Lecture 11 Eugenics and Genetics: Anxieties

1. Lecture 11 Eugenics and Genetics:Anxieties BMS2250 Medical Ethics Semester 1, 2006-07 P. C. Lo

2. (A) Recapitulation • Moral excitements over genetic science and technology • Joseph Fletcher, Gregory Pence

3. “Today we are learning the language in which God created life…. With this profound new knowledge, human kind is on the verge of gaining immense new power to heal….” President Bill Clinton The New York Times, June 27, 2000, D8.

5. (B) General Anxieties • Literature • Movies

6. Mary W. Shelley, Frankenstein, or the Modern Prometheus, 1818

8. 1932

9. Central London Hatchery and Conditioning Centre 2540 A.D. Human beings no longer produce living offspring. Instead, surgically removed ovaries produce ova that are fertilized in artificial receptacles and incubated in specially designed bottles

11. Reproductiveconditioning • Fetuses are conditioned differently • Upper caste -- Alphas and Betas • Lower caste -- Gammas, Deltas, and Epsilons

12. 1940 The Sorcerer's Apprentice – we are incapable to control Nature’s awesome power

14. “Rape of nature” • “Control is an illusion” • “We should have some respect for that power”

16. Department of Precrime 2054 A.D. • Can we arrest and convict someone for the future murder of a man whom he has not even met? • Is it possible for the Pre-Cogs to be wrong? • How far can pre-emptive strike go?

17. What happens if some of us can foresee the future? Does fore-knowledge takes away human free will and responsibility? • Foreknowledge and Free Choice?

21. (C) To Have “Better Children” ThreeEugenic Strategies in the Genetic Age

23. Eliminating the bad (“screening out”) Prenatal diagnosis 2. Selecting the good (“choosing in”) Preimplantation genetic diagnosis (PDG) 3. Redesigning for the better (“fixing up”) Genetic engineering From: Beyond Therapy (2003), p.33

24. 1. “Screening Out” • Ultrasonogram, Amniocentesis, Chorionic villi sampling • Tay-Sachs disease, anencephaly • Downs Syndrome • Multiple congenital anomalies • ABORTION !!

25. Clinical Genetic Service Department of Health, HK • Genetic Counselling Unit – offers genetic counseling for families • Genetic Screening Unit -- operates two screening programmes for newborns, namely, glucose-6-phosphate dehydrogenase (G6PD) deficiency and congenital hypothyroidism.

26. 2. “Fixing Up” • Genetic engineering of desired traits • “Designer babies”; genetic “upgrade” • Once the specific variants of genes are identified, the requisite genes could be isolated, replicated or synthesized, and then inserted into the early embryo (or perhaps into the egg or sperm) in ways that would eventually contribute to the desired phenotypic traits.

30. Practicaldifficulties • To produce the desired result and only the desired result • To avoid abnormalities, either by activating harmful genes or by inactivating useful ones • Artificial chromosomes?

31. EthicalWorries • Do parents have the right to pre-select traits for their descendents? • To be discussed later

32. 3. “Choosing In” -- PGD To detect genetic or chromosomal abnormalities in vitro

35. Non-therapeuticapplications • To pre-select the gender of a child • To produce a child who could serve as a compatible bone-marrow or umbilical-cord-blood donor for a desperately ill sibling

38. Practicaldifficulties,eugenics-wise • Possible harm caused by removing blastomeres for testing? • Many of the desirable human phenotypic traits are very likely polygenic  likelihood of finding all the “desired” genetic variants in a single embryo is very small • Interplay of nature and nurture • Inconvenient and expensive

39. Watchvideo • Superhuman 6 “The Baby Builders” (BBC, 2000)

40. Ethical Worries • People already using PGD to screen for disease markers might seek information also about other traits • Once screening becomes automated, its cost comes down, or if society decides to reimburse for PGD, the use of this approach toward “better children” might well become the practice of at least a significant minority. From: Beyond Therapy (2003), p.44.

41. To be prevented?

42. To be tested and prevented as well? • Asthma, allergies, diabetes, heart disease? • Deafness, Shortness in height, learning disabilities? • Gender? • “Gay Gene”? Should we allow couples to do these?

43. Issues • What is normal and what is a disability or disorder, and who decides? • Are disabilities diseases? Do disabled people need to be prevented from birth?

44. (D) The Big Debate Do parents have the right to pre-select traits for their descendents?

45. Yes, they do have • the right to have a healthy child • the right to a perfect child • the right to have a child that fits the family • the right to pre-select traits for our descendents • “From chance to choice”!!

46. Furthermore • Birth control (quality) – to give the best to our children • To counteract Nature, which is indifferent, cruel, tyrannical, oppressive, hostile, reckless, relentless

48. No, they do not have that right • Human beings should not play God • Human beings should not fool (tamper with) Mother Nature

50. “Perfect” in what sense? • Absence of severe disease or deformity • Absence of flaws or imperfections  presence of desired positive traits ! • Value judgement! • Perfect with the presence of a specific “flaw,” e.g., deafness? • (“A matter of culture, not a matter of medicine!”)