Grappling with the bioethics of genetic technologies
by REV. DR. NATHAN BARCZI
Last July, the MIT Technology Review reported that a team of researchers led by Shoukhrat Mitalipov at the Oregon Health and Science University had successfully carried out the first known genetic modification of viable human embryos in the United States.1 While experts continue to debate exactly what the results of Mitalipov’s study proved,2 it was clearly a significant step in demonstrating the feasibility of using CRISPR (a technology for editing the human genome, developed in 2013 by teams of researchers in Cambridge, Massachusetts, and Berkeley, California) in clinical settings.
“This is the kind of research that is essential if we are to know if it’s possible to safely and precisely make corrections” in embryos using CRISPR, legal scholar and bioethicist R. Alta Charo of the University of Wisconsin, Madison, told the biotech news magazine STAT.3 Last February, Charo played a key role in the release of a consensus report from the National Academy of Sciences. The report called for strict restrictions and stringent testing of human germline editing,4 but, for the first time, stopped short of recommending an outright prohibition. With startling speed, it has become clear that the question is when, not whether, precise and relatively cheap genetic modification of human embryos will be available to prospective parents.
Think of editing the genome like a “find-and-replace” function: a tool finds, removes, and replaces a specific sequence of genetic material. In older methods of gene editing, the search is done using protein structures, which are laborious to construct and not terribly precise. Instead, CRISPR uses RNA, which can be cheaply and quickly constructed by most good graduate students working in a lab.
It has not escaped notice that this technology raises a number of novel ethical concerns. While CRISPR holds out tremendous potential to alleviate the suffering that follows from genetic diseases such as sickle cell anemia and Huntington’s disease, it could eventually also make possible, to those with access to the technology, the selection of traits such as height, eye color, and greater strength and intelligence.5
Should genetic editing be restricted to therapeutic uses only, or should any form of human enhancement be allowed? How would one define the line separating those two (the same genetic modifications, for instance, could eliminate some forms of cancer, or simply reduce the likelihood that a healthy person will develop cancer)? Should we permit germline editing, which results in genetic modifications that are passed on to subsequent generations that have no say in the matter? Some Christians who have wrestled with such issues have allowed cautious support for the technology – the Vatican, for instance, which takes a relatively conservative line on questions of bioethics, has expressed qualified support for “strictly therapeutic intervention,”6 and has even written that “[g]erm line genetic engineering with a therapeutic goal in man would in itself be acceptable were it not for the fact that it is hard to imagine how this could be achieved without disproportionate risks,”7 such as embryo loss and unintended genetic changes.
But the greatest risk lying behind genetic editing may be the risk of dehumanization. Why would this follow if we were to conceive of humanity as something that we can reshape to suit our own wishes? This is, in general, how technology works – as Paul Graham, founder of the technology accelerator Y Combinator puts it, “Technological progress means making things do more of what we want.”8 But implicit in that statement is an ontological9 gulf between ourselves and our technology. We can fashion it according to our desires without ethical concern because we are its maker. But as moral theologian Oliver O’Donovan has written, this is not how we relate to other humans, not even our own children.10 We are not their maker. To use a biblical term, we beget our children, the difference being that what is begotten and not made is ontologically equal, rather than being other or inferior (Christian theology refers to the Son as eternally begotten of the Father precisely in order to emphasize the equality of the persons of the Trinity – to refer to the Son as the creature of the Father, as Arius would have had it, would have been to reject Jesus’ full divinity).
