At the beginning of an epic virtual journey in an action-packed video game storyline, how do you begin? It all starts with character selection. In the game Skyrim: Elder Scrolls, the storyline commences with an opportunity to determine traits about your character such as eye color, hair color, and skin tone. Furthermore, attributes such as height, physique, and race are available for selection as well. To a novice, these choices may seem trivial. However, these decisions come into play later in the game with dramatic consequences, as skills and abilities derived from these traits impact the ability of a character to overcome challenges and become successful. Although the ability to choose the characteristics of a person may sound like complete science fiction, this is not the case. Genetic engineering in humans is no longer a fantasy restricted to novels.

The rapidly advancing technology of gene editing techniques has made the possibility of disease reduction and the creation of children with predetermined characteristics, commonly referred to as designer babies, something that could be right around the corner. The U.S. National Library of Medicine recently published information about the most promising method, known as the CRISPR-Cas9 complex, which was “adapted from a naturally occurring genome editing system in bacteria” (2018, para. 2). This process uses CRISPR-Cas9, which functions like a cut-and-paste tool for nucleic acids that can be injected into both somatic and germline cells.

The Cas-9 enzyme uses a sequence of RNA provided by specialists to target and attach to a specific sequence of DNA in the genome. From there, the endonuclease complex creates a break in the double-stranded helix of the DNA. After it cuts and discards the faulty/unwanted genetic material, the cell repairs the strand with healthy DNA or adds a synthetic piece to fill the gap (U.S. National…, 2018). This technique is not only more efficient than classical genome alteration, but also hundreds of times more precise with the use of the aforementioned RNA strands which can now target short sequences instead of long strands of genetic material.

These developments, along with the recent use CRISPR on human embryos, have re-sparked a longstanding debate; Is it ethical to change the genome of a child before or just after its conception? According to an article on Rising Tide Biology, there are no laws prohibiting research on gene therapy and embryonic genome modifications in the United States. Federal funding is available for research and treatments on somatic cells. However, the federal government is not currently permitted to fund research pertaining to germline (meaning reproductive) cell modification (Curran, 2018). Research on the modification of human embryos and the clinical application of germline cell editing should be both funded and encouraged by the federal government because of its potential for the correction of genetic infertility and the ability to cure or prevent genetic defects/diseases.

Genetic Infertility

Couples around the world are devastated every year when they attempt to begin a family only to discover that infertility problems prevent them from conceiving naturally. Fortunately, researchers developed a technique known as in vitro fertilization in the late 1900s. It quickly began to combat this issue. This technique is a “medical procedure in which mature egg cells are removed from a woman, fertilized with male sperm outside the body, and inserted into the uterus of the same or another woman for normal gestation” (Britannica Academic, n.d., para.1). Even though in vitro fertilization was once seen as dangerous, success in animal trials allowed it to move forward into human studies. Now, developed countries consider this method to be a common practice for human reproduction. Unfortunately, although this method is great for the absence or blockage of fallopian tubes and other simple causes of infertility, in vitro fertilization does not solve infertility issues within the zygotes themselves.

This is where genome editing comes into play. Research using the CRISPR-Cas9 complex is allowing scientists to look further into the causes of spontaneous miscarriages, too. In one recent study of infertility, CRISPR-Cas9 was used to discover and prevent the development of a protein called OCT4. That protein leads to the poor formation and subsequent collapse of embryos during their early development. This study concluded that “CRISPR–Cas9-mediated genome editing is a powerful method for investigating gene function in the context of human development” (Fogarty, et. al., 2017, para. 1). Studies such as these are making huge strides toward the eradication of first-term miscarriages caused by simple genetic defects.

An article in the Asian Bioethics Review discusses genome editing in embryos, stating that it “could be used to correct the mutation in the TUBB8-gene which is known to cause developmental arrest after fertilization. The method can be applied to the oocyte after retrieval. The edited and verified oocyte could then be used for an IVF” (Rubeis & Steger, 2018, pg. 8). In this process, it is the unfertilized reproductive cells that are altered and repaired prior to an attempt at fertilization. This approach is even less ethically questionable and should be supported by government research because it is not even a cell that could give rise to a viable organism at that point. If a mistake is made at that time in the treatment, an oocyte is easily discarded and not used for in vitro fertilization.

