Scientific and ethical aspects of Genetic modification.

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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.