The Rise of Genetic Technologies
In the modern era, improvements in genetic knowledge and technology have brought novel methods of human enhancement – prenatal screening, embryo selection, and genetic engineering.
The first prenatal screening was developed in the 1950s with ultrasound, and in the 1970s, implementation of real-time gray-scale imaging allowed earlier detection. Prenatal screening technology allows the identification of birth defects and chromosomal abnormalities before birth that may lead to disorders like Down syndrome (Huang et al., 2020). One of the most common methods of prenatal screening is amniocentesis, where amniotic fluid of the uterus is removed for testing. Once an abnormality is detected, parents may undergo selective abortion at an early gestational age or seek counseling to care for an affected child. In 2007, the American Congress of Obstetricians and Gynecologists (ACOG) recommended that clinics provide such testing to all women at their first pregnancy visit for better accessibility (Carlson & Vora, 2017).
Embryo selection through sperm banks and preimplantation genetic diagnosis (PGD) is a similar development that allows parents to choose their embryos when using in vitro fertilization (IVF). The first sperm bank was established in 1964 in Japan and the U.S., and since then, millions have been born through these banks (Park, 2018). Sperm donors are tested to ensure their health and marketability and are labeled by their ethnic and racial origins, height, weight, and eye color to allow patients their choice of donor (Daniels & Golden, 2004). Once the patient selects the donor, embryos are fertilized through the IVF test tube and doctors perform PGD to select only genetically normal embryos to implant (Parikh et al., 2018). These embryo selection processes have been growing in number accordingly with an increase in infertility and favorable governmental regulations (Park, 2018).
Figure 3. IVF where the egg is held against the needle for injection of the chosen sperm.
Image source: Wikimedia Commons
Lastly, genetic engineering developments allow people to treat genetic diseases through manipulation, deletion, or insertion of genes at target sites. The concept was first successfully experimented with in 1973 by biochemists who cut, rejoined, and inserted new DNA into E. coli bacteria. Since then, human gene therapy, processes that introduce new, manipulated genes to the body to help fight diseases, has been developed (Tamura & Toda, 2020). More recently in 2009, a gene editing technology using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) that allows editing of patients’ genes to improve prognosis was discovered. It was successfully tested on a sickle cell patient in 2019, putting genetic engineering in the public spotlight (Stein, 2021; Tamura & Toda, 2020).
These technologies seem benign at first glance, and medical practitioners claim that they differ from old human enhancement attempts in that they involve “good science and individual consent” (Vizcarrondo, 2014, p. 240). Still, they have room for misuse and negative social impact.
To start, numerous people with disabilities and diseases have discussed their negative sentiments towards these genetic technologies, stating they are direct reflections of ableism: that by identifying an individual solely based on genetic differences and promoting human progress through such eliminations, these technologies incite further stigma and leave them feeling unworthy of life (Andrews, 1994). In short, they argue that such technologies resemble past human enhancement attempts.
Furthermore, embryo selection and genetic engineering has been mal-used by medical professionals in multiple cases. For instance, in the 1970s and 80s, Dr. Donald Cline impregnated more than thirty women with his sperm against their will. Similar situations occurred in more than a dozen states in the U.S., as well as in other countries (Mroz, 2019). Additionally, though it was only recently developed, CRISPR gene editing technology has already been illegally used in 2018 by a Chinese researcher, He Jiankui, who conducted an experiment that led to the birth of two genetically modified twins. Jiankui disabled their CCR5 genes, which allow HIV infection, and claimed the twins were HIV immune. However, because the CCR5 gene is also related to major brain functions, the twins may potentially be in danger (Raposo, 2019). These mal-uses exemplify how genetic technologies may be a new form of eugenics practices if medical professionals are allowed to make their own judgements for patients, and proves the need for strict guidelines regarding their usage.
Conclusion
By studying the historical evolution and societal impacts of human enhancements, the following conclusions regarding applications of emerging technologies can be reached:
First, a social consensus must be formed before active implementation of these emerging technologies. Through extensive debates involving people with disabilities, diseases, their families, medical professionals, corporations, and policy makers, various positions on these technologies should be considered and discussed. These debates will allow proper representation of affected communities so that previous historical misuse by groups in power is not repeated.
Next, patients’ happiness and consent must be prioritized to make sure that the focus of these technologies’ application is the improvement of patient life quality, not improvement of human race. Patients must be fully aware of the choices they are making, and such decisions should not be made by medical professionals’ opinions to prevent situations where undesirable traits are determined by personal sentiments. This will ensure that medical professionals and policy makers are not blindly following societal justifications set by ableism and prevent further categorization and stigmatization of specific groups.
Lastly, strict guidelines must be enforced to prevent both intentional and unintentional misuse by medical professionals. Eugenics-favoring court rulings and governmental policies of the past demonstrate that lack of strict guidelines may exponentially popularize human enhancements and misuses. Thus, guidelines must cover misuse by including circumstances where patients cannot give proper consent, patients’ economic conditions for accessibility, and control available to the corporations involved, as well as frequent inspections, self-reports, and harsh consequences for medical professionals.
Despite improvements in science, technology, and social awareness in the present day, modern human enhancement methods may still bring the same tragic results of past Social Darwinism and eugenics. Only under considerate and regulated usage may these emerging genetic technologies become the first human enhancement attempt to leave a positive mark on history.
References
Almeida, M., & Diogo, R. (2019). Human enhancement. Evolution, Medicine, and Public Health, 2019(1), 183-189. https://doi.org/10.1093/emph/eoz026
Andrews, L. B. (1994). Assessing genetic risks: Implications for health and social policy.
Bekiempis, V. (2020, December 22). More immigrant women say they were abused by ICE gynecologist. The Guardian.
