Rehmann-Sutter Christoph
a Institute of History of Medicine and Science Studies , University of Lübeck , Lubeck , Germany.
New Bioeth. 2018 Apr;24(1):9-25. doi: 10.1080/20502877.2018.1441669.
Do we have a moral obligation to genetically cure embryos rather than selecting between them? Such an obligation would be an ethical argument for human germline gene editing (hGGE) to avoid the inheritance of genetic conditions instead of using pre-implantation genetic diagnosis (PGD). In this article, the intuition that we do have such a moral obligation is critically evaluated. The article first develops a theoretical framework for discussing the ethical questions of hGGE. This framework is based on an exploration of the phenomenology of the germline, from both biological and philosophical points of view. It interprets the germline as an embodied intergenerational relationship that carries meanings for the parents and for the children-to-be. It relates them to previous family generations, and to their own children. Hence, the germline is a phenomenologically much richer concept than just the line of cells that carry the inheritable genetic information. Against this background, selection is compared with editing and a key moral difference is identified: editing is in effect an act of co-constructing the genome, which necessarily assumes a wider range of responsibilities that include those parts that are left unedited. Introducing hGGE into societies would hence significantly affect and change the moral structure of the intergenerational relationships. Selective implantation, on the other hand (in the context of PGD), is based on a moral choice in favour of the embryo which is to be unaffected by a disease or disability that causes suffering, rather than selecting knowingly the affected one. The claim that hGGE is in the best interests of the child-to-be counterfactually assumes the presence of a patient who has an interest in being cured. The embryo (a potential future patient) is, however, brought into existence by the same act that is also the treatment. The future children who would result from treatment by hGGE may rather have an interest in not having been treated by hGGE, since it makes the intergenerational relationships more complicated and burdensome. The question 'Is hGGE justified, or even an obligation?' is answered with a No.
相较于在胚胎之间进行选择,我们是否有道德义务通过基因手段治愈胚胎呢?这样一种义务将成为支持人类生殖系基因编辑(hGGE)以避免遗传疾病遗传的伦理论据,而非使用植入前基因诊断(PGD)。在本文中,我们将对认为我们确实负有这种道德义务的直觉进行批判性评估。文章首先构建了一个用于讨论hGGE伦理问题的理论框架。该框架基于从生物学和哲学角度对生殖系现象学的探索。它将生殖系诠释为一种具身化的代际关系,这种关系对父母和未来的孩子都具有意义。它将他们与家族的前辈以及他们自己的孩子联系起来。因此,生殖系在现象学上是一个比仅仅携带可遗传基因信息的细胞系更为丰富的概念。在此背景下,将选择与编辑进行比较,并确定了一个关键的道德差异:编辑实际上是一种共同构建基因组的行为,这必然承担更广泛的责任,包括那些未被编辑的部分。因此,将hGGE引入社会将显著影响并改变代际关系的道德结构。另一方面,(在PGD背景下的)选择性植入基于一种道德选择,即支持胚胎不受导致痛苦的疾病或残疾影响,而不是明知故选受影响的胚胎。声称hGGE符合未来孩子的最佳利益是反事实地假定存在一个有治愈意愿的患者。然而,胚胎(一个潜在的未来患者)是由既是治疗行为的同一行为产生的。通过hGGE治疗产生的未来孩子可能反而有兴趣不接受hGGE治疗,因为这会使代际关系更加复杂和沉重。“hGGE是否合理,甚至是一种义务?”这个问题的答案是否定的。