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SELECTIVE REPRODUCTION AND ASSOCIATED RISKS AND BENEFITS:
AN ETHICAL CASE STUDY ON THE EFFECTS OF GENETIC ALTERATIONS
Rahul Ramanathan (rar122@pitt.edu)
The overarching idea behind genetic alteration is the
replacement of the unwanted gene with a favorable one
extracted from another organism. For example, people who
suffer from diabetes have a faulty gene that controls insulin
production. According to Dr. Murzia Cavazzana-Calvo, a
physician-scientist at the Mayo Clinic, insulin is “a naturally
occurring protein made by cells in the pancreas in humans
and other mammals. It controls the breakdown of complex
carbohydrates in the blood to glucose [sugar],” [1]. The
faulty gene in individuals who are diabetic hinders insulation
synthesis, which in turn causes blood-sugar levels to be
abnormally high. To reconcile this problem, genetic
engineers use the “plasmid transformation protocol,” [1] in
which three sub-processes are involved. The first process
involves removing the host’s faulty gene, which is done by
isolating the insulin gene with restriction enzymes. These
enzymes are proteins that cut the DNA in specific areas to
isolate the target sequence from the rest of the genetic code.
Subsequently, the faulty insulin gene is extracted from the
cell. This is done by allowing the gene to attach to a vector,
an agent (usually a large circular piece of DNA) that carries
the gene and is more easily handled when compared to the
insulin gene by itself. In a parallel procedure, the proper
insulin gene is extracted from a donor using the same
procedure mentioned above. The desired gene is then
“amplified” to produce several duplicates to minimize error
when transferring genetic material into the new host. Finally,
to complete the procedure, the desired gene is transferred to
the host’s cell by a procedure called cell fractionation [2]. In
the specific instance of the diabetic patient, following a
successful gene transfer procedure, they now will have the
regular insulin-production gene and will produce enough
insulin to keep blood-sugar levels low.
Similarly, the genes of the embryo that express physical
characteristics can be replaced by those taken from donors
that express the desired phenotype (physical characteristics)
by utilizing the same procedures.
A CUSTOM BABY: AN ISSUE TODAY
AND A REALITY TOMORROW
Today, the movement to chart the human genome has
gotten further than it ever has. Biomedical engineers and
geneticists have been working together to understand which
genes control our specific and complex physical and mental
characteristics. Suppose we were to fast forward to when that
understanding is finally achieved. What challenges will then
accompany our accomplishments? Let’s consider a scenario
where all the genes for physical and mental characteristics
have been discovered and sequenced. Let’s also consider that
the theoretical procedure for the alteration of genes to express
selective characteristics has been developed. Of course, let’s
assume that the specific technologies required for the genetic
alteration procedure have advanced enough to make the
process quite affordable as well. Nevertheless, a real case of
human genetic alteration has not yet been performed. In this
hypothetical scenario, I am a biomedical engineer working for
Aptus Endosystems (a renowned biomedical corporation) and
one of the pioneers in completing the human genome. I am
also an expert in conducting (in theory) the aforementioned
procedure. Sometime in this era, I am contacted by an Indian
couple from a relatively poor part of India, who wish to have
the genetic alteration procedure done on their expected child.
They claim that South India’s old traditions of segregating
people by caste still exist, and would like to break the family’s
history of “discrimination and humiliation.” In addition, many
parts of India are still plagued by the idea that women do not
belong in the workplace but primarily exist as a burden to
their husbands. Due to this morbid ideality, the Indian couple
also requests that I alter the formative sex characteristics of
their future child to ensure that he is male. The couple asks
for physical characteristics that resemble those of the “highest
caste,” which entails light skin, straight hair, small hands and
feet, and brown-colored eyes. And since the procedure has to
be completed before the embryo matures into a fetus, I will
have less than two months to decide my plan of action:
whether to accept or decline the couple’s request.
ASSESSING CONCERNS FOR THE
WELL-BEING OF THE GENERAL PUBLIC
SCIENTIFIC BACKGROUND AND
RELATED GENETIC ENGINEERING
PROCEDURES
As a biomedical engineer, it is important that I adhere to
an established framework to help me formulate my decision.
Specifically, the rules and regulations imposed by the
Biomedical Engineering Society Code of Ethics and the
NSPE Code of Ethics will allow me to make an informed
decision while being conscious of how it affects myself and
the engineering community.
Although engineers today are still far from developing
technologies that will allow for the sequencing of the entire
human genome, we can predict the types of technologies that
will allow us to both carry out the procedure in the future and
assess any associated complications/risks involved.
