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DESIGNING BABIES PROF. AVRAHAM STEINBERG PLANNING AND PROGRAMMING PLANNING PROGRAMMING Contraceptives Abortion Genetic screening Pre-implantation genetic diagnosis Artificial insemination In-vitro insemination Clonning Genetic engineering Genetic therapy clonning TECHNIQUES GENETIC SCREENING pre-marital pre-implantation pre-natal post-natal GENETIC ENGINEERING GENETIC THERAPY STEM-CELL MANIPULATION CLONING therapeutic reproductive ETHICAL ISSUES Science and technology per se are morally neutral The determining factor from a sociomoral perspective is the USE of science and technology JEWISH APPROACH -GENERAL Extreme caution of accepting scientific, social, technological innovations and changes ’‘חדש אסור מן התורה ’‘עושה חדשות בעל מלחמות but “Anything which we have no reason to prohibit is permitted without having to find a reason for its permissibility, for the Torah does not mention every permissible thing but rather only those things which are forbidden” [Tiferet Yisrael, Yadayim 4:3] THEOLOGICAL ISSUES KNOWLEDGE ‘PLAYING GOD’ INTERFERENCE WITH NATURE THE TYRANNY OF KNOWLEDGE for in much wisdom is much grief, and he that increaseth knowledge increaseth sorrow (Ecclesiastes 1:18) IMPORTANCE OF KNOWLEDGE O Lord, how abundant are thy works, with wisdom hast thou made them all, the earth is full of thy riches [Psalms 104:24] How great are Thou deeds, O Lord, exceedingly profound are Thou thoughts [Psalms 92:6] Maimonides’ Mishneh Torah, Yesodei ha’Torah 2:12 THEOLOGICAL ISSUES KNOWLEDGE ‘PLAYING GOD’ INTERFERENCE WITH NATURE ‘PLAYING GOD’ genetic revolution technical not fundamental genetic revolution revealing existing not creating new where there is a plan there is a planner enhanced knowledge of macro- and micro-cosmus enhances the belief in the All-Mighty God THEOLOGICAL ISSUES KNOWLEDGE ‘PLAYING GOD’ INTERFERENCE WITH NATURE INTERFERENCE WITH NATURE Principally permissible, perhaps required verapo yerape, from here one derives a healer’s permission to heal [BK 85a], and we do not say -- God smites and man heals [Rashi, loc. cit.] INTERFERENCE WITH NATURE Principally permissible, perhaps required All His work which God created to make, is interpreted by the Midrash to mean that world was left incomplete for man to complete it INTERFERENCE WITH NATURE Principally permissible, perhaps required and subdue the earth -- God gave humans power and dominion on earth to do as they wish with animals, and to build, to uproot that which is planted, etc. [Ramban, Genesis 1:28] INTERFERENCE WITH NATURE Qualifications the actual act must not involve any inherent halakhic prohibition the act must lead to no unavoidable or irreversible result which is halakhically prohibited derived benefit should surpass the detriment Good ethics start with good facts. GENETICS -- FACTS 46 chromosomes, X Y Dominant, recessive, X-linked Homozygote, heterozygote Genotype, phenotype 3 billion code ‘letters’ DNA length 2 m, wide 2 billionths of a m 30,000 genes 5,000 genetic syndromes GENETICS -- FACTS predetermination genetic predisposition Genetic Tendencies urges and traits irresistible GENETICS -- FACTS Specific, determinant genes eye color, Tay Sachs specific, partially determinant genes Down’s syndrome, epilepsy specific, predisposing genes BRCA, tumor suppressors GENETICS -- FACTS Genes and environment intelligence, toxins inter-acting genes, multi-factorial GENETICS -- FACTS ONCOLOGY tumor suppressor genes -predisposition to cancer BRCA 1-3 -- breast/ ovary malignancy NEURO-DEGENERATIVE Huntington’s disease Alzheimer’ disease Tay-Sachs disease GENETICS -- FACTS NEURO-BEHAVIORAL / CHARACTER ‘aggression’ gene ‘Homosexual’ gene ‘Intelligence’ gene TECHNIQUES GENETIC SCREENING pre-marital pre-implantation pre-natal post-natal GENETIC ENGINEERING GENETIC THERAPY STEM-CELL MANIPULATION CLONING therapeutic reproductive GENETIC SCREENING Pre-marital screening – encouraged Family history Talmudic sources Tay-Sachs Resonsa Iggrot Moshe, Even Haezer 4:10 Genetic screening (Dor Yesharim) recessive diseases GENETIC SCREENING Pre-implantation genetic diagnosis – Permissible STATUS OF EMBRYO/FETUS – JEWISH VIEW a) PROGRESSIVE ACQUISITION OF HUMAN STATUS AND RIGHTS PROGRESSIVE SHIFTING OF BALANCES BETWEEN MORAL-LEGAL CLAIM OF THE DEVELOPING EMBRYO FOR LIFE AND OTHER OPPOSING VALUES AND MORAL-LEGAL CLAIMS b) FUNDAMENTAL DIFFERENCE BETWEEN PREEMBRYO / PRE-IMPLANTATION AND EMBRYO / POST-IMPLANTATION PRE-IMPLANTED FERTILIZED EGG Respect as a human part and potential life No human status “he who spills the blood of a human within a human, his blood shall be spilled [Genesis 9:6] – a fetus within its mother’s womb [Sanhedrin 67b] “until 40 days after conception the fetus is mere fluid” [Yebamot 69b] Potential life very remote PRE-IMPLANTED FERTILIZED EGG Respect as a human part and potential life No human status Consequently pre-implantation genetic