Block Biotech Progress or Embrace It? Bioethicists Debate What's to Come.
Is progress itself an ethical obligation? Opinions vary.
ATLANTA—At the close of the BEINGS 2015 Summit, the novelist Margaret Atwood summed up her attitude towards biotechnology: She was "Ms. Grumpy." The Harvard psychologist Steven Pinker, she added, was "Dr. Happy." After attending as one of 200 delegates to the summit, I can say that most of my fellow delegates seemed distinctly more grumpy than happy, at least when it came to biotech's prospects for relieving humanity's manifold ills.
BEINGS 2015—the acronym stands for the Biotech and the Ethical Imagination: A Global Summit—is the brainchild of the Emory University bioethicist Paul Root Wolpe. Besides Atwood and Pinker, the speakers at the three-day summit included the Princeton sociologist Ruha Benjamin, the New York University bioethicist Art Caplan, the Newcastle University sociologist Erica Haimes, the University of Alberta law professor Ubaka Ogbogu, and the McGill law professor Margaret Somerville, among others. The ultimate goal is to hammer out over the next few months some kind of "foundational manuscript" that lays out "reasonable guidelines for cellular biotechnologies such as synthetic biology and stem cell research, as well as animal and human applications of these biotechnologies." A version of these guidelines would then be published in a prominent science journal. (Both Science and Nature have expressed interest.)
The summit's specific focus was science aimed at directly manipulating human cells and cells that impact human beings. (Wolpe excluded consideration of genetically modified crops, animal rights, and informed consent in research on human subjects.) These were divided into five topic areas: aspirations and goals for biotechnologies, alien organisms and new (id)entities, bioterror/bioerror, ownership/donorship, and who gets to regulate the new technologies.
The first presenter was Pinker, who opened by noting that his charge was to raise provocative questions. As my later interactions with fellow delegates showed, Pinker did indeed provoke a lot of them. He began by pointing out that global average life expectancy has been increasing, rising from 65.3 years in 1990 to 71.5 years in 2013. Moreover, the differences in life expectancy between poor and rich countries are converging as people living in poor countries enjoy longer lives. He attributes these improvements to economic development, lower rates of infection, better nutrition, the application of evidence-based public health measures, and biomedical research. Since biomedical research promises vast increases in human life, health, and flourishing, he argued, the best thing those assembled at BEINGS 2015 do was to "stay out of the way."
Pinker argued that vague bioethical principles like "dignity," "genetic privacy," and "social justice" were particularly unhelpful. He added that bioethicists should avoid thwarting biomedical progress based on highly speculative harms. Noting that human beings are terrible at predicting the medium- and long-term future, he urged the delegates to consider the costs of bogging down research.
Next up was Atwood, who told the audience that the title of her "Edward Talk" (contrasted with TED Talks, get it?) is "The Lid Is Off the Box." Why the Pandora allusion? Because biotechnologists, she said, now have "one of the most significant—if not the most significant—power: the power to create new beings." Atwood referenced her 2003 post-apocalyptic novel Oryx and Crake, which she described as a "fun-filled romp" about human extinction. In that book, genetically engineered new beings replace the human race that has been deliberately killed off by a biotech plague.
Resorting to the Tale of Two Cities trope, Atwood declared our era both the best and worst of times. Best because of the breathtaking pace in the increase of knowledge: Biotechnology promises to make people smarter, healthier, and longer-lived, as well as cuter and hunkier. Worst because climate change is threatening food supplies, expanding the range of tropical diseases, and warming oceans, which will kill off oxygen-producing algae. "If you can't eat or breathe, having healthy kidneys is beside the point," Atwood said. She did, however, suggest that biotech could create organisms that mop up extra carbon dioxide to cool the planet, grow food using less toxins, arrest the decline in pollinators by creating honeybees that are more resistant to diseases and pollutants, and, finally, eliminate most inheritable diseases.
Atwood also cited recent research that finds that factors in young blood rejuvenate old bodies. "That's bad news for babies," she joked, sketching out a scenario in which infant plasma is siphoned off to rejuvenate "some old farts." She ended, "I have been as positive as could be expected given the circumstances; namely that it's the year 2015."
In the panel discussion following Pinker and Atwood, Wolpe asked Arthur Caplan to reflect on the ethical implications of CRISPR, a technology that makes it a lot easier to edit genes. Caplan suggested that the public does not trust researchers to do the right thing with new technologies. He pointed to a recent experiment in which Chinese researchers used CRISPR to edit the genes of defective human embryos, and a proposal to use the technology to create gene drives that could be released to curate wild populations. He pointed out that prominent scientists have published a articles in major journals urging a go-slow approach for both embryo editing and gene drives. All of these articles cite the 1975 Asilomar Conference, where scientists called for a moratorium on genetic engineering.
Yoon-Seong Lee, a physician at Seoul National University, wondered whether biotechnologists might some day suffer from "Oppenheimer's remorse"—a reference to the Manhattan Project's technical director, Robert Oppenheimer, who came to regret his role in developing the atomic bomb. Pinker forcefully countered that the atomic bomb is a technology designed to kill people, while biomedical research is designed to cure people. Bioethically speaking, Pinker declared, "Nothing can be learned from the Manhattan Project."