University of Pittsburgh, Swanson School of Engineering
2015-11-03
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Rahul Ramanathan
First and foremost, my actions must “enhance the safety,
health, and welfare of the public,” [3]. Although the genetic
modification procedure would help the family at hand, there
are long-term effects on society that we cannot be certain of
at this point. For example, if this procedure is completed
successfully, it is inevitable that more families in the future
will start to consider genetic engineering for their own
children. Based on what we know today, healthy families
have a diverse “gene pool” [4] which allows for variation in
genetics among family members. Variation is the key to
evolution and is nature’s natural way of selecting desired
characteristics. If we were to change that by selectively
altering genes, there will be a lack of variation. This results in
offspring generations looking increasingly similar to the
parental generations. As genetic modification becomes more
popular and accessible with each successive procedure, the
entire human genome will eventually converge into one,
rather than diverging as it should. The definition of evolution
as we know it would be distorted and we would surely
experience issues that will prevent the evolution of the human
race as a whole.
With the increase in prevalence of genetically altered
humans, collectively termed “designer babies”, yet another
class division will appear. Designer babies will undoubtedly
be advantaged compared to non-designer babies due their
selected characteristics, and this will promote a culture of
inequality and division between the two. This is a major
problem, as the original intention of this particular case and
procedure was to help the Indian couple overcome that exact
cultural barrier.
A greater problem arises when more parents are given
freedom to choose the sex of their child. According to a
survey conducted by Princeton University in 1941, it was
found that “…Americans preferred a boy to a girl by a 38%
to 24% margin.” [5]. When this survey was conducted again
in June 2011, it was found that “If Americans could have only
one child, they would prefer that it be a boy rather than a girl,
by a 40% to 28% margin, with the rest having no preference
or no opinion on the matter,” [5]. These results are indicative
of the explicit preference towards the male gender over the
female gender. Thankfully, nature places no preference
between the two genders, and any couple has a 50% chance
of having a child of either gender. What if more couples, such
as the Indian couple in this hypothetical case study, were
allowed to choose the gender of their child? From the same
survey conducted by Princeton University, it was noted that
“Americans with lower education levels are more likely to say
they would favor a boy; those with postgraduate education
essentially break even in their preferences,” [5]. If this data
were to be extrapolated to encompass the world population,
we can inductively state that the majority of the world’s
poorer population will prefer the male gender. If others were
given the same opportunity for carrying out the same genetic
modification procedures as the couple mentioned in this case
study, we would observe a growing ratio of males to females.
There can be substantial consequences associated with this
ratio imbalance. Aside from the obvious concern of an
increase in interspecific competition between men to find a
female partner, crime is predicted to rise [6], as “The
combination of psychological vulnerability and sexual
frustration [experienced by men due to the ratio imbalance]
might lead to aggression and violence,” [7]. In other words, it
is predicted that some men could turn to violence when faced
with lack of sexual stimulation and mental vulnerability
caused by an imbalanced sex ratio. The gender ratio
imbalance also suggests proliferation of the sex industry.
Throughout the past 20 years, India and China have seen an
increase in sex trafficking and coercion [7]. These nations
also lead in the greatest SRB (sex ratio at birth). Although this
correlation does not imply causation, it is evident that SRB
could have a profound effect on the propagation of the sex
industry. [7] Despite multiple negative effects of an
incongruent male-female ratio, Dr. Therese Hesketh of the
The European Molecular Biology Organization states that
there are a few benefits to an increased male population as
well. Dr. Hesketh states that women are “a valuable
commodity when sex ratios are high,” [7] resulting in “less
premarital and extramarital sex, lower divorce rates and less
illegitimacy,” [7]. In addition, it is predicted that women will
have higher self-esteems, decreasing the rates of depression
and suicide [7]. Thus, it seems that there are both positives
and negatives to sex selection, although nature is considered
to be at equilibrium best when the ratio of men to women is
1:1 [6].
There does exist a limit to where we can modify physical
expression to our advantage as individuals. However, as we
approach this limit, the general welfare of the public and
society is threatened.
ETHICAL ISSUES RELATED TO GENE
DONATION
In order for genetic modification to be carried out, the
desired gene must be taken from an organism, in this case
namely a human, that expresses the characteristic(s) that the
specific gene is responsible for. However, there are many
socio-ethical issues that arise from this “gene donation.”
Foremost, there are many legality issues when retrieving
genetic information from any given individual. Many of the
requirements and complications for obtaining genetic
information parallel those required for organ donations. For
example, unless the donor of the genetic information is a “first
relative” (mother, father, brother, sister, son, daughter, and/or
grandparent) [8], special permission from the donor is
required, accompanied by excessive red tape. In our specific
case study of an Indian couple that is looking for a child with
vastly different physical attributes than their own, they have
no choice but to retrieve the desired gene from someone
outside of their family. Due to the excessive paperwork and
legal issues, many people are not incentivized to donate their
genetic material to someone unbeknownst to them, unless a
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monetized incentive is offered [8]. According to Dr. Sunil
Shroff, who recently published an article titled Legal and
Ethical Aspects of Organ Donation and Transplantation,
“Most unrelated donations occur when the donor expresses
their true affection for the recipient.” [8]. This situation can
be comparable to gene donation as well; however, it must be
noted that there is a clear distinction between organ donation
and gene donation: the latter is merely a privilege. This further
reduces the incentive for potential gene donors, as it is easier
and morally superior for donors to support someone in need
rather than someone who is privileged enough to undergo a
genetic modification procedure. Thus, in order to fulfill the
wishes of the couple, I must be able to find a suitable and
willing donor who expresses the physical characteristics that
the couple desires for their child, while maintaining proper
legal standards and procedures.
