Transcript the tyranny of knowledge

DESIGNING BABIES
PROF. AVRAHAM STEINBERG
PLANNING AND PROGRAMMING
PLANNING
PROGRAMMING
Contraceptives
Abortion
Genetic screening
Pre-implantation
genetic diagnosis
Artificial insemination
In-vitro insemination
Clonning
Genetic engineering
Genetic therapy
clonning
TECHNIQUES
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GENETIC SCREENING
pre-marital
pre-implantation
pre-natal
post-natal
GENETIC ENGINEERING
GENETIC THERAPY
STEM-CELL MANIPULATION
CLONING
therapeutic
reproductive
ETHICAL ISSUES
 Science
and technology per se are
morally neutral
 The
determining factor from a sociomoral perspective is the USE of science
and technology
JEWISH APPROACH -GENERAL

Extreme caution of accepting scientific, social,
technological innovations and changes
’‫‘חדש אסור מן התורה‬
’‫‘עושה חדשות בעל מלחמות‬
but
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“Anything which we have no reason to prohibit is
permitted without having to find a reason for its
permissibility, for the Torah does not mention every
permissible thing but rather only those things which are
forbidden”
[Tiferet Yisrael, Yadayim 4:3]
THEOLOGICAL ISSUES
KNOWLEDGE
‘PLAYING GOD’
INTERFERENCE WITH NATURE
THE TYRANNY OF
KNOWLEDGE
for in much wisdom is much grief,
and he that increaseth knowledge
increaseth sorrow
(Ecclesiastes 1:18)
IMPORTANCE OF KNOWLEDGE
O Lord, how abundant are thy works, with
wisdom hast thou made them all, the earth is
full of thy riches
[Psalms 104:24]
How great are Thou deeds, O Lord,
exceedingly profound are Thou thoughts
[Psalms 92:6]
Maimonides’ Mishneh Torah, Yesodei ha’Torah
2:12
THEOLOGICAL ISSUES
KNOWLEDGE
‘PLAYING GOD’
INTERFERENCE WITH NATURE
‘PLAYING GOD’
 genetic
revolution  technical not
fundamental
 genetic revolution  revealing existing
not creating new
 where there is a plan  there is a
planner
 enhanced knowledge of macro- and
micro-cosmus enhances the belief in
the All-Mighty God
THEOLOGICAL ISSUES
KNOWLEDGE
‘PLAYING GOD’
INTERFERENCE WITH NATURE
INTERFERENCE WITH NATURE
Principally permissible, perhaps
required
verapo yerape, from here one derives a
healer’s permission to heal [BK 85a],
and we do not say -- God smites and
man heals [Rashi, loc. cit.]
INTERFERENCE WITH NATURE
Principally permissible, perhaps
required
All His work which God created to make,
is interpreted by the Midrash to mean
that world was left incomplete for man
to complete it
INTERFERENCE WITH NATURE
Principally permissible, perhaps
required
and subdue the earth -- God gave
humans power and dominion on earth
to do as they wish with animals, and to
build, to uproot that which is planted,
etc.
[Ramban, Genesis 1:28]
INTERFERENCE WITH NATURE
Qualifications
 the actual act must not involve any
inherent halakhic prohibition
 the act must lead to no unavoidable or
irreversible result which is halakhically
prohibited
 derived benefit should surpass the
detriment
Good ethics start
with good facts.
