Rethinking the ethical challenges of life technology

On November 26, 2018, two days before the 2nd International Human Genome Editors’ Summit, a news article entitled “The world’s first genetically edited baby with immune AIDS was born in China” quickly detonated the network and was responsible for the clinical The Southern Science and Technology University, a young scientist of the pilot project, He Jiankui, quickly clarified the personal behavior of the trial department during the period of unpaid leave, and pointed out that the genetic editing research on human embryos violated academic ethics and academic norms and will start immediately. An independent investigation of the incident. On January 21, 2019, the Guangdong Genetic Editing Infant Investigation Team published the official investigation conclusions, and found that the incident was He Jiankui’s pursuit of personal fame and fortune, self-raised funds, deliberately evading supervision, privately organizing relevant personnel, and implementing reproductive bans prohibited by the state. The purpose of the human embryo gene editing activities, the day Southern University of Science and Technology announced the dismissal of himself. In late February, a paper on the ethical guidelines for assisted reproductive technology published in The CRISPR Journal was retracted.

The He Jiankui incident reminds us of a problem that, in the face of the rapid development of genetic editing biotechnology, the government must make a difference at the legislative level, the scientific community in moral self-discipline, and the ethicists in regulating and guiding, in order to prevent it from being brought to humans. Come to irreversible damage. In summary, there is a complex interaction between the development of science and technology and the consequences of social application, and the subject of Science, Technology and Society (STS) is the core theme of this content, caused by the He Jiankui incident. Attention, and the subsequent development of technical governance measures, seems to be a good example of STS.

However, it is worth noting that on November 26, the Sina Science and Technology Channel survey conducted on the trial showed that more than 36,000 people participated in the vote, 37.8% did not support, 25.35% supported, and 36.85% neutral. It shows that in the lack of understanding of human embryonic gene editing technology, the public has not renounced the support of the technology for the prevention of serious diseases such as AIDS. In other words, the guidance of public opinion led by the scientific community and the popularization of knowledge are not completely consistent with the cognitive or moral tendencies of ordinary people (especially those suffering from various major diseases and their families), and after the incident, the public It is always the passive recipient of information. The scientific knowledge, ethical review and philosophical reflection on this matter come from the unilateral interpretation and dissemination of the community of science or related humanities. The core appeal of experts mainly involves the editing of human embryonic genes. The strict control of clinical trials even prohibits the punishment of researchers who violate regulations, and requires the government to establish corresponding regulatory measures. From the final result of the incident, these appeals have been met and implemented, proving the moral self-discipline of the mainstream scientific community. And the enforcement mechanism that appeals to the will of the state is effective.

In order to achieve these demands, scholars in the field of life sciences and related humanities research have criticized the various technical and ethical problems of the He Jiankui incident through media, newspapers, academic journals and other media. These opinions can be roughly divided into the following aspects:

The first is the immature gene editing technology. As a third-generation gene editing technology, CRISPR/Cas9 has the advantages of high accuracy, low target rate, simple technical requirements, easy operation and low price compared with previous ZFNs technology and TALENs technology, but it is needed for genetic modification of germline. In terms of 100% accuracy, CRISPR/Cas9 still has significant clinical risks, so technical risk is the primary reason for opponents. This risk is not only in the operation of the He Jiankui event to knock out the CCR5 gene, but for all Germ genetic modification for human therapeutic purposes.

Second is the risk caused by insufficient medical knowledge. For example, a modified gene may play a role in the human body that is not currently known. If rushed to modify it may bring other potential risks.

Finally, there is a threat to human biological integrity. Inappropriate genetic modification of human embryos leads to the isolation of the fetus after birth, and the isolation of the offspring into the human gene pool, which has an unpredictable impact on human follow-up generation, to some extent equivalent to the current Humans have made decisions in place of future generations, making their biological nature likely to change.

The above three types of risks are directed at the genetic modification of the germline itself. For the genetically modified infants who are immune to AIDS in the He Jiankui incident, the conclusion based on the above risk analysis is due to the current maternal and child blockade technology. Development and HIV can have other routes of infection, so the risk of this clinical trial is huge, but the benefits are not obvious, so from the perspective of the risk-benefit medical ethics review, there is no need to conduct such an experiment.

However, whether the above defense is sufficient for the general public still needs judgment. The same is the germline genetic modification. In 2015, Huang Jun of Sun Yat-Sen University published a research paper on the use of CRISPR technology to modify human embryonic genes for the first time. It was originally thought by the New York Times reporter to cross the long-established ethical boundaries of the West, but ultimately He successfully obtained the ethics defense and was elected as one of the top ten figures in Nature magazine. The main difference between it and He Jiankui lies in two points: First, Huang is a basic research on thalassemia, and He is a genetic enhancement to some extent (that is, genetic modification makes babies and their possible offspring immune to AIDS). Ability), which belongs to the scope of clinical trials for the human body; secondly, the completion of the human embryonic genetic modification allows the fetus to be born, and the yellow is the inactive three-primary zygotic embryo (that is, the abnormal embryo itself), these two differences make The scientific community and the media have produced a completely opposite polarized assessment of the two: one is almost ruined and the other is an annual scientific man.

