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胚系基因组编辑与胚胎植入前遗传学诊断:胚系干预有其合理之处吗?

Germline genome editing versus preimplantation genetic diagnosis: Is there a case in favour of germline interventions?

机构信息

Institute of Ethics and History of Medicine, University of Tübingen, Germany.

出版信息

Bioethics. 2020 Jan;34(1):60-69. doi: 10.1111/bioe.12635. Epub 2019 Aug 25.

Abstract

CRISPR is widely considered to be a disruptive technology. However, when it comes to the most controversial topic, germline genome editing (GGE), there is no consensus on whether this technology has any substantial advantages over existing procedures such as embryo selection after in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). Answering this question, however, is crucial for evaluating whether the pursuit of further research and development on GGE is justified. This paper explores the question from both a clinical and a moral viewpoint, namely whether GGE has any advantages over existing technologies of selective reproduction and whether GGE could complement or even replace them. In a first step, I review an argument of extended applicability. The paper confirms that there are some scenarios in which only germline intervention allows couples to have (biologically related) healthy offspring, because selection will not avoid disease. In a second step, I examine possible moral arguments in favour of genetic modification, namely that GGE could save some embryos and that GGE would provide certain benefits for a future person that PGD does not. Both arguments for GGE have limitations. With regard to the extended applicability of GGE, however, a weak case in favour of GGE should still be made.

摘要

CRISPR 被广泛认为是一种颠覆性技术。然而,在最具争议的话题——种系基因组编辑(GGE)方面,对于这项技术是否比体外受精(IVF)后胚胎选择和植入前遗传学诊断(PGD)等现有程序具有任何实质性优势,尚无共识。然而,回答这个问题对于评估是否有理由追求 GGE 的进一步研究和开发至关重要。本文从临床和道德的角度探讨了这个问题,即 GGE 是否比现有的选择性生殖技术具有优势,以及 GGE 是否可以补充甚至取代它们。在第一步中,我回顾了一个扩展适用性的论点。本文证实,在某些情况下,只有种系干预才能让夫妇拥有(生物学上相关的)健康后代,因为选择无法避免疾病。在第二步中,我考察了支持基因修饰的可能的道德论点,即 GGE 可以拯救一些胚胎,并且 GGE 将为未来的人提供某些 PGD 无法提供的好处。这两个支持 GGE 的论点都有局限性。然而,对于 GGE 的扩展适用性,仍应提出一个支持 GGE 的弱论点。

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