Abstract
Imagine a future where genetic diseases are eradicated. Sophisticated techniques identify ‘harmful’ genes and we edit them out. Wouldn’t that make a better a world? What about the danger of these techniques falling into the wrong hands, at the mercy of evil scientists and regimes to further their prejudices and hate? We might not be as far away from these weighty moral and ethical challenges as we imagine. Geneticists familiar with the CRISPR-cas9 gene-editing system know that the future is upon us.
Christopher Gyngell, an ethicist from Oxford University, believes that it will soon be possible to use the CRISPR system to rewrite the human genome. 1 The wonder of CRISPR gene editing is that it makes it possible to edit DNA in cells which are heritable, such as germ cells or embryonic cells. Gyngell sees the potential in these methods, the benefits to research and the ability to reduce single gene disorders and chronic diseases.
Gyngell’s answer to the risks is tight regulation. But Kiruna Stamell, an actress with acromesomelic dysplasia, believes otherwise. Not only will gene editing fail to improve the health of future generations, she says, but it will impact on societal well being and inequality. 2 Do we really want ‘a future so overflowing with health that it can’t accommodate anyone who isn’t full of well being?’ Why crave a society that does not tolerate deviation or variation?
Endoscopic tattoo may not bring the same moral dilemmas as gene editing, but like any new technique comes with unanswered questions. The rationale seems sound. Mark a colorectal cancer during colonoscopy so that the correct section of bowel is resected. The difficulty here is that endoscopic tattoo is another technique that is gaining popularity without a sufficiently understood evidence base. Yang and colleagues help to update us with their clinical review. 3
While new techniques have their place, so do humans. Wasan et al. describe the experience of Ontario, Canada, in attempting to move away from a traditional physician-centric healthcare model to one that utilises the full potential of all health potentials, such as nurse practitioners. 4
The warning for doctors is not to rest on your laurels. In the future, albeit by technology or other humans, you may be replaced or made redundant.