Engineering the Human Germline

A list of pros and cons compiled by David Heaf

Glossary

Here an effort has been made to collect together in condensed form some of the legal, social, philosophical, ethical and spiritual perspectives associated with human germline genetic engineering (GE), making genetically modified (GM) humans. A far more extensive and thereby less concise presentation of the arguments is available at Gregory Stock’s web site devoted to engineering the human germline at http://research.mednet.ucla.edu/pmts/Germline/default.htm. See also http://research.mednet.ucla.edu/pmts/Stock.htm.

No ethics can be higher than the inner moral intuition of individuals who are faced with a real life situation which calls for free moral action. Abiding by all outer influences such as codes, rules, regulations, laws, norms, commandments, observances, conventions, customs or traditions is not in itself ethical unless the individual can make the moral intuition which lies behind a particular outer influence his own in a specific situation. The following pros and cons are not necessarily based on the moral intuitions of individuals. Some may arise from what is more generic in the human species, namely greed, lust for power, self-aggrandisement, hubris, dreams of universal happiness etc. It is advisable for society to prepare for this technology which is not yet used on people but which the genetic engineers tell us inevitably will be. Such preparation involves pondering the arguments for and against. The field offers plenty of scope for casuistry. What we find essentially lacking from many of the presentations so far is an explicit statement of the picture of man held by writer or speaker. It is almost always left implicit and up to the reader or listener to discern for themselves what the underlying picture of man really is.

We also note that in published material the moral issues hardly ever take into account the idea that the human individuality evolves through repeated earth lives. When reincarnation is brought into the debate it augments the viewpoints based on nature and nurture alone.

Student’s often ask about ‘designer babies’. The basic technology for making a ‘designer baby’ is probably already present in the world because of the successful cloning and genetic modification of animals. But its application to humans is most probably still science fiction. Nevertheless, the author welcomes information from anyone who knows otherwise.

Gene therapy clinical protocols already run into the thousands. These involve somatic gene therapy, i.e. affecting the soma or body cells only, not the germ cells (egg, sperm) involved in reproduction. Part of the scientific community is calling for research to include therapy and even enhancement which involves altering the germ cells thus introducing the possibility that the alterations will pass down the generations.

As GM humans are not with us yet, many of the arguments on both sides of the debate are speculative. Thus arises the danger of a sanctimonious moral absolutism which is out of touch with the legitimate needs of human beings. This cuts both ways.

Some attempt has been made to group related arguments together in a tabular form by putting them opposite counter-arguments in the table. This form of demarcation is not intended to be rigid, but hopefully it brings enough order to help the reader to pick and choose.

Pros

Cons

Even Plato recommended selective breeding in the human population to create castes for specific roles in society. Personal or private eugenics is far better than state eugenics. A state ban on private eugenics would be as harmful to the genetically disadvantaged as was the eugenics of the Nazis. The very word ‘eugenics’ is used by people to stigmatise any aspect of the application of human genetics that they happen to dislike. When the public sees the benefits of successful germline GE the scientists will receive acclaim. The kind of ideas that Plato advocates can be described as eugenics and eugenics was practised in the totalitarian regime of Hitler’s Third Reich. Most people now rightly reject eugenic practices. There is no difference in principle between the eugenics which was put into practice not so long ago in USA, Scandinavia and Germany and the modern techno-eugenics offered by the proponents of germline GE.
Certain techniques exist which could eventually allow germline GE to be reversible. One possibility, at least at first, is making GM humans who can only breed further with the help of medically assisted reproduction. If germline GE could be made as safe as normal reproduction, what would be the objection to using it? The need for reversibility or restricted transfer down the generations is evidenced by the fact that when new GE technology is discovered, new gene constructs, people will want the new version of the ‘software’ not the old. Human germline GE will pass the mistakes of the genetic engineers on to later generations. An ever expanding web of suffering could result, as happens at present with genetic disabilities. Harmful changes, e.g. an increased risk of cancer, may not surface until much later in the life of the GM human, possibly even after they have their own grandchildren. A harmful change may even not show up until a particular genetic combination happens in a later generation. We cannot test for harm unless we know in advance what to look for.
Some religious groups object to the destruction of embryos once they have been created. To them it amounts to killing a human being. GE would be a more ethically acceptable alternative because it would be carried out before conception. However, because pre-implantation diagnosis (PID) is already a workable technique and is likely to remain safer than GE in the long run, it is also likely to remain the choice for truly therapeutic purposes which are determined not only by cost considerations but also by ethical committees which protect patient interests. For enhancement, i.e. adding genes or whole chromosomes which are not already in the parents, GE will be the likely choice. There is currently no consensus amongst gene therapy researchers that germline GE should not be used for enhancement. There already exists a medical option for people who want to have children but risk genetic disease and that is pre-implantation diagnosis (PID) during in vitro fertilisation (IVF) or medically assisted conception. Any embryos found to be abnormal are not implanted. This was used in the famous case of Adam Nash in the USA during the year 2000. Once germline GE has been developed for therapy the slippery slope will operate and there will be demands to use it for enhancement, producing ‘designer babies’. The existing practice of using the drug Ritalin to enhance a child’s performance in school is a model for how germline GE will be used.