There are those who argue not only that we may, but that we are obligated to, take all available steps to enhance ourselves and our offspring genetically.11 And post-humanists such as Gregory Stock see a future of ubiquitous genetic enhancement as inevitable: “In the first half of the twenty-first century biological understanding will likely become less an end in itself than a means to manipulate biology. In one century, we have moved from observing to understanding to engineering.”12
This is a situation CS Lewis warned of in The Abolition of Man: “It is in Man’s power to treat himself as a mere ‘natural object’ and his own judgments of value as raw material for scientific manipulation to alter at will. The objection to his doing so does not lie in the fact that this point of view (like one’s first day in a dissecting room) is painful and shocking till we grow used to it. The pain and the shock are at most a warning and a symptom. The real objection is that if man chooses to treat himself as raw material, raw material he will be: not raw material to be manipulated, as he fondly imagined, by himself, but by mere appetite.…” The consequences of this shift are unpredictable. In 2004, Yuval Levin observed in The New Atlantis that “The most fundamental fact of human natality has always been that human nature emerges from the womb in essentially the same general form in every generation; or, as conservatives like to put it, that human nature has no history. The implications of this insight can hardly be overstated.”13 This fundamental fact means that advances in technology – or changes in culture, or politics, or any other realm of human life – can always be evaluated against the backdrop of a fixed human nature. That nature may not be exactly as we want it to be in every respect, but it provides a point of reference that is given to us, not up to our control or redefinition. To this point in human history, our nature has been a given. And this meant, quoting Lewis again, that “For the wise men of old the cardinal problem had been how to conform the soul to reality, and the solution had been knowledge, self-discipline, and virtue. For magic and applied science alike the problem is how to subdue reality to the wishes of men: the solution is a technique: and both, in the practice of this technique, are ready to do things hitherto regarded as disgusting and impious.” What is at issue is a redefinition of humanity that amounts to dehumanization, no longer preserving the inviolate dignity of a human nature that is given, but treating it as a function of our desires.
There is evidence of such redefinition taking place already in the context of the development of CRISPR. To critics of the moves taken by Dr. Mitalipov’s team, the Stanford law professor and bioethicist Hank Greely pointed out that there had never been any intention to implant the modified embryos – they were only “research embryos… not to be transferred for possible implantation,” and therefore “not a big deal.” But these were viable embryos; physically speaking, there was no difference between these “research embryos” and any other healthy embryo at the same stage of development. In other words, the only difference between a “research embryo” and someone’s son or daughter at the same stage of life is the intention of the researcher. We have already adopted the stance of ontological superiority that comes with being the maker of new life rather than its begetter – and to be sure, we adopted that stance long before CRISPR was developed (O’Donovan’s initial reflections on these issues were delivered in 1983, five years after the birth of Louise Brown, the first by IVF). But CRISPR represents a sea change in the ease and precision with which we can shape our offspring to fit our preferences.
We should not underemphasize our capacity to dehumanize; it is, sadly, one of the very characteristics that makes humanity unique, as documented by the sobering book Less Than Human, by the philosopher David Livingstone Smith.14 Smith demonstrates that humans are alone in the animal kingdom in their capacity to turn group against group, family against family, nation against nation, not merely in becoming violent but in engaging in treatment so cruel that it can only be justified by thinking of the victims as entirely other.
Moreover, as Smith argues, the capacity to dehumanize is not restricted to a single time period or culture, or only to one side of any given conflict, but is universal across known human history. Just in recent months, the news have been full of examples of human beings treated as less than fully human, from genocide in Myanmar to widespread allegations of sexual harassment, and worse, in Hollywood and the halls of government.
The progress of liberal humanism has proved no impediment to dehumanizing tendencies. In support of his own anti-Semitic policies, Adolf Hitler pointed to the American eugenics movement of the early 20th century. At that time, Charles William Eliot, a Harvard president, was an outspoken opponent of immigration and intermarriage between races (including not only blacks marrying whites, but Irish Catholics marrying Anglo-Saxon Protestants), and a supporter of the forced sterilization of those considered “feebleminded” or “criminalistic.”15 And it was Supreme Court Justice Oliver Wendell Holmes Jr. that wrote the majority opinion in Buck v. Bell, which upheld the forced sterilization of Carrie Buck, a woman designated “feebleminded” by the state of Virginia. “Three generations of imbeciles are enough,” wrote Holmes, referring to Buck’s mother and infant daughter.
This history – our history – should give us pause as we develop technologies with potentially dehumanizing applications. The point is not to put a stop to their development altogether; this would forfeit the opportunity to prevent much human suffering. But we need to ask where we can find the resources to identify those lines which cannot be crossed without violating human dignity. In the rest of this article I want to suggest that Christianity provides a definition of humanity that provides maximally robust protections against the possibility of dehumanization.
