Ethical challenges of genome editing



Preventing the transmission of inherited genetic diseases, and increasing food production rates in farmed animals are two potential applications of genome editing technologies that require urgent ethical scrutiny, according to a new report by the Nuffield Council on Bioethics.

The Council, which includes academics from King’s, has today published the first findings of its review looking at the potential impact of recent advances in genome editing such as the CRISPR-Cas9 system across many areas of biological research. The report found evidence that, given its technical advantages and rates of uptake, genome editing is already having an almost unprecedented impact in research. The Council considered the possible effects of these advances in fields such as health care, food production, industry and public health.

Professor Karen Yeung, Director of the Centre for Technology, Law & Society at King’s and a member of the Nuffield Council on Bioethics Working Group, who conducted the review said: ‘We examined the way in which these technologies are being taken up in the research community and what we found is that, because of a number of advantages which they offer in relation to existing techniques for manipulating DNA, they are having an unprecedented transformative effect on the biological sciences and for that reason they have the potential to change our expectations and ambitions about human control over the biological world.

‘One of the reasons why we are undertaking this review is to encourage public deliberation. We think that the potential applications for human health are very important, but also in relation to food production where the technology is really almost ready to go and that is why we are trying to think carefully about the ethical dimensions in order to try and identify the paths of development that we think are the most ethically appropriate.’

The Council will now begin work on two further inquiries addressing the ethical and practical questions raised by possible uses of genome editing in different fields. The first of these will focus on the potential use of genome editing in human reproduction to avoid the transmission of heritable genetic conditions, and the second on livestock to improve systems of animal husbandry and food production.

Dr Andy Greenfield, Chair of the Nuffield Council on Bioethics Working Group who conducted the review, said:‘Genome editing is already showing a potential to transform not only how biological research is carried out, but more importantly our expectations and ambitions for addressing challenges such as disease prevention and food security. Although most uses so far have been in research, the potential applications seem to be almost unlimited, given that the techniques are applicable to all organisms, from bacteria to plants, animals, and human beings.’

Avoiding genetic disease

Human reproductive applications are probably the most talked about potential application of genome editing technologies and raise some of the most complex ethical concerns. Genome editing could one day offer an alternative approach to preventing the inheritance of diseases such as cystic fibrosis.

Concerns have been stirred by reports of research in China to correct disease-causing genetic mutations in non-viable embryos in 2015 and the granting, by the Human Fertilisation and Embryology Authority (HFEA), of a licence to allow genome editing of embryos in the UK February 2016.

Professor Yeung is Chair of the newly established Nuffield Council on Bioethics Working Party on human reproductive applications and said: ‘Genome editing is a potentially powerful set of techniques that holds many future possibilities, including that of altering certain genetic features at the embryonic stage that are known to lead to serious and life-limiting disease. In the UK and in many other countries, a long path to legislative change would have to be followed before this could become a treatment option. But it is only right that we acknowledge where this new science may lead and explore the possible paths ahead to ensure the one on which we set out today is the right one. We will be very interested to hear people’s views on this aspect of genome editing technologies in our new inquiry.’

Many people have concerns about the possible use of genome editing in humans, for example, about the risks of unintended effects due to off target DNA alterations, and the implications of making irreversible changes that will be passed on to future generations. Another key concern is the possible orientation of research towards human enhancement, going beyond disease prevention into the engineering of ‘desirable’ genetic characteristics. As with other technologies and innovations, the potential benefits and harms of genome editing might not be distributed equitably, and some people are worried that negative effects could cause discrimination, injustice or disadvantage to certain individuals or groups.

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Penn Medicine Bioethicists Call for Return to Asylums for Long-Term Psychiatric Care



JAMA Viewpoint Characterizes Current Model for Treating Mentally Ill as “Ethically Unacceptable and Financially Costly”

As the United States population has doubled since 1955, the number of inpatient psychiatric beds in the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. residents with serious mental illness. A new viewpoint in JAMA,written by Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, of the department of Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, looks at the evolution away from inpatient psychiatric beds, evaluates the current system for housing and treating the mentally ill, and then suggests a modern approach to institutionalized mental health care as a solution.

“For the past 60 years or more, social, political and economic forces coalesced to move severely mentally ill patients out of psychiatric hospitals,” write the authors. They say the civil rights movement propelled deinstitutionalization, reports of hospital abuse offended public consciousness, and new drugs gave patients independence. In addition, economics and federal policies accelerated the transformation because outpatient therapy and drug treatment were less expensive than inpatient care, and the federal legislation like the Community Mental Health Centers Act and Medicaid led to states closing or limiting the size of so-called institutions for mental diseases.

However, the authors write, “deinstitutionalization has really been transinstitutionalization.” Some patients with chronic psychiatric diseases were moved to nursing homes or hospitals. Others became homeless, utilizing hospital emergency departments for both care and housing. But “most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities. Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder.” According to the authors, “this results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness and incarceration.”

Read more: Penn Medicine Bioethicists Call for Return to Asylums for Long-Term Psychiatric Care


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