diagnosis (PGD) and discarding defective pre-embryos – Permissible research on stem cells via destruction of blastocyte – Permissible PRE-IMPLANTATION GENETIC DIAGNOSIS = PGD Rav Eliashiv principle approval = NF1 Rav Halberstam and Rav Neuvirt detailed approval and supervision Review Committee PRINCIPLES Serious, single gene, diseases Halakhically married couple PRE-IMPLANTATION GENETIC DIAGNOSIS = PGD DILEMMAS Methods to obtain semen: condom during cohabitation problems: risk of pregnancy possibility of Niddah solution: freeze sperm other methods PRE-IMPLANTATION GENETIC DIAGNOSIS = PGD DILEMMAS Carrier state: differentiate between X-linked and recessive carrier state differentiate between IVF for fertility purposes and IVF for PGD differentiate between whole cycle of sick and carrier state and partial PRE-IMPLANTATION GENETIC DIAGNOSIS = PGD DILEMMAS Adult-onset disease, i.e. BRCA HLA-compatible child Sex selection “Social” disease, i.e. homosexuality Adult pregnant women, i.e., Down’s Number of children in family SCREENING Pre-natal diagnosis – Debatable Ultrasound Markers CVS Amniocenthesis GENETIC SCREENING PRE-NATAL ABORTION ISSUES DELIVERY MANAGEMENT TECHNIQUES GENETIC SCREENING pre-marital pre-implantation pre-natal post-natal GENETIC ENGINEERING GENETIC THERAPY STEM-CELL MANIPULATION CLONING therapeutic reproductive GENETIC THERAPY FACTS AND PURPOSES gene therapy germ-line therapy diseases physical characteristics physical mental behavioral Somatic GENETIC THERAPY Genetic therapy is no different than any other medical therapy. Hence, it is included in the permission of Heal he should heal and the obligation to enhance health and to save life. TECHNIQUES GENETIC SCREENING pre-marital pre-implantation pre-natal post-natal GENETIC ENGINEERING GENETIC THERAPY STEM-CELL MANIPULATION CLONING therapeutic reproductive STEM CELL RESEARCH What are stem cells and why are people so interested in them? Pluripotential cells Unlimited divisions STEM CELLS -- APPLICATIONS Treatment of degenerative diseases i.e. Parkinson’s, Alzheimer, diabetes, stroke, infarct Organ transplantation Basic research of cell differentiaiton i.e., malignancy, congenital defects Applied research i.e., testing new drugs STEM-CELL RESEARCH – APPLICATION (1) superfluous fertilized eggs after fertility treatment (IVF) YES directly created for purpose of stem-cell NO therapeutic cloning YES STEM-CELL RESEARCH – APPLICATION (2) miscarried fetus YES abortion for purpose of stem-cell NO Adults YES TECHNIQUES GENETIC SCREENING pre-marital pre-implantation pre-natal post-natal GENETIC ENGINEERING GENETIC THERAPY STEM-CELL MANIPULATION CLONING therapeutic reproductive Human Cloning: Two Distinct Applications Reproductive cloning - a clonal preembryo is implanted in a woman's womb with intent to create a fully formed living child. Therapeutic cloning - a clonal pre-embryo is produced, but instead of being implanted in a womb, it is used to generate stem cells. THERAPEUTIC CLONING ADVANTAGES Immunological identity – no rejection Specifically designed No emitting of sperm PROBLEMS Many eggs required Sources of eggs – volunteers, identified, danger to donor, sale REPRODUCTIVE CLONING POTENTIAL MEDICAL BENEFITS Renew functioning of damaged cells, or replacement of dead cells [i.e., Parkinson, Alzheimer] Halt uncontrolled reproduction of cells [i.e., malignancy] Animals/people with similar immune systems [i.e., organ donors] Solution for infertile couples POTENTIAL PROBLEMS AND DAMAGES Eugenics Identical people, no individuality Absence of genetic variability Undesirable changes in mature cells “Black market” of fetuses Who is the Father? Mother? People becoming means rather than ends Radical changes in world’s social order, parenthood, family POTENTIAL PROBLEMS -AMELIORATING FACTORS Influence of development -- learning and environment Time factor Mitochondial DNA Interaction of genetic material ETHICAL vs MORAL Questionable moral issues Currently definitely ethical issues Undesirable damaged offspring HALAKHIC ISSUES Witchcraft -- as a transformation in the order of creation Cross-breeding animal and plant species [kilayim] Three partners in the human being -father, mother and G-d HALAKHIC ISSUES “Anything done as a natural activity is not included in the prohibition of witchcraft. Even if we knew how to create creatures without natural procreation … we may engage in this activity, since anything natural does not fall under the rubric of witchcraft” [R. M. Ha’Meiri (1249-1316), Sanhedrin 67b] HALAKHIC PROBLEMS the clonee a ‘golem’? Does one fulfill the commandment to “be fruitful and multiply”? How is fatherhood / motherhood defined in a cloning situation? Is HALAKHIC PROBLEMS -FATHERHOOD / MOTHERHOOD Mature cell, ovum and womb of same woman Mature cell from husband, ovum and womb of wife Mature cell from a first-degree relative Mature cell from a female, ovum and womb of another female THANK YOU !