar

33. Kripke, S. Naming and Necessity. Oxford: Basil Blackwell 1980:113.Google Scholar

34. As argued by e.g. David Heyd. See Heyd, D. Genethics: Moral Issues in the Creation of People. Berkeley and Los Angeles: University of California Press, 1992.Google Scholar

35. Holtug, N, Sandøe, P. Who benefits? — Why personal identity does not matter in a moral evaluation of germ-line gene therapy. Journal of Applied Philosophy 1996;13:157–66. In this article, we also argue that even if the gene therapy itself was to affect the identity of the resulting individual (because of the genotypic or phenotypic impact), this would be irrelevant for a moral assessment of germ-line therapy.CrossRefGoogle Scholar

36. However, as I shall argue later, IVF and preimplantation diagnosis could he used to prevent disease-causing genes from being passed on to future generations instead, at a slighter risk.

37. See note 8. Chadwick, 1992:125–7.Google Scholar

38. Lappé, M. Ethical issues in manipulating the human germ line. Journal of Medicine and Philosophy 1991;16:628.CrossRefGoogle ScholarPubMed

39. Moseley, R. Commentary: maintaining the somatic/germ-line distinction: some ethical drawbacks. Journal of Medicine and Philosophy 1991;16:642–3.CrossRefGoogle ScholarPubMed

40. Although autonomy is typically a value defended by deontologists, it is sometimes defended by consequentialists as a value to be promoted.

41. Tauer, CA. Does human gene therapy raise new ethical questions? Human Gene Therapy 1990;1:414.CrossRefGoogle ScholarPubMed

42. See note 23. Wessels, 1994:239.Google Scholar

43. Dixon, P. The Genetic Revolution. Eastborne: Kingsway Publications, 1993:178–9.Google Scholar

44. Jonas, H. Technik, Medizin and Ethik. Frankfurt am Main: Suhrkamp, 1987:197.Google Scholar

45. See note 38. Lappé, 1991:630–1.Google Scholar

46. Suzuki, D, Knudtson, P. Genethics: The Ethics of Engineering Life. London: Unwin Hyman, 1989:191.Google Scholar

47. Even if one accepts the Doctrine of Doing and Allowing, and so believes that the risks involved in acting are morally more important than the risks involved in omitting, one would still have to weigh these weighted risks (and benefits) against each other. Of course, it is possible to hold that even the slightest risk involved in acting trumps even the largest risk involved in omitting, but this view is so implausible that it must be considered a nonstarter.

48. Berger, EM, Gert, BM. Genetic disorders and the ethical status of germ-line gene therapy. Journal of Medicine and Philosophy 1991;16:675–7.CrossRefGoogle ScholarPubMed

49. British Medical Association. Our Genetic Future. Oxford: Oxford University Press, 1992:186.Google Scholar

50. See also note 46. Suzuki, , Knudtson, 1989:188.Google Scholar

51. Adherents of the Argument from Evolution must also consider selective abortion and genetic counseling dubious. For some reason, these worries are seldomly articulated.

52. Nolan, K, Swenson, S. New tools, new dilemmas: genetic frontiers. Hastings Center Report 1988; 18:(6)43.Google ScholarPubMed

53. See also note 46. Suzuki, , Knudtson, 1989:84–6.Google Scholar

54. See note 18. Harris, 1992:165.Google Scholar

55. Incidentally, it is expected that new progress will be made in fighting malaria by means of genetic engineering; see note 43. Dixon, 1993:24. Also see note 56.Google Scholar

56. Seventeenth International Congress of Genetics. Genetics and the Understanding of Life, National Centre for Biotechnology Education, University of Reading, 1994:11.Google Scholar

57. See note 49. British Medical Association 1992:187–8.Google Scholar

58. See note 43. Dixon, 1993:176–7.Google Scholar

59. For discussion of the argument as presented by the British Medical Association, see Harris, J. Biotechnology, friend or foe? Ethics and controls. In: Dyson, A, Harris, J, eds. Ethics and Biotechnology. London: Routledge, 1994:224–5.Google Scholar

60. Nozick, R. Anarchy, State and Utopia. Oxford: Basil Blackwell, 1990:314–5.Google Scholar

61. The terms ‘normal’ and ‘healthy’ are of course quite vague.

62. See note 11. Holtug, 1993:407.Google Scholar

63. See note 17. Glover, 1984:56.Google Scholar

64. See note 17. Glover, 1984:14.Google Scholar

65. Gardner, W. Can human genetic enhancement be prohibited? Journal of Medicine and Philosophy 1995:20:6584, at 68.CrossRefGoogle ScholarPubMed

66. Even if our aim is to make the decisions they will want us to have made, acting in what we believe to be their interest is the best bet.

Of course, it may be in the interest of future people that they are able to exercise their auton omy maximally. If this were the case, it would not provide us with an argument against enhancing these people, but maybe with a duty to enhance their capacities for autonomy. (Max Charlesworth defends the view that autonomy in this sense is the relevant criterion when making decisions about enhancement engineering; see Charlesworth, M. Life, Death, Genes and Ethics. Crows Nest: Australian Broadcasting Corporation, 1991:93–5.)Google Scholar

67. See note 17. Glover, 1984:149.Google Scholar

68. See note 11. Holtug, 1993.Google Scholar