Bioethical Issue Paper
Azusa Pacific University
Bioethics & Healthcare Policy
Sharon K. Titus, PhD, MSN, RN
November 3, 2019
Bioethical Issue Paper
(please add references to this section/ My instructor stated the following “include data of the problem and its significance of genetic engineering and modifying the human germline”)
Genetic engineering is one of the recent unique technology that is creating a massive buzz in the world of genetics and science. Also referred to as Eugenics, genetic engineering refers to a genome editing technology that enables scientists – medical researchers and geneticists – to edit certain parts of the genome by altering, adding, or removing sections of DNA sequence. Studies show that people targeted by eugenics programs are unmarried women, children, people with mental problems, and “feeble-minded” individuals. For instance, in the last century, many states in the US had passed laws in which these populations were sterilized to enhance their genetic traits and ensure their offspring have desired qualities. It is a pressing ethic issue because people subjected to eugenic procedures may not have been provided with a chance to make the decision whether to the procedure. Thus, it is a topic worthy discussion to determine ethical considerations, cultural dynamics, and nursing professional policies on the issue. Eugenic practices violate moral and cultural values, human rights, and ethical principles; hence, laws and policies should be developed to govern these practices and ensure they are done with the realms of bioethical principles.
Ethical Issues and Dimensions
(Please add brief paragraph here stating summary of dimensions to introduce this section)
(Also, for this section my instructor wrote “both of your dimensions are well chosen. However, both lack content that directly speaks to the topic sentence. Suggest revising both sections of your dimensions so that they are clear, focused on your issue.”)
Health Promotion through Gene Manipulation Technologies
The idea behind eugenics in the nursing profession is to promote health and aid in creating a society in which humans have desirable traits. Here, nurses and healthcare professionals are aiming to perform medical procedures to people with undesirable qualities and add traits deemed favourable to their genes. In doing so, it is believed that we will have enhanced humans who are resistant to diseases holding qualities to be both bright and creative. In this vein, medical engineers have developed numerous technological tools and techniques to edit the human genome. A good example of genetic engineering technology facing huge controversy is CRISPR-Cas9 is termed to be the most versatile, simplest, and precise method that can be used to manipulate genes and create an organism with desired traits. It is a technology that presents a real possibility of modifying human germline. (Doudna & Charpentier, 2014). Since CRISPR-Cas9 emerged in 2012, it uses have expanded as witnessed with increased patented applications, numerous publications, and massive funding to research projects focusing on its advancements. Gene modification, it is a process to find a DNA piece that can be modified and bound to it and recruits the Cas9 enzyme whose function is to cut DNA. Evidently, there are side effects of gene modification that promises to enhance human lives. When desired fragments of DNA are reduced, it allows removal or modification of specific DNA sequences (Shalem et al., 2014). Hence, humans with desired genes are developed.
Positive and Negative Aspects of Trait Selection (PROS and CONS)
Positive traits. (Please provide break down one or two specific examples of how eugenics help)
Negative traits. (Emphasis is here, please provide break down of multiple examples of how eugenics is negative)
Lack of patient education with trait selection. Another nursing practice that is necessary regarding the issue of eugenics practice is patient education. Studies show that little has been done to educate the patient about these practices, there benefits and consequences. Some of the provisions in the code of ethics of the nursing profession outline the importance of patient education before they undertake medical procedures. Besides, educating patients helps them to provide informed consent detailing that they have understood and agreed to undergo a certain medical procedure. This shows that if the patient were educated, we would have minimal cases or issues of eugenics practices and bioethics. That is because the patient will have been informed about the operation and provided physicians with informed consent.