GENETICS -- FACTS
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46 chromosomes, X Y
Dominant, recessive, X-linked
Homozygote, heterozygote
Genotype, phenotype
3 billion code ‘letters’
DNA length 2 m, wide 2
billionths of a m
30,000 genes
5,000 genetic syndromes
GENETICS -- FACTS
predetermination  genetic
predisposition
 Genetic
 Tendencies
urges
and traits  irresistible
GENETICS -- FACTS
 Specific,
determinant genes
eye color, Tay Sachs
 specific,
partially determinant genes
Down’s syndrome, epilepsy
 specific,
predisposing genes
BRCA, tumor suppressors
GENETICS -- FACTS
 Genes
and environment
intelligence, toxins
 inter-acting
genes, multi-factorial
GENETICS -- FACTS
ONCOLOGY
 tumor suppressor genes -predisposition to cancer
 BRCA 1-3 -- breast/ ovary malignancy
NEURO-DEGENERATIVE
 Huntington’s disease
 Alzheimer’ disease
 Tay-Sachs disease
GENETICS -- FACTS
NEURO-BEHAVIORAL / CHARACTER
 ‘aggression’
gene
 ‘Homosexual’ gene
 ‘Intelligence’ gene
TECHNIQUES
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GENETIC SCREENING
pre-marital
pre-implantation
pre-natal
post-natal
GENETIC ENGINEERING
GENETIC THERAPY
STEM-CELL MANIPULATION
CLONING
therapeutic
reproductive
GENETIC SCREENING
Pre-marital screening –
encouraged
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Family history
Talmudic sources
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Tay-Sachs
Resonsa Iggrot Moshe, Even Haezer 4:10
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Genetic screening (Dor Yesharim)
recessive diseases
GENETIC SCREENING
Pre-implantation
genetic diagnosis –
Permissible
STATUS OF EMBRYO/FETUS –
JEWISH VIEW
a) PROGRESSIVE ACQUISITION OF HUMAN STATUS
AND RIGHTS
PROGRESSIVE SHIFTING OF BALANCES BETWEEN
MORAL-LEGAL CLAIM OF THE DEVELOPING
EMBRYO FOR LIFE AND OTHER OPPOSING
VALUES AND MORAL-LEGAL CLAIMS
b) FUNDAMENTAL DIFFERENCE BETWEEN PREEMBRYO / PRE-IMPLANTATION
AND EMBRYO / POST-IMPLANTATION
PRE-IMPLANTED FERTILIZED
EGG
Respect as a human part and potential life
No human status
“he who spills the blood of a human within a human,
his blood shall be spilled [Genesis 9:6] – a fetus within
its mother’s womb [Sanhedrin 67b]
“until 40 days after conception the fetus is mere fluid”
[Yebamot 69b]
Potential life very remote
PRE-IMPLANTED FERTILIZED
EGG
Respect as a human part and potential life
No human status
Consequently
pre-implantation genetic diagnosis (PGD) and
discarding defective pre-embryos –
Permissible
research on stem cells via destruction of blastocyte –
Permissible
PRE-IMPLANTATION GENETIC
DIAGNOSIS = PGD
 Rav
Eliashiv principle approval = NF1
 Rav Halberstam and Rav Neuvirt
detailed approval and supervision
 Review Committee
PRINCIPLES
 Serious, single gene, diseases
 Halakhically married couple
PRE-IMPLANTATION GENETIC
DIAGNOSIS = PGD
DILEMMAS
 Methods
to obtain semen:
condom during cohabitation
problems: risk of pregnancy
possibility of Niddah
solution: freeze sperm
other methods
PRE-IMPLANTATION GENETIC
DIAGNOSIS = PGD
DILEMMAS
 Carrier
state:
differentiate between X-linked
and recessive carrier state
 differentiate between IVF for
fertility purposes and IVF for PGD
 differentiate between whole cycle
of sick and carrier state and partial
PRE-IMPLANTATION GENETIC
DIAGNOSIS = PGD
DILEMMAS
 Adult-onset disease, i.e. BRCA
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HLA-compatible child
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Sex selection
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“Social” disease, i.e. homosexuality
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Adult pregnant women, i.e., Down’s
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Number of children in family
SCREENING
Pre-natal diagnosis –
Debatable
 Ultrasound
 Markers
 CVS
 Amniocenthesis
GENETIC SCREENING
PRE-NATAL
ABORTION ISSUES
DELIVERY MANAGEMENT
TECHNIQUES
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GENETIC SCREENING
pre-marital
pre-implantation
pre-natal
post-natal
GENETIC ENGINEERING
GENETIC THERAPY
STEM-CELL MANIPULATION
CLONING
therapeutic
reproductive
GENETIC THERAPY
FACTS AND PURPOSES
gene therapy  germ-line
therapy
 diseases  physical characteristics
 physical  mental  behavioral
 Somatic
GENETIC THERAPY
Genetic therapy is no different than any
other medical therapy. Hence, it is
included in the permission of Heal he
should heal and the obligation to
enhance health and to save life.
