Decisions concerning use of gene therapy will probably not be made within the privacy of what was once a dyadic doctor–patient relationship. More likely, some overarching guidelines will emerge directing or limiting the practice. Debate and position-taking over the myriad scientific, social, ethical, legal, and political implications of research into and manipulation of the human genome has intensified since the U.S. government officially launched the Human Genome Project in 1988 by appropriating funds to the Department of Energy and the National Institutes of Health (NIH) for genome research. The discourse this costly research endeavor has generated in the scientific and bioethics literature and even in the popular press outlines a host of issues likely to evoke attempts at line drawing and policymaking. Many of these issues lend themselves easily to the shorthand of dualistic opposition: somatic cell therapy (insertion of genes into patients' nonreproductive cells or tissue to accomplish the work of defective or missing genes) versus germ line therapy or engineering (manipulation of a patient's reproductive [germ] cells and the undifferentiated cells of early embryos); correction of defects and disease only versus enhancement of conditions not considered defects or diseases; intervening on the basis of phenotype only (physically expressed genetic traits or symptoms) versus intervening on the basis of genotype also (the biochemical composition of an individual's genome).