Prospects for “Genetic Therapy” ‐ Can a Person Benefit From Being Altered?

Abstract

Mapping the human genome is an immense project with numerous objectives. Indeed, it is likely that some of its most important ramifications and applications remain as yet unglimpsed. All we can presently attempt is to focus on some of the more obvious possibilities and prepare for the problems already looming on our horizon. One such possibility is that of Prenatal Genetic Intervention (PGI), which might be said to be a therapeutic intervention on behalf of the embryonic child. In this paper, I argue that "genetic therapy" is likely to be a misnomer, and that if PGI becomes possible, we should generally resist its inclusion under the special moral duty of providing health care. "Therapy" necessarily means helping a person, while PGI -- though effecting improvements from an impersonal perspective -- will frequently not consist in directly helping any person. This is due not to the embryo not being a person, but rather to the basic philosophical problem of personal identity persisting through significant alterations -- especially the alteration of genotype. The decisive moral question then hinges on the definition of "significant" alteration. I shall examine the feasibility of drawing analogies from criteria for personal identity proposed in discussions of how persons maintain their identity across time and through physical and psychological change. Certain metaphysical aspects of human identity and individuality will be also touched upon, partly in terms derived from classical Judaism. In conclusion I argue that, regarding embryos in particular, persistence of genotype must generally be deemed a necessary condition for maintaining personal identity. Therefore, many proposals for PGI should be excluded from the notion of therapeutic intervention and thus denied the special moral status of requests for therapy.

4 Procreative Beneficence: is Selection Really Better Than Genetic Modification?

“…My first, and less important, reason is that the previous arguments are too dependent on a controversial view of identity. For some, holding what DeGrazia calls the thesis of fragile prenatal identity (DeGrazia 2005), prenatal genetic manipulation can also be identity affecting (Zohar 1991). Though I do not support this view, it is worth keeping in mind that there is no universal agreement on this question.…”

One or Two: An Examination of the Recent Case of the Conjoined Twins from Malta

“…The fact that there is life after the procedure by no means implies survival of a particular life. Zohar (1991) persuasively argues that a person cannot benefit from being altered, simply because the altered person would not be the pre-alteration one. Zohar discusses genetic therapy, and I do not see why a radical ''phenotypic therapy'', such as extensive separation surgery, would not qualify as a change in personhood as well.…”

Gene Editing, Identity and Benefit

“…It is often assumed that, other things being equal, we have stronger moral reasons to benefit particular people than we do to bring about impersonal improvements (see, for example, Zohar 1995 : 276–8; McMahan 1998 : 473; Savulescu et al. 2006 ).…”