Department of Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK.
J Med Ethics. 2019 Aug;45(8):526-527. doi: 10.1136/medethics-2019-105390. Epub 2019 Mar 12.
Gyngell and colleagues consider that the recent Nuffield Council report does not go far enough: heritable genome editing (HGE) is not just justifiable in a few rare cases; instead, there is a moral imperative to undertake it. We agree that there is a moral argument for this, but in the real world it is mitigated by the fact that it is not usually possible to ensure a better life. We suggest that a moral imperative for HGE can currently only be concluded if one first buys into an overly deterministic view of a genome sequence, and the role of variation within in it, in the aetiology of the disease: most diseases cannot simply be attributed to specific genetic variants that we could edit away. Multiple, poorly understood genetic and environmental factors interact to influence the expression of diseases with a genetic component, even well understood 'monogenic' disorders. Population-level genome analyses are now demonstrating that many genetic 'mutations' are much less predictive than previously thought Furthermore, HGE might introduce new risks just as it reduces old ones; or remove protections not yet clearly delineated.
金格尔和同事们认为，最近的纳菲尔德理事会报告做得还不够：可遗传性基因组编辑（HGE）不仅仅在少数几种罕见情况下是合理的；相反，进行 HGE 是有道德义务的。我们同意这是有道德论据的，但在现实世界中，由于通常不可能确保更好的生活，这种情况有所缓解。我们认为，只有当人们首先接受基因组序列的过度决定论观点，以及其内在变异在疾病发病机制中的作用时，HGE 才具有道德必要性：大多数疾病不能简单地归因于我们可以编辑掉的特定遗传变体。多种未被充分理解的遗传和环境因素相互作用，影响具有遗传成分的疾病的表达，即使是被很好理解的“单基因”疾病也是如此。人群水平的基因组分析现在表明，许多遗传“突变”的预测性远不如以前认为的那么高。此外，HGE 可能会引入新的风险，就像它减少旧的风险一样；或者消除尚未明确划定的保护措施。