Even PID presents a slippery slope. As genetic screening of the embryo advances it could be used for selecting not just genetically healthy embryos but also embryos showing genes associated with higher than average faculties once they are children or adults.

People already select a mate and are thus already imposing – albeit perhaps unconsciously – their own idea of what is better on succeeding generations. This is not stigmatised as a eugenic practice. In fact it is freely permitted for good or ill. Human GE would extend the reproductive freedom of the individual. Parents already enhance their children by giving them the best education they can supplemented with all sorts of extra learning opportunities out of school. Furthermore, the already unnatural procedure of in vitro fertilisation (IVF) has been left to develop freely and privately in the USA for decades and this seems to be working satisfactorily. There are already state imposed limitations to parental autonomy in society so it would not be unreasonable to bring in safeguards to see that they act responsibly.

There is no codified right to remain unmodified because before conception there is no person present who might carry such a right. Once the person is born, they are who they are and only then have rights, but certainly not retrospectively. Anyway, who a person is is probably only 50% to do with their genes.

Germline GE might usher in the worst excesses of libertarianism. Parents would impose their own idea of what is ‘better’ on their children and will thus be acting out of egoism to create a private eugenics. Children will be objectified, commodified. Their right to remain unmodified will be taken away and they will be deprived of the apparently complete randomness that genetic assortment of their parent’s genes currently offers. This will take away the unpredictability of a person’s heritage. Who will defend the interests of the GM human being who is being created? There may even be a huge increase in lawsuits for ‘wrongful birth’ as intergenerational liabilities are fixed in legal codes.
Over 23 years experience with in-vitro fertilisation (IVF) has shown that IVF children are amongst the most wanted by their parents. Parents want children who can live happy lives and will thus seek to remove genetic obstacles or even seek enhancements when they are technically feasible. All decisions about having children, whether naturally, or by IVF, or by IVF combined with GE, carry the same order of social impact for the people affected. Parental expectations might be raised too high and they will be disappointed when their offspring show new defects not catered for by the genetic modification. The principle of the intrinsic value of a human being will be breached in that children will not be valued in themselves but instead for what their genetic modification is supposed to promise. GE will undermine unconditional parental love.
People have the right to free determination of their own reproduction. It is absurd to establish this as a right and then to legislate as to how it should be done. Undermining freedom of reproduction risks undermining human rights in general. If freedom is to be limited because of alleged harm, then people have a right to require actual evidence of that harm.  If safe human GE is available it would be immoral for those at risk to bring a genetically disabled person into the world. And it would be against the medical ethical principle of beneficence if doctors did not use the technology available. As the technology becomes more reliable and therefore safer, more will choose it voluntarily. State mandated vaccination has had clear epidemiological benefits albeit with limited numbers of adverse effects and deaths. Parents will feel under social pressure to opt for therapy or enhancement. Indeed it might even be made compulsory like vaccinations are in some countries, thus further violating parental freedom. Such coercion was foreseen by Aldous Huxley in his book Brave New World in which the state had completely taken over the business of reproduction. Something similar is likely to happen once safe, routine germline GE has been brought into the world.
It is a logical extension of in-vitro fertilisation (IVF). When on 25 July 1975 Louise May Brown, the first test tube baby, was born there was equal public concern then but now society accepts IVF. And likewise, with germline GE the pioneer ‘patients’ will gradually change social norms. Already the IVF procedure of intra-cytoplasmic sperm injection (ICSI) for sperm that are not motile risks increasing the rate of male infertility in the general population.
