different views

Far more controversial is the prospect of conducting human germ line therapy. Debate over genetic manipulation of human eggs, sperm, and embryonic cells has raged for more than fifteen years. In 1983, a cross-section of the nation's religious leaders and prominent scientists announced their opposition to such experiments, on eugenics grounds, and urged a worldwide ban. (The coalition was put together by The Foundation on Economic Trends.)

Programming genetic changes into the human germ line to direct the evolutionary development of future generations is the most radical human experiment ever contemplated and raises unprecedented moral, social, and environmental risks for the whole of humanity. Even so, a growing number of molecular biologists, medical practitioners, and pharmaceutical companies are anxious to take the gamble, convinced that controlling our evolutionary destiny is humankind's next great social frontier. Their arguments are couched in terms of personal health, individual choice, and collective responsibility for future generations.

Writing in The Journal of Medicine and Philosophy, Dr. Burke Zimmerman makes several points in defense of germ line cell therapy over somatic cell therapy. To begin with, he argues that the increasing use of somatic therapy is only likely to increase the number of survivors with defective genes in their germ lines-genes that will continue to accumulate and further "pollute" the genetic pool of the species, passing an increasing number of genetic problems onto succeeding generations. Secondly, although somatic therapy may be able to treat many disorders in which treatment lies in replacing populations of cells, it might never prove effective in addressing diseases involving solid tissues, organs, and functions dependent on structure - for example the brain - and therefore, germ line therapy is likely the only remedy, short of abortion, against such disorders.

Zimmerman and other proponents of germ line therapy argue for a broadening of the ethical mandate of the healing professions to include responsibility for the health of those not yet conceived. The interests of the patient, they say, should be extended to include the interests of "the entire genetic legacy that may result from intervention in the germ line." Moreover, parents ought not to be denied their right as parents to make choices on how best to protect the health of their unborn children during pregnancy. To deny them the opportunity to take corrective action in the sex cells or at the early embryonic stage would be a serious breach of medical responsibility. Proponents of germ line therapy ask why millions of individuals need to be subjected to painful, intrusive, and potentially risky somatic therapy when the gene or genes responsible for their diseases could be more easily eliminated from the germ line, at less expense, and with less discomfort.

Finally, the health costs to society need to be factored into the equation, say the advocates of germ line therapy. Although the costs of genetic intervention into the germ line to cure diseases are likely to remain high in the early years, the cost is likely to drop dramatically in the future as the methods and techniques become more refined. The lifetime cost of caring for generations of patients suffering from Parkinson's disease or severe Down's syndrome is likely to be far greater than simple prevention in the form of genetic intervention at the germ line level.

GENETIC RESPONSIBILITY

In the coming decades, scientists will learn more about how genes function. They will become increasingly adept at turning genes "on" and "off." They will become more sophisticated in the techniques of recombining genes and altering genetic codes. At every step of the way, conscious decisions will have to be made as to which kinds of permanent changes in the biological codes of life are worth pursuing and which are not. A society and civilization steeped in "engineering" the gene pool of the planet cannot possibly hope to escape the kind of ongoing eugenics decisions that go hand and hand with each new advance in biotechnology. There will be enormous social pressure to conform with the underlying logic of genetic engineering, especially when it comes to its human applications.

Parents in the biotech century will be increasingly forced to decide whether to take their chances with the traditional genetic lottery and use their own unaltered egg and sperm, knowing their children may inherit some "undesirable" traits, or undergo corrective gene changes on their sperm, egg, embryo, or fetus, or substitute egg or sperm from a donor through in vitro fertilization and surrogacy arrangements. If they choose to go with the traditional approach and let genetic fate determine their child's biological destiny, they could find themselves culpable if something goes dreadfully wrong in the developing fetus, something they could have avoided had they availed themselves of corrective genetic intervention at the sex cell or embryo stage.

In the Biotech Century, a parent's failure to correct genetic defects in utero might well be regarded as a heinous crime. Society may conclude that every parent has a responsibility to provide as safe and secure an environment as humanly possible for their unborn child. Not to do so might be considered a breech of parental duty for which the parents could be held morally, if not legally, liable. Mothers have already been held liable for having given birth to crack cocaine addicted babies and babies with fetal alcohol syndrome. Prosecutors have argued that mothers passing on these painful addictions to their unborn children are culpable under existing child abuse statutes, and ought to be held liable for the effect of their lifestyle on their babies.

Proponents of human genetic engineering argue that it would be cruel and irresponsible not to use this powerful new technology to eliminate serious "genetic disorders." The problem with this argument, says The New York Times in an editorial entitled, "Whether to Make Perfect Humans," is that "there is no discernible line to be drawn between making inheritable repair of genetic defects and improving the species." The Times rightly points out that once scientists are able to repair genetic defects, "it will become much harder to argue against additional genes that confer desired qualities, like better health, looks or brains."

If diabetes, sickle cell anemia, and cancer are to be prevented by altering the genetic makeup of individuals, why not proceed to other less serious "defects": myopia, color blindness, dyslexia, obesity, short stature? Indeed, what is to preclude a society from deciding that a certain skin color is a disorder? In the end, why would we ever say no to any alteration of the genetic code that might enhance the well-being of our offspring? It would be difficult to imagine parents rejecting genetic modifications that promised to improve, in some way, the opportunities for their progeny.

It is likely that as new screening technologies become more universally available, and genetic surgery at the embryonic and fetal stage becomes more widely acceptable, the issue of parental responsibility will be hotly debated, both in the courts and in the legislatures. The very fact that parents will increasingly be able to intervene to ensure the health of their child before birth, is likely to raise the concomitant issue of the responsibilities and obligations to their unborn children. Why shouldn't parents be held responsible for taking proper care of their unborn child? For that matter, why shouldn't parents be held liable for neglecting their child's welfare in the womb in cases where they failed to or refused to screen for and correct genetic defects that could prove harmful to their offspring?

With Americans already spending billions of dollars on cosmetic surgery to improve their looks and psychotropic drugs to alter their mood and behavior, the use of genetic therapies to enhance their unborn children also seems a likely prospect. According to a 1992 Harris poll, 43 percent of Americans "would approve using gene therapy to improve babies' physical characteristics." Many advocates of germ line intervention are already arguing for enhancement therapy. They contend that the current debate over corrective measures to address serious illnesses is too limited and urge a more expansive discussion to include the advantage of enhancement therapy as well. As to the oft heard criticism that genetic enhancement will favor children of the rich at the expense of children of the poor-as the rich will be the only ones capable of paying for genetic enhancement of their offspring - proponents argue that the children of well-off parents have always enjoyed the advantages that wealth and inheritance can confer. Is it such a leap, they ask rhetorically, to want to pass along genetic gifts to their children along with material riches? Advocates ask us to consider the positive side of germ line enhancement, even if it gives an advantage to the children of those who can afford the technology. "What about ... increasing the number of talented people. Wouldn't society be better off in the long run?" asks Dr. Burke Zimmerman.