Pinker pointed out that the embryos used in the Chinese CRISPR germline editing experiment were double fertilized and so could not have developed into babies. He also argued that the Asilomar moratorium is a terrible model for trying to earn the public's trust, saying it backfired because "it terrified people into thinking we're Frankenstein, Prometheus, and Dr. Faustus."
The summit turned next to alien organisms and new identities. Ruha Benjamin started out by asserting that "innovation and inequity go hand-in-hand." The benefits of technological progress "already go to those who monopolize resources," she argued, and modern biotechnologies as currently deployed "insure a world resembling Gattaca and Elysium" that "builds upon and amplifies current systems of domination." Benjamin urged the summit delegates to "stop worshipping at the altar of individual choice. It is not the end-all and be-all." Instead we should focus on distributive justice and "collectively refuse the notion that questions of social justice are anti-science."
How to prevent bioterror or bioerror, that is, harms caused by organisms escaped from labs or badly designed? Caplan reminded the summiteers of the brouhaha when two research groups developed nastier and more infectious flu viruses in 2012. The researchers wanted to publish their results, but a lot of people called for censorship, arguing that this would give terrorists the recipe for a flu pandemic that could kill millions of people.
Why did the researchers do the work? Because they were aiming to identify in advance the mutations that might transform bird flu into a deadly human disease. This would help monitor naturally circulating viruses so as to give humanity an early warning. "The worst terrorist that humankind faces is nature," Caplan noted. In any case, the necessary openness of science means attempts at censorship are ultimately useless. "The bottom line is that I think research on what nature is trying to do to kill us is worth the risk of possible bioterrorism," asserted Caplan. He was entirely correct.
With regard to bioerror, Caplan made some sensible suggestions. For example, engineered organisms should all be "branded" so that they can be traced back to their makers, who can be held accountable. In addition, the ability to switch them off could be built into engineered organisms. As it happens, during the summit, Nature Communications published a study this week describing how CRISPR can be used to install a "kill switch" in genetically modified organisms.
Another presenter, McGill law professor Margaret Somerville, is especially concerned about the future of the human germline. The germline is defined as the cellular lineage especially of a sexually reproducing animal from which eggs and sperm are derived and in which a cell undergoing mutation can be passed to the next generation. The genes in such a cell might be edited at the behest of parents – correcting, say, sickle cell trait – thus ensuring that their progeny and future generations would be free of that genetic malady. Should people be allowed to treat the genes they could pass down to their children as their property and do with them as they choose?
For Somerville, and for many other summiteers, the answer is an emphatic no. Somerville asserts that "the human germline should be treated as sacred." Why sacred? Because the human germline occupies a special place in the "metaphysical ecosystem" of the values, principles, attitudes, beliefs, and shared stories that constitute the bases of our society. Recognizing something as sacred, according to Somerville, means that we have an obligation to not "lay waste" to it and must preserve it pristinely intact for future generations. "We are required to hold the human germline in trust for future generations as the common heritage of humanity," she concludes.
Somerville also cited the German philosopher Jurgen Habermas' tired and incoherent claims that all human beings have a right to come into existence through chance. In order to be free, Somerville and Habermas assert, people must have contingent origins so that they can always go back and remake themselves. During the session, I pointed out that this amounts to no more than the assertion that human freedom is somehow dependent upon genetic ignorance. If that were the case, then human freedom would be over as soon as cheap genomic testing becomes widely available. In fact, to whatever extent we were ever at the mercy of our genes, we no longer will be. Instead our genes will increasingly be at the mercy of our brains.
I also reminded the audience that not a single person in the room had given their consent to be born, much less to be born with the specific complement of genes they carry. Thus any future genetically enhanced children will stand in the exact same moral relationship to their parents that we unenhanced do now: with no consent to birth or genetic heritage.
As far as metaphysical ecosystems go, it's a very good thing that liberal, market-based societies have "laid waste" to the principles, attitudes, beliefs, and shared stories that earlier ratified domination, discrimination, and worse toward groups of people based on racial, ethnic, sexual preference, and gender differences. And as both Pinker and the Harvard biologist George Church pointed out, human genes are constantly mutating and being edited through sexual selection, so there is no coherent concept of "the human germline."
The summit ended with concluding remarks from Atwood and Pinker. Atwood focused again on the alleged global environmental crisis and the need to push humanity from fossil fuels to renewables. She believes that shift implies the adoption of a "stewardship model" of bioethics. Apparently, that means we should opt to preserve the human germline just as it is.
Pinker argued that the notion of human flourishing is less contentious than people think. Most people, he suggested, would agree that life is better than death, health is better than disease, wealth is better than poverty, knowledge is better than ignorance, and discussion is better than violence. While far too many people still die prematurely, suffer from preventable disease, remain impoverished and uneducated, and endure violence, over the past two centuries dramatic improvements in all of these measures have been achieved. Biomedical science has played a big role in that progress and will play an even bigger role in the future.
Interestingly, when I cited Pinker's examples of human flourishing, several of my colleagues vigorously disagreed. Why? Because, they argued, some people prefer death, others choose lives of pious poverty, and uneducated native peoples are often wiser than alienated folks from industrialized countries.
"The goal of bioethics is to ensure progress for as long as possible," Pinker concluded. If it can't do that, it should just stay out of the way.
Disclosure: I am a drafting delegate, which means that I will be working with my summit colleagues on aspects of the BEINGS 2015 fundamental document for the next several months.