There is no clear line between therapy for a genuinely medical genetic condition on the one hand and enhancement of a child’s appearance or faculties on the other. Therefore enhancement should be permitted too. The technology will get cheaper with time and thus more generally accessible. It could conceivably even increase equality of opportunity. In any case, there is no natural or moral law that says that people should be endowed with equal qualities. Inequity is just a fact of life and as there is clearly no serious intention amongst mankind as a whole to eliminate existing inequity, what does it matter if GM humans bring a bit more. There is no clear line between therapy for a genuinely medical genetic condition on the one hand and enhancement of a child’s appearance or faculties on the other. Therefore there is a risk that it will be used to give children of the rich, the genetic aristocracy, an unfair advantage over others. The likelihood of private funding of germline GE means that it will accentuate the already existing inequity in society as regards access to healthcare. Resources should be allocated instead to reducing existing inequity. GE has a low priority compared with this.
If making GM humans was stigmatised, it might end up as something only renegade scientists do in secret. It will anyway put too much power in society in the hands of the genetic engineers.
Of course germline GE needs societal approval. People will be educated in a non-directive, non-polemical way about the benefits and appropriate use of the technology. More science of genetics would need to be taught in schools in order to raise public awareness. The interests of both society and individual would be kept in balance. Children with Down’s syndrome are looked after, even looked after at public expense if their parents reject them. There is no reason to suppose that the genetically disadvantaged will be less catered for when there are GM humans on the earth. Widespread use of GE might lead to low self-esteem and increasing stigmatisation of the genetic have nots, the gene poor, who already suffer enough because of people’s fear or disrespect for abnormality. Existing xenophobia might intensify.

Too many vested interests are involved and history does not lead us to believe that the interests of society and the individual would be kept in balance.

Whilst it is as yet science fiction the genetic engineer may one day be able to offer more desirable bodies, increased longevity, raised IQ, better athletic performance in sports. When people are genetically enhanced it will benefit the whole of society, just as happens already with gifted people. Enhancement by germline GE is the logical conclusion of preventive medicine because removing a bad gene from the gene pool is like removing smallpox from the population. There is no justification for abstractly assigning sanctity to the gene pool. It would be absurd for a species to wish to remain static rather than part of evolution. Evolution changes the gene pool anyway, we would only be adding one new method.

Certainly it will be difficult to prevent scientists from discovering how to enhance humans. If a region of the earth developed a bad gene pool, immigration from it could be restricted by requiring evidence of genetic status as already happens in the case of communicable disease carriers from certain regions who in the interests of public health have to show evidence of vaccination or enter quarantine.

The genetic profile of society, the gene pool of the whole population, the very nature of the human species will be altered. Who is to decide what the alteration should be? Determining good and bad genes merely reflects social prejudices. People will focus on qualities which give their offspring a competitive edge rather than on qualities such as love and compassion. For instance, all the talk is of genes for intelligence, never for compassion. There is also an obvious parallel with an existing misuse of medical technology, namely doping in sport.

Removing a ‘bad’ gene, such as the relatively common one associated with cystic fibrosis (1 in 2000), from the gene pool of the whole population would take thousands of years and an unprecedented amount of consistent and determined coercion.