Cargill, T. F. (2020). Eugenics in high school history. The Independent Review, 25(1), 5-26.
Carlson, L. M., & Vora, N. L. (2017). Prenatal diagnosis. Obstetrics and Gynecology Clinics of North America, 44(2), 245-256. https://doi.org/10.1016/j.ogc.2017.02.004
Daniels, C. R., & Golden, J. (2004). Procreative compounds: Popular eugenics, artificial insemination and the rise of the American sperm banking industry. Journal of Social History, 38(1), 5-27.
Freeden, M. (1979). Eugenics and progressive thought: A study in ideological affinity. The Historical Journal, 22(3), 645-671.
Galton, D. J. (1998). Greek theories on eugenics. Journal of Medical Ethics, 24(4), 263-267. https://doi.org/10.1136/jme.24.4.263
Galton, F. (1978). Hereditary genius: An inquiry into its laws and consequences (Vol. 1). J. Friedmann.
Grenon, I., & Merrick, J. (2014). Intellectual and developmental disabilities: Eugenics. Frontiers in Public Health, 2. https://doi.org/10.3389/fpubh.2014.00201
Grodin, M. A., Miller, E. L., & Kelly, J. I. (2018). The Nazi physicians as leaders in eugenics and “Euthanasia”: Lessons for today. American Journal of Public Health, 108(1), 53-57. https://doi.org/10.2105/AJPH.2017.304120
Güvercin, C., & Arda, B. (2008). Eugenics c oncept: From plato to present. Human Reproduction & Genetic Ethics, 14(2), 20-26. https://doi.org/10.1558/hrge.v14i2.20
Huang, T., Gibbons, C., Rashid, S., Priston, M. K., Bedford, H. M., Mak-tam, E., & Meschino, W. S. (2020). Prenatal screening for trisomy 21: A comparative performance and cost analysis of different screening strategies. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-03394-w
Mroz, J. (2019, August 21). Their mothers chose donor sperm. the doctors used their own. New York Times. https://www.nytimes.com/2019/08/21/health/sperm-donors-fraud-doctors.html
Neri, D. (1998). Encyclopedia of applied ethics: Vol. 2. Eugenics. Academic press.
Offer, J. (2013). From ‘natural selection’ to ‘survival of the fittest’: On the significance of spencer’s refashioning of darwin in the 1860s. Journal of Classical Sociology, 14(2), 156-177. https://doi.org/10.1177/1468795X13491646
Parikh, F., Athalye, A., Naik, N., Naik, D., Sanap, R., & Madon, P. (2018). Preimplantation genetic testing: Its evolution, where are we today? Journal of Human Reproductive Sciences, 11(4), 306. https://doi.org/10.4103/jhrs.JHRS_132_18
Park, N. C. (2018). Sperm bank: From laboratory to patient. The World Journal of Men’s Health, 36(2), 89. https://doi.org/10.5534/wjmh.182002
Patel, P. (2017). Forced sterilization of women as discrimination. Public Health Reviews, 38(1). https://doi.org/10.1186/s40985-017-0060-9
Pernick, M. S. (1997). Eugenics and public health in american history. American Journal of Public Health, 87(11), 1767-1772. https://doi.org/10.2105/AJPH.87.11.1767
Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Hafizur rahman, M. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences, 1136(1), 161-171. https://doi.org/10.1196/annals.1425.011
Proctor, R. (1988). Racial hygiene: Medicine under the Nazis. Harvard University Press.
Rajagopal. (2012). Darwinism in business. Darwinian Fitness in the Global Marketplace, 1-33. https://doi.org/10.1057/9781137268334_1
Raposo, V. L. (2019). The first Chinese edited babies: A leap of faith in science. JBRA Assisted Reproduction. https://doi.org/10.5935/1518-0557.20190042
Reilly, P. R. (1987). Involuntary sterilization in the United States: A surgical solution. The Quarterly Review of Biology, 62(2), 153-170.
Reilly, P. R. (2015). Eugenics and involuntary sterilization: 1907–2015. Annual Review of Genomics and Human Genetics, 16(1), 351-368. https://doi.org/10.1146/annurev-genom-090314-024930
Smaw, E. D. (2021). Uterus collectors: The case for reproductive justice for african american, native american, and hispanic american female victims of eugenics programs in the united states. Bioethics, 36(3), 318-327. https://doi.org/10.1111/bioe.12977
Souza, V. S. de. (2016). A eugenia brasileira e suas conexões internacionais: Uma análise a partir das controvérsias entre renato kehl e edgard roquette-pinto, 1920-1930. História, Ciências, Saúde-Manguinhos, 23(suppl 1), 93-110. https://doi.org/10.1590/S0104-59702016000500006
Stein, R. (2021, December 31). First sickle cell patient treated with CRISPR gene-editing still thriving. NPR.
Stern, A. M. (2005). STERILIZED in the name of public health. American Journal of Public Health, 95(7), 1128-1138. https://doi.org/10.2105/AJPH.2004.041608
Tamura, R., & Toda, M. (2020). Historic overview of genetic engineering technologies for human gene therapy. Neurologia Medico-chirurgica, 60(10), 483-491. https://doi.org/10.2176/nmc.ra.2020-0049
Vizcarrondo, F. E. (2014). Human enhancement: The new eugenics. The Linacre Quarterly, 81(3), 239-243. https://doi.org/10.1179/2050854914Y.0000000021
Volscho, T. W. (2010). Sterilization racism and pan-ethnic disparities of the past decade: The continued encroachment on reproductive rights. Wicazo Sa Review, 25(1), 17-31. https://doi.org/10.1353/wic.0.0053
Warner, A. G. (1894). American charities: A study in philanthropy and economics. New York: Thomas Y. Crowell & Company.