Scientific and ethical aspects of Genetic modification.

Scientific and ethical aspects of Genetic modification. Paper details: Title Abstract (Summary) Introduction/Background Hypotheses and objectives Methodology How to disseminate your findings Ethical considerations Summary and conclusions References Archives of Medical Research 34 (2003) 247–268 REVIEW ARTICLE Gene Therapy: Theoretical and Bioethical Concepts Kevin R. Smith School of Contemporary Sciences, University of Abertay Dundee, Dundee, Scotland, UK Received for publication April 14, 2003; accepted May 16, 2003 (03/061). Gene therapy holds great promise. Somatic gene therapy has the potential to treat a wide range of disorders, including inherited conditions, cancers, and infectious diseases. Early progress has already been made in the treatment of a range of disorders. Ethical issues surrounding somatic gene therapy are primarily those concerned with safety. Germline gene therapy is theoretically possible but raises serious ethical concerns concerning future generations. 2003 IMSS. Published by Elsevier Science Inc. Introduction The term gene therapy refers to the introduction of exogenous genetic sequences (transgenes) into human subjects with the aim of correcting phenotypic or genotypic abnormalities or providing cells with new functions. Thus, gene therapy is a form of genetic modification (GM). To date, gene therapy research involving humans has been focused almost exclusively on the modification of somatic cells (including cancerous cells). By contrast, direct research into the manipulation of human germline cells is in its infancy. The reason behind this contrast between somatic and germline gene therapies lies in the ethical implications associated with each approach. In the former case, genetic modifications should only affect the individual patient, whereas alterations to the human germline have the potential to affect future generations. The Ethics of Genetic Manipulation It is commonly held that one’s ethics are a matter of personal belief, and that there are as many ethical positions as there are individuals. In bioethics, this view has some weight: it enjoins us to respect the views of patients themselves and supports the democratization and plurality of membership Address reprint requests to: Kevin R. Smith, Ph.D., Lecturer and Health Sciences Coordinator, School of Contemporary Sciences, University of Abertay Dundee, Kydd Building, Dundee, Scotland, DD1 1HG, UK. Phone: (44) (0) 1382-308669; FAX: (44) (0) 1382-308261; E-mail: mltkrs@ tay.ac.uk 0188-4409/03 $–see front matter. Copyright 2003 IMSS. Published by Elsevier Science Inc. doi: 10.1016/S0188-4409(03)00070-5 of ethics committees. Nevertheless, the view that ethics are purely a matter of individual belief is highly problematic, primarily because it provides absolutely no guide for deciding what course of action to take when faced with ethical dilemmas. (As a member of an ethics committee, one may ponder: on what basis ought I to proceed?) One possible solution to this problem is an appeal to intuition: we ought to let our intuitive responses guide our ethical judgments. However, while this approach may have its uses in everyday life it is severely limited in the context of bioethics. Scientific and technological advances produce novel, highly esoteric ethical problems. It seems clear that our intuitive ethical responses, insofar as such responses are an inherent part of our evolved human nature, simply cannot cope reliably with novel issues such as human genetic manipulation, human stem cell research, human sex selection, human cloning, or other similar possibilities put forth by contemporary science and technology. As an alternative to intuition, various metaphysical and religious doctrines hold ethical views on biomedical issues. In particular, the debate about human genetic manipulation abounds with rhetorical pleas, such as those concerning the claimed reprehensibility of playing God. While such views have rhetorical force, they are rendered ineffective as general guides to ethical action by (a) the major problem of fundamental lack of agreement among different religions, and (b) their lack of moral purchase on secular persons. Thus, as far as bioethics are concerned there may be little hope of taking the discussion any further with those who hold such views.