International control would be necessary because normal migration would allow genes from a bad gene pool to leak into other parts of the world just as sickle cell genes have travelled from south to north.

GM humans free of genetic disabilities would reduce the financial burden on the governments for health care. Society including the government and clinicians will be able to set limits to what can be done under public healthcare schemes. Anything beyond this should be left to free individual choice. Even cosmetic surgery is felt as a necessity by the person who undergoes it. Just as traditional genetic medicine does not work consciously to alter the gene pool of the whole population, so also germline GE will not have that conscious intention. At this level then, there will be no difference in the aims of genetic medicine old or new. And in the process it would be stupidity not to exclude the less fit genes. It will be impossible to decide what is a medically necessary therapy. Genetic medicine has hitherto been about managing phenotypic traits – i.e. actual disease, but parents may expect that their GM child is not only free of the unwanted genetic trait in their phenotype but also does not carry it in their genome. This goes beyond the normal duty of medicine. Already clinical geneticists face requests for gender selection. It would be a matter of serious concern if the state required people to use germline GE out of concern for health costs. Furthermore, genetic medicine (clinical genetics) has never worked consciously to alter the genome of the whole population. There is a risk that GE will be used for conscious, deliberate manipulation of the gene pool, i.e. for conscious evolution.
Society will be free to decide whether it wants to use GE for therapy or for enhancement or for military purposes etc. Human-animal hybrids could perform all sorts of useful services to society. People will use the technology to add genes from animals to humans with the aim of producing dramatic enhancements, say for military purposes. Secret use for military purposes would undermine any wishes of society as is already the case with chemical and biological weapons development.
GE could first be developed in animals including monkeys. This would accord with one of the principles in the Nuremberg code on medical ethics. Then it could be exhaustively tested on human embryos up to the age to which experimentation is permitted in different states. Standard pre-implantation diagnosis (PID) could be carried out and an embryo would not even be implanted in a uterus if the GM has not been successful. Implantation would be only with fully informed consent and at first in cases where a severe genetic disease is present which everyone agrees should be eliminated, e.g. Huntington’s chorea. Closer than normal monitoring of the developing foetus could take place and if before the time in pregnancy when abortion is permitted it could be terminated. Unfortunately, the real tests will not be possible on animals because of their different genetic make up. The human genome is so complex that it will not be possible to predict the outcome of a genetic manipulation in a given case. Just as upgrading a computer by changing a component can cause conflicts, adding parts to the human organism may so violate its integrity that it is thrown completely out of balance. A ‘good gene’ may simply not work as a good gene in a given individual. It is safer for human beings to enhance themselves by lifestyle (diet, exercise, recreation, meditation) than by techno-eugenic methods. Genetic engineers are lured by the na´ve information technology analogy of faulty genes being simply bugs in the code which just need to be fixed. A worse scenario involves linking germline GE with artificial intelligence producing machine-animals – we cannot call them humans.
There is not and probably never will be a worldwide consensus as to where personhood begins. What is clear is that assuming that a person does not exist before conception -- and without a body this seems a valid assumption -- there can be no question of violating the human dignity of a person by genetic modification prior to conception. One cannot respect the dignity of someone who is not yet conceived. Furthermore, dignity is something a person acquires as they live their life in self respect and respect for others. Dignity is not something which according to the essentialists is created ex nihilo at birth. It is not possible to claim that GM therapy or enhancement would benefit (or disbenefit) the child because the result would -- so one argument goes -- be a different child with a different body. Otherwise one would have to assume that personhood exists in an ovum (egg), the most likely cell to be subjected to GM. The only benefit (or disbenefit) would be to the person who ordered the therapy or enhancement. If there is non-being before a GM embryo, it comes down then to the self-interests of the parent. This is an ethical conundrum in that there is no affected person on whom to base an ethical decision before the intervention takes place. How then will society decide what is right for the resulting child.
It is precisely the higher spiritual faculty of the human being, namely the ability to think, to reason, that has enabled mankind to take charge of its own destiny and to adapt the environment or overcome the shortcomings of the human body. The human being is as much a part of nature as any other living being. It is in the nature of the human being to modify nature. Indeed, ever since the human being became able to set conscious goals, human evolution has been artificial evolution. Therefore it accords completely with humanness, with being human, to modify the human body by medicaments, by surgery or by genetic modification. Already medical treatment reaches further and further back into the life of the foetus. Germline GE would therefore be the logical goal of foetal medicine. All kinds of research has been temporarily delayed on moral grounds, sometimes for centuries, e.g. dissection of cadavers. Because of irrational public outrage, the same delay of research appears to be happening to germline GE. Just because something is deemed to be natural it does not mean that it is also good. All appeals to naturalism are bound to fail for obvious reasons.

