Gene therapy. An ethical profile of a new medical territory

Abstract

From early on, the possibility of genetic intervention in humans has been the subject of philosophical and ethical reflection in the scientific community. It became the object of public debate and parliamentary decision-making under the rule of law even before the first authorized trials on human subjects could start. This article explains why the debate on germ-line intervention and genetic enhancement is still ongoing. The focus is on somatic gene therapy. There is a political and academic consensus that it represents an adequate tool for a high-ranking end if some points are considered and taken into account. But where do we stand and what are the ethical conclusions we can draw from recent clinical experiences?

Progress and prospects: gene therapy for performance and appearance enhancement

“…These include concerns regarding modifying the human genome, the distinction between therapy and enhancement, the possible ethical concerns related to enhancement itself, and the risks involved in conducting gene therapy treatments in practice. 4,7,8 Given the potential to achieve enhancement of an individual through modification of somatic cells by gene therapy, there is a concern that the enhancement technologies used for genetic modification of somatic cells will be purposely applied to germline cells, 4,8 leading to acceleration of changes in the human evolution. A second concern relates to the distinction between therapy and enhancement.…”

“…3 Other examples of widely accepted approaches for appearance enhancement include use of drugs and hair follicle transplantation for hair loss and surgical procedures to reverse the appearance of aging or unwanted body fat. 3,4 Coffee drinking, the most common form of mental enhancement, is essentially a drug delivery system for caffeine, as is cigarette smoking to deliver nicotine to the central nervous system. 1 Despite this common acceptance of physical and mental enhancement strategies, society draws the line at some strategies, either because the risk seems to be too high for what is considered a minor benefit, and/or the strategy per se is not acceptable.…”

“…For many ethicists, genetic therapies are of significant concern, in that they represent a slippery ethical slope ending in the acceptance of germ line therapies. 4,7,8 Gene therapy was originally designed to compensate for and/or treat genetic or acquired diseases such as cystic fibrosis, bleeding disorders, muscular dystrophies and cancer, 9 but gene therapy can also be employed for nontherapeutic purposes as an enhancement intervention. 1,4 In the context that gene therapy is basically a delivery system for proteins, it is understandable that the technology of gene therapy is of concern regarding its use as 'enhancement therapy'.…”

“…4,7,8 Gene therapy was originally designed to compensate for and/or treat genetic or acquired diseases such as cystic fibrosis, bleeding disorders, muscular dystrophies and cancer, 9 but gene therapy can also be employed for nontherapeutic purposes as an enhancement intervention. 1,4 In the context that gene therapy is basically a delivery system for proteins, it is understandable that the technology of gene therapy is of concern regarding its use as 'enhancement therapy'. In this review, we focus on recent advances in the field and first discuss examples of gene therapy that can be used for performance enhancement, such as augmentation of oxygen carrying capacity and muscle mass or enhancing memory and cognition (Tables 1 and 2).…”

Ethical Issues in Cellular and Molecular Medicine and Tissue Engineering

“…Although a considerable discussion about gene therapy has been reported long before the first approved human gene therapy trial in 1990 was initiated on severe combined immune deficiency patients the debate remains controversial [26,[51][52][53][54][55][56].…”