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In this article, we will outline the social and ethical considerations of using genetic screening and gene therapy in medicine. But before proceeding to discuss the social and ethical concerns regarding the use of genetic screening and gene therapy, first, let us recall what are gene therapy and genetic screening.
What is Gene Therapy?
Gene therapy includes using different mechanisms to modify the genetic material of an individual to treat or cure diseases. Today, because of the increased understanding of the human genome, scientists are able to replace the faulty gene, inactivate a faulty gene or insert a new gene.
Now, let us see what is genetic screening.
What is Genetic Screening?
Genetic screening refers to the process that tests a population for a genetic disorder. The purpose of genetic screening is to detect a subgroup of people who either have a disease or they can pass the disease to their offspring. Genetic screening helps scientists and researchers to identify a smaller group of people from a large population. This smaller group of people may possess a higher risk of developing a disease and they might also pass this disease to their offspring.
Now, the question arises what is the difference between genetic testing and genetic screening? Well, the answer is straightforward, Genetic testing emphasizes an individual, whereas genetic screening focuses on an entire population of people. Genetic screening tries to detect those individuals in a population who are at increased risk to develop a genetic disease or pass it to their children.
Uses of Gene Technology in Medicine
Genetic technology which involves both genetic screening and gene therapy is becoming widespread in medicine. In the field of medicine, genetic screening is helping in the following ways:
- Have people with a family history of a genetic disease analyze their DNA in order to determine if they are at a greater risk of developing that disease
- Helps people to carry out the pre-implantation genetic diagnosis (PGD). PGD involves analyzing the DNA of the embryos that are created outside the body through an IVF procedure. This diagnosis helps the medical specialists to select those embryos for implantation that do not carry a harmful allele
Gene therapy is also quite common in the field of medicine. It is helping people in the following way:
- In medicine, gene therapy is introducing corrected copies of genes into patients that have genetic disorders which include hemophilia, cystic fibrosis, and severe combined immunodeficiency.
In the next section of the article, we will discuss the social and ethical considerations of genetic screening.
Social and Ethical Considerations of Genetic Screening
The use of genetic screening in medicine involves many social and ethical considerations which include:
- Individuals are able to take preventative measures to control or prevent the potential disease. The example includes going for an elective mastectomy when detected with BRCA1 and BRCA2
- People can select embryos that do not carry faulty genes that can cause disease by using pre-implantation genetic diagnosis. This can result in the fear of creating “designer babies” (which involves creating or selecting embryos with tissue matches for the older siblings). During in-vitro fertilization, medical experts can carry out a pre-implantation genetic diagnosis. To do so, they extract the cells from the embryo in an embryo biopsy and genetically screen it to pre-select the embryos that do not contain faulty alleles
- Genetic screening allows people to benefit from the expertise of genetic counselors. Genetic counselors can help people to make informed decisions about their future children. For instance, they can provide guidance related to the financial implications of having a child and the termination of the fetus if the quality of life seems poor.
- Genetic screening involves the risk of miscarriage which can have emotional consequences for the prospective parents. This is because the procedures used to collect the DNA are not 100% risk-free. These procedures include:
- Amniocentesis: It is employed to get an amniotic fluid sample using a hypodermic needle at 15 and 16 weeks of pregnancy
- Chorionic villus sampling: This procedure is employed to get a small sample of the placenta using a needle. It is done at 10 and 13 weeks of pregnancy.
- Based on the results, a couple may choose to terminate the pregnancy because the embryo has a genetic disorder, for instance, cystic fibrosis and thalassemia. Some people may even terminate the embryo due to a small defect that could develop into a healthy child and lead a normal life
- Helps people to make informed reproductive decisions, for instance, thalassemia
- It helps people to determine the risk of having a disease beforehand, especially of those diseases which do not have any cure
- It allows people to decide the age at which screening should start
- It can put the person at an increased risk of discrimination and stigmatization. A person may be stigmatized based on the disease or discriminated against by employers or health insurers.
- It involves concerns regarding the confidentiality of the data collected.
In the next section of the article, we will discuss the social and ethical considerations of using gene therapy.
Social and Ethical Considerations of Using Gene Therapy
Like genetic screening, gene therapy also involves many social and ethical considerations which are discussed below:
- Gene therapy has many potential side effects which can prove fatal for individuals. For instance, the children who were treated for SCID developed leukemia which is a life-threatening disease
- Confusion regarding the use of germline gene therapy. It involves the modification of genes in egg and sperm cells which leads to the modification being transferred to future generations. It can either cure a disease or can lead to long-term side effects
- It involves concerns regarding the commercial viability of pharmaceutical companies. It means that if the disease is rare, then the companies may not make a profit due to the small number of patients
- Gene therapy may be expansive because sometimes multiple injections of genes are needed if the somatic cells are short-lived. Due to its increased cost, only a few people could have access to the treatment
- It increases the possibility of people becoming less accepting of disabilities as they will become less common
- It involves the concern regarding who should decide which genes can be modified and which cannot
- It can increase sporting performances unfairly through gene doping in which genes are modified to give an unfair advantage.
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