If it is the individuality which makes us who we are we should not be worried about changing a few genes in the genome. The individuality will integrate those changes in continuing to be who they are. A person’s humanness, their true humanity, will rule supreme over any material alterations just as it does when they have artificial limbs, surgical implants or organ transplants.

The human being is an essentially spiritual being and people feel a deep spiritual unease at the thought of tinkering with the human genome. Human dignity and the integrity of the individual, of the true self meant in a spiritual sense (that self which we refer to as ‘I’), would be violated by the kind of invasion of the body envisaged by the genetic engineers. Human GE is unnatural, which in this context means that it does not accord with humanness. It would make us more like machines. It is trying to achieve by material means in the test tube what should be achieved by the higher faculties of the soul. Consciousness, awareness, ways of thinking and behaving are more fitting targets for enhancement and should be left to the autonomy of the evolving individual concerned. Soul qualities such as wisdom and compassion cannot be made in the laboratory. Moral and spiritual development is a top down not a bottom up approach. It must come from the self. GE is a quick fix which could have serious repercussions for the individualities who are violated to satisfy their parents genetic desires. The offspring will have heteronomy instead of autonomy. The GM person will be to a certain extent like a slave. Alternatives exist without compromising individual integrity, e.g. refraining from having children when there is a serious risk of passing on a genetic disease. The human genome has been raised by the materialist to the level of a caricature of the human soul and this raises the danger that it will be seen as the soul itself in some minds.
Already with abortion, gender change operations, in vitro fertilisation (IVF) and other medical interventions, medical tourism is an accepted practice. There is little agitation for global legislation because cultures and their associated ethics differ. However, there are already successful transnational agreements including bioethics conventions. An international convention regulating germline GE could be drawn up if there was sufficient will. However such regulation should not be drawn up in such a way that it stifles potentially beneficial research. There is no universal normative bioethical position on germline GE and any regulation should be sufficiently flexible to accommodate regional differences in the extent of individual parental freedom. Unless there is a global convention banning germline GE eugenic tourism will allow people to get round bans introduced in particular countries.
The first germline GE is likely to concentrate on monogenic rather than polygenic traits precisely because of the complexity of the latter. Many traits are influenced by dozens possibly hundreds of genes and are dependent on the social context, e.g. upbringing and education, for their manifestation. As the social context varies, how will germline GE, i.e. medicine alone, deliver a particular characteristic, for instance a desired level of aggression whether it be reduced or increased?
The family can be regarded as a cohesive force which benefits society. Blood ties are therefore important. Reproductive technologies such as the techno-eugenics of germline GE emphasise blood ties. However, we live in a time where there is a breakdown in rigid adherence to the idea of the biological family and where making a virtue of racial attributes is frowned upon by societies which recognise the virtues of human beings treating each other as brothers and sisters regardless of the underlying blood relationships. Therefore germline GE is a step backwards into the blood mentality. It goes against the evolution and gradual manifestation of humanity in the human being.
Society already spends billions on terminal care. Germline enhancement might even make older generations healthier and thus more productive as was envisaged by Aldous Huxley in his book Brave New World. Because fear of death is so strong people will want to use germline genetic enhancement to postpone ageing and death. This could increase the financial burden on society.
There is no evidence yet that there is any lack of fulfilment in the lives of the individualities who have come into the world through in vitro fertilisation. Indeed, not only are these children very much wanted -- as evidenced by the obstacles which the parents, especially the mother, have to overcome -- but also a small community of healthcare workers become deeply connected with the destiny of the IVF child. One could justifiably argue that these people are connected more deeply than just at a technical level with the incarnation of the individualities whom they help into the world. And precisely with some doctrines of reincarnation if the body becomes more perfect it is beneficial in the long term to the self which is manifested through it. GM humans could thus turn out to be better endowed spiritually as a result of such intervention. Anyway, who is to say that the self would not choose a GM body? The individual human being goes through repeated earth lives as part of a long process of perfecting itself, of becoming more human. The incarnating individuality in collaboration with other beings prepares its own earthly body over many generations in advance of a particular incarnation. The self actually chooses its body. The resulting heredity is thus not just an accident of nature. Interfering with the germline therefore interferes with what has been prepared in order properly to gain from the experiences of a particular earthly life. In this sense there is a violation of the integrity of the individuality.