TECHNIQUES
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GENETIC SCREENING
pre-marital
pre-implantation
pre-natal
post-natal
GENETIC ENGINEERING
GENETIC THERAPY
STEM-CELL MANIPULATION
CLONING
therapeutic
reproductive
STEM CELL RESEARCH
What are stem cells and
why are people so
interested in them?
Pluripotential cells
Unlimited divisions
STEM CELLS -- APPLICATIONS
 Treatment
of degenerative diseases
i.e. Parkinson’s, Alzheimer, diabetes, stroke, infarct
 Organ
transplantation
 Basic research of cell differentiaiton
i.e., malignancy, congenital defects
 Applied
research
i.e., testing new drugs
STEM-CELL RESEARCH –
APPLICATION (1)
superfluous fertilized eggs after fertility
treatment (IVF)
YES
directly created for purpose of stem-cell
NO
therapeutic cloning
YES
STEM-CELL RESEARCH –
APPLICATION (2)
miscarried fetus
YES
abortion for purpose of stem-cell
NO
Adults
YES
TECHNIQUES
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GENETIC SCREENING
pre-marital
pre-implantation
pre-natal
post-natal
GENETIC ENGINEERING
GENETIC THERAPY
STEM-CELL MANIPULATION
CLONING
therapeutic
reproductive
Human Cloning:
Two Distinct Applications
 Reproductive
cloning - a clonal preembryo is implanted in a woman's womb
with intent to create a fully formed living
child.
 Therapeutic
cloning - a clonal pre-embryo
is produced, but instead of being
implanted in a womb, it is used to
generate stem cells.
THERAPEUTIC CLONING
ADVANTAGES
Immunological identity – no rejection
Specifically designed
No emitting of sperm
PROBLEMS
Many eggs required
Sources of eggs – volunteers, identified,
danger to donor, sale
REPRODUCTIVE CLONING
POTENTIAL MEDICAL BENEFITS
 Renew
functioning of damaged cells, or
replacement of dead cells [i.e., Parkinson,
Alzheimer]
 Halt
uncontrolled reproduction of cells
[i.e., malignancy]
 Animals/people
with similar immune
systems [i.e., organ donors]
 Solution for infertile couples
POTENTIAL PROBLEMS AND
DAMAGES
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Eugenics
Identical people, no
individuality
Absence of genetic
variability
Undesirable
changes in mature
cells
“Black market” of
fetuses
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Who is the Father?
Mother?
 People becoming
means rather than
ends
 Radical changes in
world’s social order,
parenthood, family
POTENTIAL PROBLEMS -AMELIORATING FACTORS
 Influence
of development -- learning
and environment
 Time factor
 Mitochondial DNA
 Interaction of genetic material
ETHICAL vs MORAL
Questionable moral issues
Currently definitely ethical issues
Undesirable damaged offspring
HALAKHIC ISSUES
 Witchcraft
-- as a transformation in the
order of creation
 Cross-breeding animal and plant
species [kilayim]
 Three partners in the human being -father, mother and G-d
HALAKHIC ISSUES
“Anything done as a natural activity is
not included in the prohibition of
witchcraft. Even if we knew how to
create creatures without natural
procreation … we may engage in this
activity, since anything natural does
not fall under the rubric of witchcraft”
[R. M. Ha’Meiri (1249-1316), Sanhedrin 67b]
HALAKHIC PROBLEMS
the clonee a ‘golem’?
 Does one fulfill the commandment to
“be fruitful and multiply”?
 How is fatherhood / motherhood
defined in a cloning situation?
 Is
HALAKHIC PROBLEMS -FATHERHOOD / MOTHERHOOD
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Mature cell, ovum and womb of same woman
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Mature cell from husband, ovum and womb
of wife
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Mature cell from a first-degree relative
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Mature cell from a female, ovum and womb
of another female
THANK YOU !