But from another perspective, He and Huang’s research still has a lot in common. For example, the scientific purpose of its research includes the improvement of current gene editing technology, making it more effective and rapid, at least for the genetic patients and their families, and the congratulations are allowed in the International Scientific Community in 2017. The germline genome editing experiment began to test after reaching consensus, and the yellow research was carried out in 2015. As for the clinical trial of somatic gene therapy, countries have basically deregulated since the 21st century and approved thousands of clinical trials. For the majority of patients, the latest ten years have become familiar with gene therapy programs, and many people are willing to take reasonable risks to participate in the trial. Therefore, the scientific community has reached a consensus that there is no ethical obstacle to the somatic genome editing in the human genome editing for basic research and clinical treatment. The germline genome editing is conditional, but it is cautious for gene enhancement. The public is more widely discussed and involved. He Jiankui’s step is to use the germline genome editing for gene enhancement under conditions of immature conditions (genetic editing of human embryos under the premise of maternal babies and infants blocking technology), which violates academic and industry consensus. And related government regulatory policies.

However, in addition to educating the public, this incident has made people more cautious about genetic modification of the germline. Waiting for the maturity of its clinical application, is it worthwhile to reflect on it from other perspectives? The core point of the scientific community’s opposition so far comes from a tool rationality, that is, through the risk-benefit analysis to determine whether the germline genome modification can be used for clinical treatment or enhancement, and the risk is mainly determined by the basic research of scientists. In this scene, the sacred undecorated value rationality of the genome as a human biological essence is not shown. In other words, what scientists do is only a rational “calculation”. If the benefit is greater than the risk, then it can be carried out. Can’t.

One problem that arises from this is that this rational “calculation” is undoubtedly anthropocentrism, because there is no similar constraint on the genetic modification of other species. Instead, it is necessary to establish an animal model through genetic editing of experimental animals. Human clinical treatment provides support. As for the impact of genetic modification of the human germline on future generations, there are two different perspectives for defense: one is still from instrumental rationality, that is, based on the position of technological controlism to analyze whether the impact of current genetic editing is Can be tracked and controlled, and calculate risks and benefits accordingly; the other is based on value rationality, the germline genome that determines the nature of human biology cannot be edited, and human beings are sacred as a unique higher biological species.

The author does not intend to re-evaluate the application of the germline genome modification technology reflected by the He Jiankui incident from the perspective of medical ethics, but based on a stronger anthropocentrism position, claiming that the human germline genome modification can be used for treatment. It can also be used for gene enhancement, and because of the increased impact of human activities in nature, there is an increasing demand for medical needs and other aspects of biological characteristics. It is not enough to conduct risk-benefit analysis from the individual level. Basic research Knowledge accumulation often lags behind actual needs. From animal models to human clinical trials and treatments, it often takes a long wait. Therefore, it is necessary to measure risks and benefits from a macro level, and if necessary, to undertake higher risks to develop somatic and germline cells. The clinical application of genetic modification technology.

The author’s claim begins with this question: Should humans play the role of God to edit their genes? Scientists do not make assumptions about whether God exists (because it is not necessary for them), its attitude is not necessary if it is not necessary, that is, no other solutions can be found, and the risk is calculated repeatedly – the benefit is more than feasible when it is edited. Human own somatic and germline cell genes. Theologians, biologists, and even the general public are relatively cautious about this issue, do not interfere with the nature created by God (including humans), and do not actively intervene in the evolutionary process of human beings, “the skin of the body, the parents.” In short, the premise of this problem is that genes have been defined as the unique nature of human beings, so the deeper question behind them is: Why do we become human beings? What is the nature of our species as a human species?

The above discussion is basically based on biological significance. For example, according to the essence of species, it is believed that biological species can be uniquely identified by genome or a specific genetic region (so-called “DNA barcode”), and humans are no exception. . But the question “Why do we become human” also includes the following three meanings: human beings are biologically unique and fundamentally different from other higher organisms, so we can redesign genes of other species to serve humans without ethical responsibility. Secondly, due to the different nature of biology, human beings have a unique social and cultural structure. The third is that human beings have a class of subjectivity in philosophies. They realize the ability of human beings to transform the external world as a species, and have continuous learning. And the ability to progress. In short, the formulation of this question embodies the biological uniqueness and superiority of human species in the known world (known in the universe, the only natural intelligent organism that has evolved to date on Earth), subjectivity, and A sense of responsibility associated with it.

