Engineering the better baby: Benefits and dangers

Arthur Caplan The more time we spend debating whether to adopt a technology that undoubtedly will be adopted, the less we will have to consider more relevant issues. We need to know how to respond to the promise of taller, smarter, healthier, cuter, stronger, and more loving children before commercial providers begin rolling out their marketing campaigns To be sure, this eventuality is being hotly debated. The main arguments against genetic modification of human embryos are that it would be unsafe and unfair, and that modification would quickly go beyond efforts to reduce the incidence of inherited maladies. But, ultimately, none of these reasons is likely to be persuasive enough to stop the technology from being widely used. Safety is clearly an important factor, but it is unlikely to be a decisive one. The new gene-editing techniques appear to be very accurate. Animal tests and experiments with human embryos that will not leave lab dishes seem to be on track to prove that there is little risk involved in their application. Likewise, as valid an ethical concern as fairness may be, it has never held back the adoption of technology. Yes, the benefits of CRISPR are likely to be made available primarily through private, profit-seeking companies, giving the rich far better access to the technology than the poor. But that fact is not likely to lead to a moratorium – much less a ban – on gene editing. The world is rife with disparities. The rich send their kids to elite schools, while the poor hope the building in which their child attends lessons does not collapse while class is in session. And yet, as unfair as this may be, the rich are not waitingfor the playing field to be leveled; they are making wide use of elite private education. The same dynamic will play out with genetic engineering. The critics’ last argument – that opening the door to repairing genetic disorders will also leave the way open for eugenics – is the most worrying. The same technology that can be deployed to eliminate hereditary diseases can undoubtedly be used to try to build genetically enhanced children. And yet, as slippery as this slope might be, we will, sooner or later, find ourselves inching our way down it. The world is plagued with hereditary diseases that cause very real misery: sickle cell anemia, hemophilia, type 1 diabetes, cystic fibrosis, mitochondrial diseases, polycystic kidney disease, Tay-Sachs disease, Canavan disease, mucopolysaccharidoses, polycystic kidney disease, some forms of breast, prostate, and colon cancer – the list goes on. It is absurd to think that genetic engineering will not be used to eliminate them. Pressure from parents seeking to prevent their children and grandchildren from suffering will undoubtedly overwhelm concerns about the possibility that others will use the same technology to attempt to build superkids – and rightly so. The sick should not be held hostage to worries about possible dangers or abuses. There is no reason to waste time arguing about whether humans should be genetically engineered. As justifiable as some of the ethical concerns may be, there are simply too many benefits to be gained from preventing hereditary diseases. Those seeking to limit genetic engineering to such efforts would be better off devoting their energies to explaining why eugenics is wrong, rather than attempting to stop the march of progress toward healing the sick and eliminating awful disorders. The slope may indeed be slippery. That is why it is far more important to refocus the public debate on appropriate safeguards. Rather than arguing about whether CRISPR should be used in humans, we should be working to determine who decides when it is safe enough to be deployed, what counseling should be provided for parents considering its use, and how to broaden access for the poor. The more time we spend debating whether to adopt a technology that undoubtedly will be adopted, the less we will have to consider more relevant issues. We need to know, for example, how to respond to the promise of taller, smarter, healthier, cuter, stronger, and more loving children before commercial providers begin rolling out their marketing campaigns. Caplan is Director of the Division of Medical Ethics at the NYU Langone Medical Center in New York City. There should no longer be any doubt about whether humans will one day be genetically modified. A new tool – called CRISPR – is already being used to edit the genomes of insects and animals. Essentially a very sharp molecular knife, CRISPR allows scientists to carve out and insert genes precisely and inexpensively. It is only a matter of time before it will be used to engineer our descendants – eliminating many dangerous hereditary diseases in the process.

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