Eugenics has made it possible to enhance human beings and the entire society by encouraging the production of individuals with desired characteristics while discouraging the production of individuals with undesirable traits. Medically, genes are edited, and certain traits are added or removed from human DNA. As eugenics practices continue to be conducted in our medical labs, several legislative bills have been passed to support or limit it. In the last century, over 33 states made laws to authorize eugenic sterilization to several categories of people, including “feeble-minded,” “mentally ill,” and “criminals.” Populations that were targeted by these programs were poor children, people in African American communities, and unmarried women. In most cases, these people were deemed unfit to reproduce; hence, eugenic programs were developed to make them reproduce. Their genes would be altered and edited to ensure they reproduced offspring with desirable traits. In 2019, Senate Bill 1698 was brought forward to the Senate to compensate or offer a financial break to victims of Eugenics programs in the states of Virginia and North Carolina. These people were sterilized under state eugenics programs and are now seeking full compensatory payments because it was done against their will. If this bill were to pass and become a law, it would become the first fed legislation in the US to recognize and address the history of sterilization where people were abused during the 20th century in the name of putting desired genes and eliminating the undesirable qualities. North Carolina become the first state to issue plans to repatriate these living eugenic victims via monetary compensation. On the same vein, Virginia passed a similar bill in 2015 and compensated 12 living victims. The passage of these bills shows that the government understands the ethical fundamental of protecting people against bioengineering practices carried on by human beings against their will (Hjörleifsson & Schei, 2016). When these programs were conducted, people subjected to them did not offer their consent to participate in them, nor were autonomy respected before the programs. These were forced sterilization against the will of those subjected to them. The code of conduct and ethical principles outlines ethical guidelines that medical practices should follow to ensure the rights of the patients are met. In contrast, sterilization programs violated ethical principles such as beneficence, nonmaleficence, and justice (Blanck & De Paor, 2014). They did more harm than good to these people. Therefore, bills on eugenics are seeking to protect people from practices that can turn against their well-being and give them the right to reject advances in taking these procedures.
Beneficence and Nonmaleficence (PLEASE ADD “JUSTICE” SECTION AND PROVIDE EUGENICS SPECIFIC CONTENT IN RELATION TO HOW THIS PRINCIPLE IS COMPROMISED. DO NOT TALK ABOUT BILLS IN THE JUSTICE SECTION)
These are bioethical principles that address the idea that actions by health care professionals, including medical engineers, physicians, and nurses, should promote the greater good, have a moral obligation, and cause no harm. That is, patients should receive appropriate services and which are best for them. This means that health care professions should consider the welfare of the patient before they carry out any procedure on the individual seeking care. These actions should be to do good and not inflict pain on the patient. Several past studies have shown that eugenics practices have caused more harm than good to the patient. In 20th-century eugenics programs which had been developed in many states caused more harm than good to the patient. It is for this reason that legislative bills are being developed to compensate those forced to undergo these procedures, as discussed earlier.
Ethical Considerations and Cultural Dynamism
Altering God’s Work
Although eugenics has much to offer, its benefit is overshadowed by moral, ethical, and safety concerns of modifying the human germline. The big ethic issue here is lying on the fact genetic engineering has come to alter God’s work. By editing traits and DNA features, scientists are trying to play the role of God in determining what and what features a spring will have and which too goes against moral and ethical values (Wolpe, 2013). The bible says that every individual was created in God’s image and has a specific purpose on this earth. When God gives one specific character, he knows what he is doing and the purpose of those traits. Some cultures are against eugenic practices because they argue it has come to do away with God’s work. They feel like the scientist has come to alter or try to undo God’s work of creation. This goes contrary to the belief in God and societal values (Berkman, et al., 2014).
Alienation of Human Rights
The use of eugenics practices will alienate human rights by deciding what characteristics a child or individual should have or added, and those that should be removed. Hence, it fails to respect human autonomy since researchers are the ones to decided DNA features that one should possess. Additionally, the technology is unpredictable and leads to severe consequences on individuals treated with it and their offspring. By causing harm to human beings, technology will cause more harm than good. For example, a study conducted in 2014, American biochemist Jennifer Doudna saw her postdoctoral college present an experiment in which a virus which has been engineered to insert CRISPR element into a mouse – it would sleep and breath in the modified virus. Consequently, the experiment leads to the rise of mutations, which ended up creating a new model of human lung cancer. So, instead of being a solution to human problems, technology is adding more health problems to people. In this vein, we can argue that genetic engineering technologies will violate the ethical principles of beneficence, justice, and respect for autonomy.
Creation of Transhumanism
There is also the possibility that gene editing can result in the creation of transhumanism in society. Transhumanism means that humans have evolved beyond their current mental and physical limitations using means of science practices and technological ideas. When one’s genes are edited, they are enhanced to remove his or her limitations and added qualities that increase mental and physical abilities. Unlike natural people whose genes are unedited and natural, people with edited genes will be more intelligent and their behaviors modified. As such, since only a few people can get the genes edited – wealthy people due to inequity in the use of the technology – they may be discriminated in our societies and be referred to as transhuman. This will create a division in the society where will have superhumans versus natural humans. This is bad for society because it goes against the moral and ethical values of people living together with peace and harmony. We will end up having an inequitable distribution of resources and preferences.