It is unlikely that any state would be able to guess what traits are needed to enable it to produce a dominant society. Great civilisations have in the past been brought down by what seem to be inferior races (e.g. the Romans by northern tribes). In any case survival is likely to be better assured by maintaining a diversity of traits in a society rather than working to a uniform model. States involved in global competition for survival will be forced into using the progress in germline GE to create master races. If they do not, their neighbours will. We have seen the same kind of thing with nuclear and biological weapons.
We do not currently prevent the genetically disabled from procreating with one another. Only in the case of severe mental handicap is procreation prevented, e.g. by sterilisation, where it is seen to be potentially injurious to the mother or any baby that may otherwise result. Natural human breeding is for the most part a lottery and germline GE could help to make it less so. Germline GE might be used by the genetically disabled to bring someone into the world who was disabled in the same way.
Any untoward outcomes would be actively sought in societies which pioneer germline GE and steps taken to deal with problems that arise. Widespread adoption of germline GE could spread hitherto unknown social pathologies.
We already have Olympic games for the disabled. In future we will have an Olympic games for the genetically or otherwise medically enhanced. Society values achievement based on natural abilities, particularly when overcoming hindrances. Genetic enhancement might devalue achievement in that more spectacular achievements might be attained by the GM humans.
Modern medical intervention, e.g. giving insulin to diabetics has long contributed to altering the genetic diversity of the population if only by helping people to survive, breed and thereby pass on their genes who would normally have died before reaching reproductive maturity. Any changes that man makes are taken up by the organism that is the entire genetic diversity of humanity and integrated into that organism. Anything which does not fit will simply be rejected by that higher organismic hierarchy. We need not worry because, nature has its own checks and balances. Furthermore, only a small percentage, say 1%, of the genome is likely to be altered. Germline GE could eventually reduce the genetic diversity of the human race. Valuable genes needed for surviving disease -- for example sickle cell anaemia which confers some protection from malaria and cystic fibrosis which may give some protection from cholera -- and plagues, may be lost. Some genes of currently unknown function may be evolving which have benefits for mankind in the future. Ad hoc removal of genes from the population could drive humanity up an evolutionary cul de sac. Natural evolution may turn out in the long run to be a wiser enhancer of the human race than the genetic engineer. Even a 1% alteration of the genome when it involves millions of children will add up to a significant effect on the population.
Where a genetic condition exists in a couple engaged in natural reproduction the option exists for genetic testing of the foetus for a growing number of conditions followed by the offer of abortion if the condition is present. Many couples find abortion completely unacceptable. Germline GE of the ovum combined with in vitro fertilisation (IVF) could circumvent this problem. GE could even end up medically safer than genetic screening combined with abortion. Couples who have a genetic disability yet who want children could simply adopt one of the millions of unwanted babies. They would be rendering a great service to society.
Until we have tried it out we do not know what benefits it will bring to society. A road has to be steered between a complete ban and a laissez faire policy. Some kind of regulatory agency or hierarchy of review bodies, institutional peer review boards, local research ethical committees, with the decision makers drawn from stakeholders in society would be one possible sensible way ahead. In any case, as time goes by, the moral climate will change. A complete ban in a particular country could turn it into a cultural backwater. Progress could be made cautiously. Withdrawing public funding from human GE would relegate it to Saturday labs or other countries where it is funded. It is probably unstoppable. Germline GE is dangerous, divisive and violates the intrinsic worth of the human being. It should therefore be banned.

