Dr. Marilyn Coors: CRISPR Gene Editing and the Ethics of Organic vs. Modified Personhood
Q: What is Crispr gene editing and what is the Church’s stance on this? Are we looking at a future where we could change who we are at the genetic level – ie our gender, our intelligence, any developmental disabilities or genetic predispositions we may have? What does this mean for developing children in the womb? Does a parent have the authority to change the genetic makeup of their child before the child reaches adulthood? If we are made body and soul in the image and likeness of God, and therefore the human person has dignity? Can we alter the image so much that we lose the likeness? How does the Church determine where to draw the line?
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) is a revolutionary new genome engineering technique that can target and cut a specific DNA sequence. The process then utilizes the cut to edit DNA, insert new DNA, or knock out a gene completely. Essentially, this technique has the ability to rewrite the human genome at will because it is relatively simple, efficient, and cost effective. For these reasons, it will have incredibly powerful applications for healthcare, the environment, and agriculture. CRISPR is already used to modify insects, animals, plants, microorganisms, produce human therapies, and, most controversially, alter human embryos. It is readily apparent that there are promises and perils involved with genome editing.
The promise of CRISPR includes many potential therapeutic applications such as cancer, Down Syndrome, Parkinson’s Disease, Huntington’s Disease, macular degeneration, AIDS, and so many more. CRISPR allows researchers to specifically and easily correct a mutation in DNA to remedy a serious medical defect. Therapeutic applications to treat or cure an individual person’s disease are permissible and desirable according to Church teaching. Dignitas Personae, a 2008 instruction from Vatican’s Congregation for the Doctrine of the Faith states “Procedures used on somatic cells for strictly therapeutic purposes are in principle morally licit….it is necessary to establish beforehand that the person being treated will not be exposed to risks to his health or physical integrity which are excessive….” (n. 26)
There are ethical challenges created by therapeutic applications of CRISPR. Safety is an extremely important consideration. In order to safely realize the benefits CRISPR promises, scientists need to precisely control the sites on the genome at which changes occur. Although the state of the technology is improving rapidly, there are concerns with site specificity and a potential for unwanted genetic modifications—called off target effects. If genetic changes take place at unintended yet similar DNA sequences, CRISPR could cause harmful side effects.
CRISPR is also used to modify early embryos, eggs, or sperm (the germline). The ability to rewrite the human germline raises significant moral concerns for Catholics. Modification of the germline usually entails in vitro fertilization (IVF), which Church teaching holds to be illicit. IVF is illicit because the procedure replaces the marital act, and conception occurs in a laboratory by technicians rather than in the loving embrace of husband and wife. In addition, IVF often entails the destruction of embryos.
There are additional moral concerns swirling around modifying the human germline that are held by Catholics and many, many others as well. The risks of modifying the germline are unpredictable and could entail unforeseen or uncontrollable side effects, known as off target mutations. It is important to note that germline gene changes are carried in all cells, cannot be reversed, and will be transmitted to future generations–whether harmful or beneficial.
In addition, CRISPR germline gene modification can potentially be used to engineer human behavior or traits or produce designer embryos. This type of modification crosses the line from restoring health to enhancing human characteristics or even creating a new type of human being that doesn’t exist in nature. Dignitas Personae addresses this very important distinction directly: “such interventions would promote a eugenic mentality and would introduce an indirect social stigma with regard to people who lack certain qualities, while privileging qualities that happen to be appreciated by a certain culture or society.… Finally it must also be noted that in the attempt to create a new type of human being one can recognize an ideological element in which man tries to take the place of his Creator” (n. 27).
Let’s address some practical moral questions alluded to in Dignitas Personae. Is it moral to alter an unborn child’s genome to reduce the risk of Alzheimer’s disease? Dignitas Personae tells us it is usually moral and desirable to alter the cells of a particular person to reduce the risk of Alzheimer’s, if it is safe. In contrast, the alteration of an unborn person to avoid Alzheimer’s usually requires IVF techniques, which are illicit as discussed above. Also, the potential harm of unintended genomic changes escalate in a developing embryo. For these reasons, altering the unborn is immoral according to Church teaching even though there is likely net benefit if the disease is eliminated.
What about the morality of enhancing intelligence or improving athleticism in the unborn beyond what is currently considered outstanding? Some individuals pursue the “best” higher education or engage in intense strength training for themselves—and/or for their children. In both instances, those resulting enhancements are reversible and have the consent of the person involved. Improving intelligence or strength in the unborn is dramatically more problematic, because it likely involves IVF and entails other serious problems. The appeal of given enhancements will fluctuate over time with the current cultures and fads, yet, germline changes are hard wired in an individual and will be passed down to his/her descendants. Obviously, there is no consent from the altered individual(s), and the potential harms of mistakes are unknown and could outweigh the benefits.
Moreover, the issues of accessibility and cost are additional moral concerns related to CRISPR. Therapies that result from CRISPR will likely be expensive, particularly patient-specific treatments like customized genome editing. It will be especially difficult for patients of average means or those who are uninsured to realize the benefits. If the promises of CRISPR materialize, so will the demand, and it will be necessary to justly address access issues.
Marilyn E. Coors, Ph.D.
Associate Profess of Bioethics and Genetics
Center of Bioethics and Humanities
University of Colorado Anschutz Medical Center