However, the “species” itself is a controversial concept in the history of evolutionary biology. Different interpretations such as essentialism, nominalism, biology, and pluralism have raised questions about whether this issue is established. What the author is taking here is The nominalism or contractivist view holds that “species” is a concept based on the current level of understanding, and is a theoretical entity introduced in human rational cognitive activities, according to which to organize relevant knowledge systems. Since the various essentialist interpretations that exist today cannot exhaust the possibilities of the future, the connotation of the concept of species is also changing, and thus the question of “how do we become humans (species)” is partially resolved in the biological sense, The long time of the universe and the future evolutionary scale, biologically, humans do not have a unique essence, that is, absolute essentialism does not hold. Therefore, the targeted intervention of species evolution that may be caused by the modification of human germ cell lines does not seem to be a problem of concern. The design of human will is equal to the choice of natural selection. Humans have no absolute essential nature in biology. . From this it can be inferred that there is no particularity in the “species” that have the subjective consciousness, rational knowledge and tool manufacturing ability, specific social structure and culture, and can intervene between the individual and the nature, and guess the time in the universe and evolution. There are many similar species on the scale, and it is not important that these “species” are higher organisms that have evolved naturally or artificially, or are creations of certain higher organisms (artificial creations for humans).

The above analysis clarifies that humans do not have the absolute essential stipulation of biology, but this does not mean that “species” cannot be discussed under certain time and space conditions. The premise of discussion is to recognize the relative uniqueness of human beings as higher biological species. The prescriptive nature of species is dynamic and relative, and its connotation changes with the advancement of knowledge. In this sense, species is inherently prescriptive, so why we become human beings is a serious issue. For example, it is currently believed that the social and subjective consciousness of human beings is also a necessary condition for the essential provisions of human beings. Because if the essential prescriptive nature of a particular time and space species is completely eliminated, it will lead to many ethical adverse consequences.

If it is recognized that species have relative essential presuppositions, and therefore humans have such provisions, then such prescriptives need to include at least biological (genetic, morphological, etc.) and cultural definitions. Symbolic animals, rational animals, etc. are all cultural. Defined, biologically innate language acquisition skills, complex brain structure. Modifications to germline cell lines may alter biological presupposition and may even change cultural presuppositions (eg loss of language learning ability, etc.).

But changing the relative nature of the biological presupposition will inevitably lead us to become human beings? The unique genome is the biological presupposition of humans. Why only allow natural selection without allowing manual intervention? Modern integrated evolution believes that biological evolution is gradual (based on variable variability), and does manual intervention lead to mutations during shorter generation replacements? One big difference is that the ability of contemporary human beings to transform nature has brought about a great change in the natural choice of modern comprehensive evolution. The natural choice here has obvious humanity’s cultural or social purpose. For example, if prenatal genetic screening is used, scientists like Hawking or geniuses with special talents will not be born, because prenatal genetic screening itself cannot be achieved from the complete level of knowledge or ethics. The perfect unity of purpose and regularity. The question is not whether we should intervene in the natural evolution of human species, but for the special species of human beings, natural selection itself has permeated human values ​​and cognitive levels of life phenomena. This natural selection pressure combined with human activities has also led to the need for genetic enhancement (for example, astronauts in interplanetary navigation need to adjust their metabolic levels), so the question is not whether to modify the human germ cell genes, but rather to reflect on What is the motivation for editing reproductive genes outside of medical purposes?

We know that natural selection is not perfect, and the number of existing biological species is far less than the number of species that have been extinct in evolution. The relative nature of human beings is a dynamic set. The known biological prescriptiveness is only one subset that can be changed. How the natural variation or artificial modification of an individual spreads in a group will be an important issue in the future. Due to the particularity of human biology, it is difficult to obtain sufficient data and efficacy by relying solely on animal models and somatic genetic modification, and it is difficult to have absolute safety margins. Sometimes, for the benefit of all subsequent generations of human beings, it is necessary to carry out routines. A clinical trial of risk and even greater risk, this risk-benefit analysis can be directed at humans as a whole rather than individuals. We can’t sit down and count on the enormous number of patients every year, and we must act. Active intervention in the objective world and society means a desire and ability to grasp the world. This kind of subjective initiative is the core foundation for us to become a unique human being. In this sense, strong anthropocentrism is acceptable if Degradation to the level of biological evolution, the biological essence as the fundamental, is undoubtedly incompatible with the definition of our human culture, the so-called biological and cultural interaction in the connection, the inseparable holistic position is not completely Founded, the cultural identity of human beings really determines why we become human beings.