OUR INFLUENCE ON THE FUTURE OF
OUR PROGENY
There has been much controversy surrounding the issue of
promoting selectively engineered babies from a sociological
standpoint. Some geneticists, such as Y.J. Koszarycz, believe
that parents should not maintain the right to design their
child’s future before they are even brought into the world.
Koszarycz, the author of Genetic Engineering: Creating an
Ethical Framework states that by enforcing genetic alterations
to the human genome, we are “… [reducing humans] to the
status of a non-being - a non-person being denied the right to
develop individual, full human potential with the right to
make free, informed decisions,” [11]. In essence, genetic
alterations are dehumanizing procedures that can be
comparable to building a robot or machine that is
predetermined to perform a desired function. Koszarycz also
states that choosing a child’s specific physical characteristics
sends “…a very negative message about people with [other
traits], [a message] that says that it would be better if they had
not been born,” [11]. Evidently, these outcomes seem
contrary to what we as a society strive to achieve. It is our
responsibility as adults to foster an environment that is
inclusive towards all children, despite their physical
differences. We must strive to equip future generations with
skills and knowledge to become valuable contributors to
society, and promoting equality should be at the forefront of
achieving that goal.
IDENTIFYING AND ASSESSING
POSSIBLE NEGATIVE OUTCOMES OF
GENETIC MODIFICATION PROCEDURES
As with any procedure, there always exists a possible
factor of risk and/or failure. As engineers are required to
“…accept personal responsibility for their professional
activities…” and “…advise their clients or employers when
they believe a project will not be successful,” [3] I must assess
the risks involved in the genetic modification procedures and
respond accordingly. Unfortunately, the specific procedure
requested by the couple in our case study has never clinically
been tested, and thus holds potential for failure.
The human genome is extremely complex, and even genes
that express the same trait often have different compositions
and sequences. Just as donor organs pose a risk of being
rejected by the host’s body, donor genes can also be rejected
by the developing embryo, either resulting in no expression
of the gene, expression of an unrelated gene, or expression of
the faulty gene. [9]
Once the desired genes from the donor have been
transferred to the host cell to begin development, it is allowed
to mature into a blastula, which is the term for an early-stage
embryo. However, this is a very delicate stage that is
susceptible to failure. For example, a study conducted in 2008
by Stanford School of Biosciences found that when
performing an insulin gene transplant in pigs, two out of the
five trials showed signs of erroneous development of the
blastula stage. At this point in time, the blastula did not go
through cell division properly and resulted in an aborted fetus.
[10] The cause of the abnormal cell division after genetic
modification procedures remains unknown, but the risk of
erroneous development exists, and must be taken into
consideration when carrying out these genetic modification
procedures.
AN ECLECTIC PERSPECTIVE AND AN
INFORMED DECISION
As I approach the point of making an informed decision
about whether to accept or decline the couple’s request, it is
important that I gather opinions from non-scientific sources
as well. From a young age, I have always sought guidance
from my father in times of personal dilemmas. Thus, I
contacted Dr. T.R. Ramanathan on October 26 th, 2015 via
cellphone and I asked that he provide a personal view on the
case at hand. He stated that “…designer babies might cause
turmoil in certain Christian populations, since some hold
strong views on how much we, as humans, should interfere
with God’s role as creator,” [12]. My father’s input should be
a primary influence in forming a conclusion, since I must be
conscious of the extent to which my decision will affect
different groups of people, including religious communities.
Although science revolves around theory and
experimentation, I believe that it is necessary to look at issues
in a philosophical aspect as well. To get a professional
philosophical view on the case, I contacted Dr. Nora Boyd, a
History of Philosophy and Science professor at the University
of Pittsburgh. Dr. Boyd believes that predetermining physical
characteristics can lead to a bigoted and superficial society
that will resort to judging individuals by their appearance
rather than by their talent and potential. Dr. Boyd states that
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this will become a major problem when privileged members
of the society are able to predetermine their children’s
phenotype based on society’s version of the “perfect
physicality” [13].
At a first glance, it is evident that the Indian couple will
initially benefit from the genetic alteration procedure.
