Challenging the Therapy/Enhancement Distinction in CRISPR Gene Editing
CRISPR science enables genomic engineering that has major implications in disease prevention and therapy, but also in various non-human applications. Despite CRISPR’s great potential, there are major scientific concerns that must be further investigated: off-target effects, chimerism, unknown epigenetic effects, and long term on-target effects. Moreover, there are also social justice concerns regarding the democratization of CRISPR technology due to its highly pragmatic and executable nature. This makes policy development to regulate CRISPR very challenging. Historically in the United States, genomic engineering policy has been under the FDA’s jurisdiction. However, multiple institutional committees have reported guidelines on CRISPR policy, including transnational collaborations that also respect cultural contextual differences. The FDA and institutional guidelines share a common prescription to allow CRISPR editing for therapeutic purposes only and not for enhancement. Unfortunately, the very notions of therapy and enhancements are unclear, because they depend on one’s notion of nature and what normal means. Understanding of the baseline “normal” as a statistical average overcomes the need to unify various philosophical views on “nature”. Moreover, the medical statistical view of “normal”, “disease”, integrates personal safety issues with communal equity social justice considerations. In conclusion, regulations development of CRISPR editing requires not only additional scientific research but also a rethinking of the notion of “normal” in relation to equity and access.
I am grateful for the support of the Center for Theology and the Natural Sciences (CTNS), especially Dr. Ted Peters. Moreover, I am grateful for the valuable discussions with colleagues from CTNS, Harvard Divinity School Center for Science, Religion and Culture (SRC) and the Sinai and Synapses Fellowship at the National Jewish Center for Learning and Leadership (CLAL). Finally, I would like to thank Danielle Fumagalli for providing valuable feedback on multiple versions of this chapter.
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