When it comes to technological advances that could reduce human suffering, improve health and reduce disease, we are generally all in favour. But recent advances in procedures that tinker with reproductive cells are often seen as an exception. They attract fierce opposition from people who believe they are unethical and should be treated as serious criminal offences – which in some jurisdictions they are already. I don’t think these arguments are decisive, however. Indeed some of them are not convincing at all.
Ethical debates about changing the human genome make a distinction between two different types of cells. All cells except those involved in reproduction are known as somatic. These have been the subject of less controversial research for a number of years now – for example editing a type of white blood cell known as T-cells has become a major area of enquiry in cancer research.
Cells involved in reproduction are called germ cells. Changing them, which is sometimes described as germline editing, can have effects that can be inherited by the offspring of the people whose bodies are amended. In other words, the changes can enter the gene pool.
The main objections to such procedures fall into four categories: they are unpredictable and dangerous; they are the slippery slope to eugenics and designer babies; they interfere with nature and involve playing God; and they will exacerbate social inequality and cause a division between the genetically enhanced and the rest of us.
First among equals
To begin with, not everything that leads to social inequality is unethical. And even in instances when such practices are unethical, it doesn’t automatically follow that they should be illegal.
For instance, it is clearly arguable that any advanced system of higher education might perpetuate social inequality. Those who succeed in their studies might tend to get better jobs than people who are less educated. And the children of parents who are highly educated are more likely to become highly educated than other children. But very few would argue that this makes higher education or indeed family units unethical. Neither do we normally say that scientific research should be undertaken only if won’t lead to social inequality and divisiveness. It is whimsical to attach such a requirement in the case of genome editing.
As for the course of nature, we alter it when we dam a stream or build a house. We play God if we inoculate a child against polio or operate upon a baby with a hole in her heart rather than watch her die. If we could edit a germline such that these possibilities were permanently eradicated, why shouldn’t we consider doing so? We play God when we consider it reasonable and so we should.
You have to consider the ethics of acts of omission in this context. It is wrong to push someone off a cliff. But it is also sometimes wrong to fail to prevent someone from accidentally falling off a cliff. In the same way, it would surely be wrong to deliberately edit a germline so that someone who would have lived a long and healthy life will lead a short, miserable one. But what about the reverse? What if we could deliberately edit a germline to lengthen someone’s life expectancy and make them healthier? Would we not have an ethical obligation to do so? And surely if their descendants would also enjoy the same benefits, the duty to intervene becomes even stronger.
Indeed you can turn the question around and say: if one could design healthy babies, what would be the moral justification for failing to do so? It is not obvious that there is one. The term “designer baby” is emotive, pejorative and misleading. But if there is a slope that leads to them, we should perhaps edge along it carefully.
Risks and rewards
This brings us to the fourth common objection. Several prominent scientists argued in Nature in March that there were “serious risks” around editing germ cells. They wrote:
In our view, genome editing in human embryos using current technologies could have unpredictable effects on future generations. This makes it dangerous and ethically unacceptable.
They argued that it may be impossible to know the precise effects of modifying an embryo until after birth. I would readily accept that. Yet risk and uncertainty are different concepts. Germline editing might be as likely to produce unpredicted benefits as harms. It does not follow that it is dangerous. It is, rather, uncertain.
The precise effects of failing to proceed with germline editing can be uncertain too. We are far from certain that developing such procedures will be more dangerous than avoiding them. And in some cases we can be pretty sure that some people will otherwise either die or only survive in pain, illness or incapacity. If we know that the absence of genetic editing is dangerous, why shun it? Surely we have a moral duty to do the opposite.
Finally, think about what happens with normal childbirth. In such situations, the genetic outcomes are generally not known until after birth. It does not follow that normal childbirth is dangerous, however. Even when it is dangerous and risky, it does not follow that it is unethical – nor of course that it should be illegal.
Equally it is far from clear that germ editing is dangerous. Even if it were, it does not follow that it is unethical or that it should be banned. For too long we have allowed religious groups and other well meaning people to prevent us from exploring avenues that are potentially vital to human progress with arguments that range from questionable to completely wrong. It is time we moved away from absolute bans and started focusing on how to mitigate the dangers and risks instead.