A less absolutist possibility would be to leave germline GE to privately funded development, perhaps under official regulation. Public funding could be avoided until it is a demonstrably beneficial technique.

Some countries have very restrictive legislation in place to prevent manipulation of the human being. For instance Germany bans research on the human embryo. But this is just a fig leaf because embryonic tissue is simply imported from abroad and this is tolerated. In fact countries which think that they are bioethically a special case are likely to be wrong. They almost certainly have the same diversity of moral opinion in their populations as other countries which are more permissive. This is evidenced by the fact that women are prepared to travel abroad to obtain an abortion when it is banned in their own country.  
Animals are often poor models for testing medical advances. Intra cytoplasmic sperm injection (ICSI) was not tested first on animals but now 80% of fertility clinics in USA are using the technique successfully. If germline GE gets the go ahead no human experiments should be carried out until it is shown to work on animals. It is not possible to compare Intra cytoplasmic sperm injection (ICSI) or other IVF techniques with germline GE, because they are qualitatively different things. IVF is still fertilisation, i.e. the combination of huge numbers of genes in a way similar to what happens in nature. GE is a radical new departure and needs much greater care.
There is a wide diversity of opinions about germline GE between different religions and between people in the same religion. Judaism has no doubt that a world that has germline GE is better than one that does not. Buddhist and Tantric views do not oppose germline GE. Religions which have difficulty with it include Christianity and Islam. As for the fundamenalists, it is not possible to have any reasoned discussion with them. Against the hubris accusation we can say that societies progress when the people who comprise them are optimistic, not pessimistic. Germline GE would be ‘playing God’. Human beings, with all their presumed genetic corruption, are the work of God and made in God’s own image. The process of human reproduction is sacrosanct and should not be left to the hubris of scientists. Some scientists are possessed by what the Germans call Machbarkeitswahn, the ‘can do, must do’ mentality. There is therefore a danger that what can be done will be done somewhere by scientists who are obsessed with the new power of germline GE.
Many procedures have crept into medical and obstetric practice unannounced (e.g. a 25% caesarean section rate). No conscious decision was taken at a national level to introduce them. It simply happened in the normal course of progress in the profession. The same could happen with Germline GE. Already protocols have been approved for treating mitochondrial diseases such as lactic acidosis caused by a defect in one of the 37 genes in the mitochondrion. This involves inserting the nucleus of the mother to be into an enucleate ovum from a woman with genetically normal mitochondria, followed by in vitro fertilisation (IVF) and implantation in the normal way. As the normal mitochondria will be passed on down the female germline, this amounts to germline GE. Furthermore, much of the research needed to make germline GE workable and safe will take place in fields quite other than those of human reproduction. Gradually a body of technology will accumulate which was intended originally for other purposes but which could be simply transferred to engineering the human germline. Research and patenting should be monitored to see what its implications are for interfering with the human germline and whether the motives of the researchers involved are entirely confined to those declared on their grant applications.
It is inconsistent to decry genetic reductionism and then to go on to insist that the genome should be preserved. If the human being is more than its genome, a few changes to it are not going violate the human being. In any case we do not know how much civilisations so far have affected their genomes through urbanisation, healthcare, diet, and intercontinental travel. Why not now make the changes consciously? Altering the genome by germline GE is likely to be insignificant compared with the existing alteration to it caused by environmental contaminants and radiation which bring about harmful changes such as cancer. Proponents of germline GE assign so much importance to the genome that they have fallen into the trap of genetic reductionism and determinism. The human being is much more than the sum of its genes. The genome should not be tampered with in the test tube.