The beginning of Christian ethical reflection on human dignity begins with the radical assertion that humans are created in the image of God, or the Imago Dei (Genesis 1:26–27). But what exactly does this mean? Until the mid-twentieth century, Christian thought on the imago Dei focused on uniquely human capacities, usually reason and morality.16 But if a capacity is absent, or damaged, does this mean that the imago Dei is degraded?
Recent advances in archeology and history provide scholars a much richer context for understanding how the Bible uses the word “image”—one which goes beyond mere capacity.17
First, in many ways, the creation narrative in Genesis 1 resembles a pattern of temple construction.18 Now, if you were building a temple in the ancient world, the final step would be to erect an image of the deity. This is exactly what God does when he says, “Let us make man in our image.” The cosmos is the temple in which God is worshipped, and humanity stands in the center to point toward God.19 This is why God commands us to make no image of Him for use in worship: we are to create no image of God because God has already created his own image—humanity itself.
Second, historians have found that in the Ancient Near East (ANE), an image of a god such as a statue was thought to contain the spirit of that god, and could serve as its representative. Ancient cultures referred to kings as “the image of god” for the same reason: a king was considered “a representative of a god . . . ruling on the god’s behalf.”20
Finally, in the last century, scholars have gained access to numerous ANE covenant documents, including treaties in which a great king would appoint a lesser king to serve as his representative ruler over some region. Scholars have observed strong structural similarities between these covenants and the Pentateuch.
With these three observations, the intent of the phrase “image of God” in Genesis 1 snaps into focus. When God gives the blessing to “Be fruitful and multiply and fill the earth and subdue it, and have dominion”21, he identifies the imago Dei as a vocation, situated within a covenantal relationship. Not only kings, but every human, without exception, is created for this unimaginably high calling, to be God’s representation, placed in His temple, showing what God is like, and his royal representative, protecting and tending the created world. Uniquely human capacities are given in service to this vocation, but they are not what it means to be human. Crucially, the vocation is established by God’s calling humanity into relationship with Himself, and not by the capacity of humanity to fulfill it. This means that a person in whom capacities are absent, lost, or undeveloped is no less an image bearer of God, and therefore no less human.
Seen this way, imago Dei has at least two clear implications for bioethics.
First, the imago Dei empowers human biology by providing it with a clear and compelling purpose. Science is one of the most powerful ways that humans fulfill their calling to subdue the earth. As scientists work to cure disease and alleviate suffering of every kind, they bring order where there is chaos, an imitation of the God who calls humanity to represent him on earth. Human biology in particular becomes a means to empower image bearers to flourish in their God-given vocations.
Second, reflection on the imago Dei raises high barriers against dehumanization. Every human being, regardless of appearance, age, circumstance, or capacity, is a sacred image of God, never to be desecrated, always to be treated with great dignity. Scientists, then, must be mindful not only of ways they may directly dehumanize image bearers, but also of ways that their research and technologies may contribute to a culture of dehumanization.
These reflections do not resolve every ethical dilemma raised by genetic science. There are, for example, strong disagreements regarding what constitutes a genetic mutation that ought to be treated as a disease to be removed, rather than as an aspect of humanity. Down’s syndrome is one example. A Christian assessment of such a question must begin with a recognition of the humanity of each individual involved. This means, at a minimum, that biologists, theologians, and ethicists must work together with persons that exhibit particular mutations, listening to them whenever possible, in assessing how and when to bring genetic science to bear on their condition. This will sharply challenge the common judgment that certain genetic conditions bring suffering so great that they make life not worth living, because the life in question is the life of a person, created in God’s image.22
What makes a human a human? Take any single attribute away, from rationality to empathy, and we still recognize the human. What, then, makes a human a human, that can never be taken away? The imago Dei, not an attribute but a divine calling resting on every human, and epitomized in the incarnation of Jesus Christ (John 1:14; Colossians 1:15; Hebrews 1:3), provides an answer that grounds our ethical impulses and empowers our ethical endeavors.
About the Author:
Rev. Dr. Nathan Barczi
Rev. Dr. Barczi is Associate Pastor at Christ the King Presbyterian Church, Cambridge, Mass. He holds a PhD in Economics from MIT, and an MA in Theology from the University of Nottingham, where he is pursuing a PhD in Theology. He and his wife, both Californians, have three children.