However, through scientific studies and experiments
conducted on the consequences and benefits of human
genome alteration, we can see that going through with the
procedure could bring more harm than benefit to society. Predetermining the sex of a child can cause gender imbalance in
the community and will lead to increased aggression and
competition between males. In addition, gene donation needs
to be further incentivized before it can become a practical
solution for acquiring desired genes. Donor genes also carry
the problem of being rejected by the host, which can result in
a terminated pregnancy. From a theological and philosophical
standpoint, it seems that many religious communities would
not respond positively to any genetic alteration procedures.
Thus, with a multifarious view of ethics and societal concerns,
I would decide to reject the couple’s request to perform
genetic alterations for their child. Unfortunately, the societal
and long-term consequences would greatly outweigh the
benefits that one family will experience. Through this
experience, I would hope to be satisfied with my decision and
to not bear any guilt for rejecting a client’s wishes. I would
suggest that all future engineers follow a similar approach to
solving problems: by adopting a multifaceted view that
considers the social, societal, physical, chronic, and
theological repercussions of their particular choices.
http://search.ebscohost.com/login.aspx?direct=true&db=aph
&AN=61872915&site=ehost-live
[7] T. Hesketh. (2012). “The Effects of Artificial Gender
Imbalance.” The European Molecular Biology Organization.
(online
report).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367246/?re
port=reader
[8] S. Shroff. (2009). “Legal and ethical aspects of organ
donation and transplantation.” Medknow Publications.
(online
report).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779960/ __ffn_sectitle
[9] D. Vetterli. (2015). “Risk Behavior and Reciprocity of
Organ Donation Attitudes in Young Men.” Transplantation
Proceedings.
(online
report).
http://search.ebscohost.com/login.aspx?direct=true&db=aph
&AN=108940466&site=ehost-live
[10] T. Lemke. (2002). “Genetic Testing, Eugenics, and
Risk.”
Critical
Public Health.
(online
report).
http://search.ebscohost.com/login.aspx?direct=true&db=aph
&AN=7385961&site=ehost-live
[11] Y. Koszarycz. (2010). “Genetic Engineering: Creating an
Ethical Framework.” Australian eJournal of Theology.
(online
report).
https://www.keele.ac.uk/media/keeleuniversity/ri/risocsci/eu
genics2013/Eugenics and the ethics of selective reproduction
Low Res.pdf
[12] T. Ramanathan. (2015, October 26). Phone Call
[13] N. Boyd. (2015, October 27). Interview. University of
Pittsburgh
REFERENCES
ADDITIONAL SOURCES:
[1] M. Cavazzana-Calvo. (2000). “Gene Therapy of Human
Severe Combined Immunodeficiency (SCID)-X1 Disease.”
Science
Magazine.
(online
report).
http://www.sciencemag.org/content/288/5466/669.full
[2] G. Edelman. (1971). “Cell Fractionation and Arrangement
on Fibers, Beads, and Surfaces.” PNAS. (online report).
http://www.pnas.org/content/68/9/2153.full.pdf
[3] (2004). “Biomedical Engineering Society Code of Ethics.”
(online report) http://bmes.org/files/2004 Approved Code of
Ethics(2).pdf
[4] A. Kumar. (2015). “Genome-wide signatures of malemediated migration shaping the Indian gene pool.” Journal of
Human
Genetics.
(online
report).
http://search.ebscohost.com/login.aspx?direct=true&db=aph
&AN=109924388&site=ehost-live
[5] S. Stieger. (2014). “Measuring Implicit Gender-Role
Orientation: The Gender Initial Preference Task.” Journal of
Personality
Assessment.
(online
report).
http://search.ebscohost.com/login.aspx?direct=true&db=aph
&AN=95430644&site=ehost-live
[6] M. Hvistendahl. (2011). “Unnatural Selection.”
Psychology
Today.
(online
report).
“Case 5 - Practical Issues in Prioritizing Needs.” Standford
Biodesign.
(online
report).
http://biodesign.stanford.edu/bdn/ethicscases/5prioritizeneed
s.jsp
(2003). “Code of Ethics for Engineers.” National Society of
Professional
Engineers.
(online
report).
http://www.mtengineers.org/pd/NSPECodeofEthics.pdf
M. Loui. (2006). “Role Play on Intellectual Property
Involving a Method for Data Compression.” Online Ethics
Center.
(online
report).
http://www.onlineethics.org/Resources/Cases/IntellectualPro
p.aspx
(2013). “Public Health and Safety—Delay in Addressing Fire
Code Violations.” National Society of Professional
Engineers.
(online
report).
http://www.nspe.org/sites/default/files/BER Case No 13-11FINAL.pdf
ACKNOWLEDGEMENTS
I would like to thank my writing center instructor, Jack
Giles, for providing me valuable feedback and suggestions for
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improvement. I would also like to thank my family for
providing me with priceless opportunities to learn and
discover myself, my environment and my capability.
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