Opponents of germline GE try to manipulate opinion by provoking fear of harm. They use fear as a tool in achieving their political aims. Germline GE is very sudden compared with the aeons of evolution. Its very rapidity could be the basis of the harm it does.
With progress in gene targeting it may eventually be possible simply to replace an existing gene with a correct copy. The longer we delay research into human GE and its problems, the longer will the barrier to everyday use of the technology remain in place. There is no way of knowing the safety of a germline change beforehand without allowing it to be used widely by the whole population. Epidemiological studies would be the only valid ultimate safety test and by then it would be too late to undo the harm. Genes work in a complex network of interactions and whilst the main effects of a gene might be known it is the subtle effects which could be crucial in the long run.
Reproductive isolation creates the conditions for speciation. This could be looked at in a positive light in that groups analogous to castes could be formed to fulfil specific roles in society. Germline GE proposals based on the use of artificial chromosomes at first sight seem to offer a small step towards a holistic approach. However, it is only a small step because adding an auxiliary chromosome to the germline will take the GM human into reproductive isolation because of the presence of insurmountable mating barriers. They would need paired chromosomes and to mate with partners who have the same artificial chromosome. The logical outcome of going in this direction would be to use a completely different set of chromosomes, i.e. donor gametes. As this already happens, why waste time developing germline GE? Are people really so obsessed with passing on their own genes?
Those who reject germline GE have the simple option of staying away from it. We can envisage them declaring themselves to be a separate category of humans just as already happens with organically bred plants and animals. Organic humans would set up their own authentication and certification procedures. Birth certificates would carry the registration details of their organic status. To achieve that status they would need to establish parentage or pass laboratory tests to show that GM humans were not used in their production. They might even wear a tattooed symbol to signal their organic status to potential mates. A large section of the public will not accept germline therapy or enhancement. They will regard it as a kind of pollution of the human race just as genetic pollution of food chains now receives widespread rejection.
Germline GE is inevitable. There is no point in trying to stop it. The development of technology often outstrips the moral development of humanity in general. We saw this with the bombs dropped on Hiroshima and Nagasaki. We should regulate to postpone the deployment of germline therapy or enhancement to a time when society is morally prepared to make decisions about its use. If the proponents of germline GE who say that it is inevitable are right, then we should begin raising public awareness and facilitating judgement forming now rather than leaving it until it is too late.
The very fact that the complete matrix of genes at work in the whole organism can somehow integrate and compensate for changes suggests that making GM humans may be much less dangerous than some people claim. Certain genetic disorders, e.g. phenylketonuria, can be compensated for by lifestyle alterations such that longevity can be greatly increased. Such intrinsic and extrinsic safeguards encourage us to progress with human GE. Gene expression is time dependent in that it varies as the organism develops. One can speak of the time body of an organism just as one can speak of the body being extended in space. This time body is also referred to as the etheric body because it is most closely associated with the life processes of the body which are in constant flux, never static. A genetic fix at a moment in time may not have the desired effects in the whole organism. In a sense, the etheric body would have to integrate the change into the unity of the organism. This may be only partly successful. We need fully to understand the organism in time as well as space before changing it. However, we know from experiments with mice that if a gene is knocked out (or in) the mouse organism sometimes completely compensates for the change, often totally suppressing any desired phenotypic effect of the genetic modification.

The author, David Heaf, welcomes additional points for and corrections to this compilation.
His email address user identity is heaf. His email server’s domain name is ifgene.org. These two pieces of information combined with the ‘@’ symbol enable a full email address to be put together. The URL of this page is http://www.ifgene.org/germline.htm . It was compiled in 2000. 

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