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Ethics of gene therapy

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Sal Cyranowski

on 6 March 2015

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Transcript of Ethics of gene therapy

Nature corrected
Mateusz Gielata / Salwador Cyranowski / Warsaw University 2014
Ethical considerations of gene therapy
Scientific Background
insight: the cases
Ethical consideration:
objections & arguments against

background image http://yazminwickham.com/
Resources
Häyry, H. 1994.
How to assess the consequences of genetic engineering?
In: Anthony Dyson and John Harris (eds).
Ethics and Biotechnology
. London.
Hedgecoe, A.M. 2001. Gene therapy. Academic Press of University College London.
Lappé, M. 1991.
Ethical issues in manipulating the human germ line
. The Journal of Medicine and Philosophy
16
: 621-639.
Zimmerman, B.K. Human germ-line therapy: The case for its development and use. The Journal of Medicine and Philosophy
16
: 593-612.
Gene therapy defined
Basic terms in use
Dream to reality: technical considerations
use of genetic information to intervene into human’s DNA in order to relieve the symptoms and prevent the causes of a disease
Hedgecoe, 2001
somatic gene therapy
GErm line gene therapy
the therapeutic genes are transferred
into the somatic cells (non sex-cells)
of a patient
effects will be restricted to the individual patient only, and will not be inherited
by the patient's offspring
or later generations
germ cells are modified by the introduction of functional genes, which are integrated into their genomes
germ cells will give rise to gametes that will
in the future combine to form a zygote
which will divide to produce all the other cells
in an organism
this will allow the therapy to be heritable
and passed on to later generations
— Somatic cellS —
all the cells forming an organism excluding gametes, germ cells and undifferentiated stem cells
— Germ line cellS —
found in testes and ovaries, any biological cells that give rise to the gametes that reproduce an organism after fertilization
— gametes —
the cells that carry maternal or fraternal genetic information and fuse to form a zygote in the process called fertilization
— stem cells —
undifferentiated biological cells that can differentiate into specialized cells and can divide (through mitosis) to produce more stem cells
Methods of application
— passive gL therapy —
IVF, selection & screening,
implementation of an embryo
(no DNA manipulation)
— direct microinject. —
of the DNA into the pronucleus of the one-celled fertilized egg
— use of es cells —
ES cell derived from the blastocyst stage which is manipulated in tissue culture
and reintroduced to an embryo
— virus vector —
virus is here used to transport desired DNA and implement it directly into diseased cells
united states of america
Thomas and Deborah McCalister
european union
Eric and Jolene Evaan
Russian federation
Anastasiya and Sasha Gribov
aim: ADA deficiency prevention (AR, 25% risk)
method: screening & selection of embryos
moral obligation
if there is a chance to select for a healthy
embryo and eradicate the mutated gene
from the offspring forward,
it is not just a chance — it is a must
value of knowledge
recognition of the requirement of
an intermediate stage between knowledge and technology that takes place in a form of novel experiments
Objections?
aim: Huntington's disease prevention (AD, 50% risk)
method: modification of gametes
medical necessity
in this case screening and selecting method for sperm cells is inefficient
the couple doesn’t want to screen and select embryos because this procedure requires killing and disposing defective embryos
social & economical
the obligation towards future generations not to worsen but even improve their wellbeing
the costs of treatment (palliative care) of HD far exceed the costs of single gene therapy
Objections?
aim: enhancement of cognitive abilities (no disease)
method: modification of an embryo
parental autonomy
parents can decide about the genetic makeup of their children just like they decide about the social environment, education, diet, etc. for the child
a duty to enhance
recognition of the intergenerational intervention and belief it’s for the good of future generations
Objections?
reasons
“Under this provision of Catholic Doctrine, an act which is otherwise ethically objectionable may be morally acceptable if it is the inevitable and unavoidable consequence of carrying our primary morally desirable intervention”
double effect law
(Lappé, 1991)
of medicine
argument against
Counterargument
human GLGT is not needed
sometimes GLGT could be
the only way of treatment
argument against
Counterargument
uncertainty of GLGT is too great
to permit on humans
we must allow some experiments to extend the knowledge in order to improve it
argument against
Counterargument
GLGT is instrinsically immoral
(religious POV)
life is unfair, people are immoral
— get over it
argument against
Counterargument
doubts as to misuse of eugenic application
we have learned the lesson, it's time to cautiously move on
argument against
Counterargument
distributive justice
there's already
a disequilibrium of goods allocation in society
argument against
Counterargument
acceptabilty of killing embryos
a topic of broader ethical consideration...
argument against
Counterargument
intergenerational issues:
lack of proxy consent
allocation of responsibility and acknowledgement of the rights of the unborn is too difficult — still insufficient to ban GLGT
problems with integrating therapeutic DNA into the genome and the rapidly dividing nature of many cells
immune response
viruses: toxicity, immune and inflamatory response, gene control and targeting issues
multigenic disorders
risk of inducing a tumour
high cost
the techniques contemplated for somatic-cell
therapy, or those used to make transgenic animals, would be quite unacceptable for germ-line applications
somatic/germ line
germ line changes
need not
be accomplished by direct alteration of sperm or ova prior to fertilization
traditional modes of genetic engineering may result in both somatic
and
germ line alteration (early development)
stem cells treatment of young children and even young adults may also
colonize
the germinal epithelium
correction
(treatment)
enhancement
(eugenics)
Targets of GL gene therapy
http://www.intechopen.com/
http://dspace.jorum.ac.uk/
http://genmed.yolasite.com/
http://pl.wikipedia.org/
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