Human genome editing needs to be discussed
Is genetic editing important for the prevention and control of polygenic diseases? A new approach from the perspective of social, economic and environmental considerations
This is a huge achievement. The authors also include a discussion of the limitations and challenges of the study. Polygenic gene editing is a large concern among them, and also because no country currently allows genome editing in a human embryo, even for single variants.
Dramatic changes can be achieved with the help of our modelling. Individuals with edited genomes have a lower risk of disease. The disease burden of polygenic diseases will be skewed to those already the worst off if HPE is only available to those in higher socio-economic groups. Diseases such as depression and heart disease may become diseases that only occur in certain demographics.
In the long term, there may be an obligation to pursue and develop technologies such as HPE. Mildly deleterious mutations that escape natural selection because of better medical care are predicted to accumulate in the gene pool62. The effect of this genetic load might manifest itself as mental and physical health problems in a few generations. However, this concept is controversial, and the conclusions are debated63,64,65. If we take seriously the idea of leaving future generations in a better state than the current generations, then we have reason to provide them with the preconditions for a good life. This includes access to clean water, unpolluted air, education and shelter, and may include using HPE to reduce the genetic risk of disease.
The Importance of Human Rights and Ethical Policies in the Presence of a High-Precision Homogeneous Epidemic
Although collectivist considerations should inform the values of governments and the goals they pursue, it is also important that these goals do not override basic human rights, such as the right to autonomy. The pursuit of collectivist goals must be compatible with basic human rights.
One alternative ethical perspective is based on collective welfarism. The goal of the approach is to provide benefits to people, including family, communities and societies. From this perspective, it is also important that HPE not be implemented in ways that decrease social cohesion, increase division and weaken our communities and society. This approach requires further analysis of what constitutes flourishing societies.
There are no easy solutions to these problems, which is why it is vital that we start to consider the implications now while the prospect of HPE is still many years away.
Reducing the incidence of polygenic diseases could further lead to a more equitable distribution of health resources within health systems. There are many chronic diseases that contribute to the cost of healthcare and loss of disability-adjusted life years. Reducing the amount of health resources spent on fighting these diseases could free up resources that could be reinvested in other health priorities. Reducing the number of people whose health depends on access to resources will free up resources for others in need.
One approach is to limit the use of HPE to situations in which a reliable relationship is found between a trait and a good well-being. This raises a problem of which conception of well-being to use, but this is a problem for any welfarist approach to individual or societal improvement.
There is a possibility to test embryos for their susceptibility to non-disease trait. However, many jurisdictions only allow embryos to undergo genetic testing and screening to prevent a serious disease50. The line between health and disease is blurred when considering polygenic traits. For example, is using HPE to reduce blood pressure a medical or non-medical application? The same question arises regarding vaccines and other preventative interventions. Polygenic editing can be used to prolong human life in extreme cases.
Polygenic gene editing is a large concern among polygenic diseases advocates and also because no country currently allows genome editing in a human embryo. Individuals with edited genomes have a lower risk of disease. Although collectivist considerations should inform the values of governments and the goals they pursue, it is also important that HPE not be implemented in ways that decrease social cohesion.