Researchers report that eugenics presents the possibility of off-target effects and mosaicism. Off-target effects refer to the genes edits that have gone wrong and can have devastating effects on the body of the individuals whose genes have been edited. Mosaicism, on the other side, refers to instances in which some cells may carry edited genes, but others fail to carry. Such issues raise safety concerns and bring an important point on the ethicality of eugenic practices. Researchers have given us a full guarantee that germline editing, which has gone right is safe. However, they have also warned the use of genome editing in clinical reproductive functions since they cannot justify its risks or potential benefits.
Nursing Professional Policy
(Please add policy in relation to topic of eugenics and how it is a bioethical concern)
Position and Recommendations
Recommendations are made on the best course of action pertaining to better health care practices that follow ethical guidelines. I believe that if genome editing is proved to be safe and effective, it should be allowed, especially in finding cures for chronic and genetic diseases. Genome editing may not necessarily be done to enhance human qualities, given the ethical controversies, but at least can be used to find treatment for serious chronic diseases, which have become a huge public concern and brought a heavy health burden to our societies. In cases where genome editing is used for reproductive purposes, the government should develop laws and policies to govern and regulate enhancements. It is morally imperative to have a society where people live with peace, love, and harmony; hence, to guarantee this, eugenics should be proved safe and effective and made available for everyone regardless of class, race, or income-levels.
Eugenics or genetic engineering technologies such as CRISPR-Cas9 presents a promising technology technique that can result in a breakthrough in many medical fields. Medical researchers indicate that this technology is applicable in many areas in the medical field. For example, it is said to be a powerful approach that can be utilized in treating a plethora of diseases such as sickle cell anemia, HIV/AIDS, numerous forms of cancer, and hemophilia. However, its application could bring a real possibility of treating serious diseases that have posed a real public health concern. However, there are downsides to this technology that need to be discussed because genetic engineering presents ethical and safety concerns to human lives. In addition to leading to more diseases, it can also result in the creation of transhumanism and designer babies in our societies. Although the passage of these bills will not support nor oppose eugenics, they provide a foundation on which people can rely on when deciding whether to participate in them or not. The possibility of carrying out successful bioengineering practices offers a promising future for humanity and society at large. However, there must be done on the realms of bioethics and respect human autonomy.
Berkman, J., Hauerwas, S., Stout, J., Meilaender, G., Childress, J. F., & Evans, J. H. (2014). Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate. Journal of the Society of Christian Ethics, 24(1), 183-217.
Blanck, G. P., & De Paor, A. (2014). US legislative and policy response: some historical context to GINA. In Genetic Discrimination (pp. 115-131). Routledge
Doudna, J. A., & Charpentier, E. (2014). The new frontier of genome engineering with CRISPR-Cas9. Science, 346(6213), 1258096.
Evans, J. H. (2019). The Empirical Examination of the Social Process of Genetic Enhancement, Objectification, and Maltreatment. The American Journal of Bioethics, 19(7), 32-34.
Hjörleifsson, S., & Schei, E. (2016). Scientific rationality, uncertainty and the governance of human genetics: an interview study with researchers at deCODE genetics. European journal of human genetics, 14(7), 802.
John, H. As promised in the fall/winter 2003 issue, we inaugurate in this volume a new feature of the JSCE, a book review section. The first reviews to appear are of John H. Evans’s book Playing God? Human Genetic Engineering and the Rational-ization of Public Bioethical Debate, as they were delivered at the 2003 annual meeting of the Society of Christian Ethics (SCE) by John Berkman, Stanley.
Shalem, O., Sanjana, N. E., Hartenian, E., Shi, X., Scott, D. A., Mikkelsen, T. S., … & Zhang, F. (2014). Genome-scale CRISPR-Cas9 knockout screening in human cells. Science, 343(6166), 84-87.
Wolpe, P. R. (2013). Review of John H. Evans, Playing God? Human Genetic Engineering and the Rationalization of Public Bioethical Debate.
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