Genetic Disease

The application of germline genetic intervention reaches even further than infertility issues. The development of CRISPR-Cas9 technology in humans is a promising way for the world’s devastating genetic diseases to be treated in an effective and affordable way, preventing unnecessary suffering and loss of life. It is no longer science fiction or theory. Researchers have successfully eliminated the presence of a genetic mutation in human embryos.

A team from Oregon Health & Science University created zygotes by fertilizing healthy oocytes with sperm cells from a carrier of the MYBPC3 mutation. This mutation leads to hypertrophic cardiomyopathy, a heritable heart condition. By using CRISPR/Cas9, the team then corrected the genetic defect in the zygotes which led to the development of viable embryos. The majority of these embryos was mutation-free (2018).

This research must be funded and encouraged by the government. For complete prevention of a disease to occur, “mutant human genes must be inactivated or replaced as soon as possible, preferably in the just-fertilized zygote stage” (Sas & Lawrenz, 2017, para. 19). Delaying the development/application of this technology that could be used to identify and fix embryos in this stage is unacceptable, especially when it involves parents who are known carriers of genetic disease. The expansion of this technology must be supported by the government to make its benefits accessible.

Some people believe that the action of editing human genes is not ethical because those edits are not natural, and therefore perceived as though they are not good for the human race. This argument is not valid because it stands on the premise that the universe is inherently good. This assumption would indicate that all things naturally occurring in it would be inherently good as well. However, with the human race’s current level of knowledge, the nature of the universe cannot be determined to be good, neutral, or bad. This is essentially a matter of perspective, often based on religion. Moreover, an assertion that the natural order of things is automatically better than modern technological improvements contradicts the entire idea of a healthcare system. John Harris, an author published in National Geographic, discusses this argument in one of his articles:

If we protected natural creatures and natural phenomena simply because they are natural, we would not be able to use antibiotics to kill bacteria or otherwise practice medicine, or combat drought, famine, or pestilence. The health care systems maintained by every developed nation can aptly be characterized as a part of what I have previously called “a comprehensive attempt to frustrate the course of nature.” . . . Natural substances or natural therapies are only better than unnatural ones if the evidence supports such a conclusion (2016).

The natural form of reproduction itself is not without its flaws. The organization Global Genes reports that more than “7,000 distinct rare diseases exist and approximately 80 percent are caused by faulty genes. The National Institutes of Health estimates that 50% of people affected by rare diseases are children, making rare diseases one of the most deadly and debilitating for children worldwide” (2015, para. 3). If a government is committed to more effective healthcare for its people, it needs to support research and any subsequent clinical application of technology that improves the rate of disease within its borders.

If genetic modification of human embryos becomes commonplace in the clinical setting, it can be reasonably concluded that people will wish to modify their children in more ways than simply disease prevention. They may want to pick the most genetically healthy embryo produced in the lab and create what is referred to as a designer baby: a child that is engineered to have specific physical traits. Some people believe that they would have an unfair advantage in society. It is true that some people would more easily succeed in certain areas such as athletics. However, just as medicinal advantages such as the use of free testosterone are regulated, governing bodies could monitor medical records of those with programmed genetic advantages and restrict their participation in Olympics or other competitions.

Furthermore, if this was a commercially available option, it would undoubtedly be an expensive procedure. For those with enough money to consider this type of genetic editing, there are already forms of alteration such as plastic surgery. The act of deciding which phenotypes to express would not create an unfair advantage. There are already differences in the way that people look, and current alteration procedures do not significantly change the opportunities available to someone compared to an ordinary person.

If research is supported and clinical application of genome alterations for health-related are made available, it will have positive consequences for the world’s population by reducing infertility issues and halting the inheritance of genetic diseases. The technique using the CRISPR-Cas9 complex is not without fault, but it has an incredible amount of potential for the betterment of healthcare practices in embryology and diseases such as cancer which occur through genetic mutation. Embryonic applications of CRISPR-Cas9 are just the beginning. Beyond research applications in that field, “many eagerly anticipate the use of CRISPR-Cas9 for the treatment and possible prevention of human disease” in other areas of the body through somatic cells, where “treatment would involve the insertion of CRISPR-Cas9 into the cells of an affected organ” (Sas & Lawrenz, 2017, para. 21). For this to be accomplished, the scientific community in the United States is in need of full support from its government and governing bodies.