In 2016, the first child of three parents was born in Mexico: his mother's mitochondrial DNA was replaced with a donor one so that a serious hereditary disease would not be passed on to the child. CRISPR can be used to edit the genome of an unborn child and cut out harmful mutations from it - the scheme has already been tested in the case of cardiomyopathy. Women may not have to give birth soon: the baby can be carried in an artificial uterus. There are no special obstacles to cloning a person other than ethical ones. Aging has been declared another disease that can and should be treated. The potential for biotechnology applications may turn out to be wider than many science fiction writers imagined - but new solutions present humanity with completely new questions that we are not ready for.
The question of how new technologies should be applied is not just about those who develop them. Biology and medicine are changing the way we think about life and death; about what is natural and what is amenable to intervention and conscious control. With the help of CRISPR technology, you can not only prevent serious genetic diseases, but also, for example, get rid of the smell of sweat from under the arms. But can parents be allowed to determine the future genetic fate of their child? It is unlikely that a child would rather be born with Leigh's syndrome and die within the first five years of life. But otherwise, genetic modeling of embryos looks controversial. After all, you cannot ask an embryo for informed consent.
The moral dilemmas that arise at the intersection of ethics, medicine and technology are dealt with by bioethics, a discipline that originated in the United States in the 1970s. And it began with the right to die.
How to die properly
In 1975, 21-year-old New Jersey resident Karen Quinlan returned home from a party, fell to the floor and stopped breathing. Her brain did not receive oxygen and went out; for several months she lay in a deep coma under an artificial respiration apparatus. In early 1976, her mother asked the doctors to disconnect Karen from the machine. She referred to Karen's own request, which she made after two of her friends painfully died of cancer.
Attending physician Karen responded to the mother's request with a flat refusal. The case was transferred to the state supreme court, and already in December 1976, Karen's request was granted - despite the hysteria in the media and even the intervention of Pope Pius XII himself.
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After this incident, bioethics began to change medical practice: bioethical committees began to be created in hospitals, where patients and their relatives can turn in case of conflicts with the medical administration. The opinion of "ordinary" people is increasingly taken into account in making medical decisions. But the debate over passive versus active euthanasia, of course, did not end there.
This year, 2-year-old British boy Alfie Evans found himself at the center of a high-profile medical scandal. In December 2016, as a result of an unidentified neurodegenerative disease, he fell into a coma. A year later, doctors saw no hope for his recovery and went to court to get the necessary permission and turn off the artificial life support system. Despite the protests of the parents, the court gave this permission.
Alfie's mother and father began to fight for the right to save the child's life and independently determine his fate. Pope Francis and Donald Trump expressed their support for the parents. The Italian authorities agreed to grant Holly citizenship and the possibility of free treatment in one of the Vatican clinics. But a British court banned the boy from being transported abroad. On April 23, Holly was disconnected from the ventilator and died about a week later.
The debate about the right to die could only have arisen after technological devices such as a ventilator appeared. Prior to this, it was impossible to maintain the life of a patient who fell into a coma for a long time. But today the right to die has become as important as the right to life. In some cases, dying is much more difficult than living, so it is not surprising that the right to euthanasia in some countries has received legislation.
Cloning people, editing children
In Don Hertzfeld's animated film Future World, people upload their consciousness to their own clones and in this way achieve some form of immortality. But for some reason, over time, their world becomes increasingly poor in emotions. To enjoy the experience, they have to go to their own past - at a time when the cloning and digitalization of consciousness did not yet exist.
Human cloning is no longer a serious technical problem today. This year it became known about the birth of the first cloned monkeys; there is no reason to believe that cloning a human will be much more difficult. It is much more difficult to answer ethical questions. The clone, of course, will not be a passive puppet, but an independent person - just like identical twins, who are technically clones of each other. But in what kind of relationship will he be with the "original"?
The procedure of mitochondrial replacement therapy already now allows parents with defects in mitochondrial DNA to conceive a healthy child without hereditary diseases. Technically, the first step in this procedure is similar to cloning. You need to take an egg from a donor woman, remove the nucleus from it, insert the mother's genetic material instead, fertilize it with the father's sperm, and then transplant it into the uterus and wait for the normal fetal maturation. The first child, whose embryo was obtained by mitochondrial replacement therapy, was born in 2016 in Mexico, the second - a year later in Ukraine. Two more conceptions using this method are likely to occur this year in the UK, the only country where mitochondrial DNA replacement is legal.
In the media, to describe the procedure, the expression “a child from three parents” is usually used. Geneticists, however, do not like this definition. The child's real mother is still one; only mitochondria are borrowed from the "second mother". But even these arguments show how much our understanding of parenting can be changed thanks to new biotechnology.
Representatives of the Catholic and Orthodox Churches oppose this procedure, in part because of its "unnatural" and possible risks, in part because of the suffering of embryos that will die during the selection of candidates for birth. In Christianity, a person is considered a person from the very moment of conception, therefore it is considered unethical to conduct research on embryos. The American geneticist of Russian origin Shukhrat Mitalipov, who developed this technology, thinks differently: “I think that research on embryos is ethical. To develop treatments for diseases, it is simply necessary to work with embryos. Otherwise, we will never learn anything. It would be unethical to just sit and do nothing."
The long-term effects of this procedure are still unknown. After the first successful experiment, genetics found out that they still failed to completely remove mDNA from cells: mitochondria from some tissues still carried a harmful mutation. This means that the disease may manifest itself in the future, but to a much lesser extent.
With regard to the social and psychological consequences that most people worry about most, it is unlikely that children "from three parents" will be somehow different from other children. When the technology of in vitro fertilization appeared, many doubted whether people who were conceived in a test tube would be the same as others. Now there are millions of such people, and no one believes that they are somehow different from others. Some even believe that IVF will eventually become the accepted method of reproduction, and that sex will simply turn into a pleasant hobby.
Embryonic gene editing is an even more complex and controversial procedure. It is carried out using CRISPR and other similar technologies. This mechanism, obtained by biologists from bacteria, allows you to cut at a specific section of DNA and replace it with the desired sequence.
Theoretically, this technology can be used to determine other parameters of the unborn child. However, it is not so easy.
Therefore, fears that parents will be able to create their own babies to order is at least premature.
But first impressions are often deceiving. Probably, it would be more ethical not to disconnect small children from artificial life support devices and not to hope for a miracle. It would be more ethical to make sure in advance that they will not become victims of fatal hereditary diseases.
Many new technologies do involve complex ethical issues. But this does not mean that these problems cannot be solved.
Author: Oleg Matfatov
