Introduction
The book1 we will review in this paper is about the future developments in biotechnology, developments that have the potential to change fundamentally human reproduction. According to Henry T. Greely, simultaneous developments in stem-cell technology, gene sequencing/interpretation, and in vitro fertilization (I.V.F.) will usher what he calls Easy PGD. PGD (pre-implementation genetic diagnosis) is the genetic profiling of embryos before implementation. It is currently used during I.V.F. to detect possible genetic diseases. I.V.F. is the artificial fertilization of an egg with a sperm in vitro (in glass), and the implantation of the resulting embryo into the uterus of the biological mother or a surrogate. PGD requires I.V.F. Currently, PGD is not easy to implement because I.V.F. is an arduous process for women. Invasive procedures are used to retrieve the eggs, and women patients are required to undergo hormonal therapy to stimulate their ovulatory processes. On the other hand, despite enormous progress in genetic technology, gene sequencing is relatively expensive, and the interpretation of the genes (what kind of phenotype a certain genotype will produce) is not very effective. Greely believes that we will see enormous progress in the near future in stem cell and gene sequencing/interpretation technology, and these developments will render PGD cheap and easy to implement. They will transform PGD into Easy PGD. With Easy PGD, parents will be able to choose from a catalog of embryos their desired children. Greely, based on the statistics of planned pregnancies, unwanted pregnancies, present DNA screening ratios, etc., says that ten years after the availability of Easy PGD “somewhere between 60 and 70 percent of pregnancies in the U.S. will have been started using it.”2 And he adds that, “if the technology continues to be, and to seem, effective, that percentage should increase over time,” and “[…] in the long run, I could imagine 90 percent of U.S. pregnancies being the result of Easy PGD.”3
Easy PGD
Greely, to better explain the implications of these new technologies, describes DNA, genes, chromosomes, the mechanisms of inheritance, and the human reproductive system. We assume that the reader knows about these to read this review. Here, we only summarize Greely’s conclusions from his discussion of the human reproductive system. Greely thinks that the natural reproductive system is very complicated, prone to infertility, and susceptible to producing myriad forms of diseases. Many people are infertile because the human reproductive system is prone to a myriad of malfunctions like weak sperms, plugged fallopian tubes, the inability of embryos to hatch to the uterus, etc. The natural reproductive system produces various genetic diseases: heritable Mendelian genetic diseases, the errors in multiplying or transferring of genes during meioses (missing chromosomes, duplication or removal of some genes, etc.) These genetic diseases and errors often create debilitating syndromes. Greely sees the human reproductive system in its natural condition as an ineffective mechanism prone to errors.4 He thinks that we should improve it with artificial methods, and Easy PGD might be the final solution to the problems of the human natural reproductive system. It will not only solve infertility and genetic diseases, but it will also give humanity to control its own evolution by steering it to a desired pathway.5 How Easy PGD will function? Gametes (sperm and eggs) will be produced by stem cell technology from the cells that could be easily obtained, like skin cells. Using I.V.F., these gametes will be artificially fertilized to obtain a certain number of embryos. Embryos’ genes will be sequenced to determine their phenotypes. The embryos that have the desired phenotypes will be chosen to be implemented into the uterus of the genetic mother or a surrogate. For Easy PGD to become a reality, bioscientists should develop further the current technologies in three areas: stem cell technology, genetic sequencing, and interpretation of genes.
The key development should happen in stem cell technology. Embryonic stem cells (ESC), also known as pluripotent stem cells (PSC), can become any other type of human cell. That means they can be used to produce gametes (eggs or sperm). It is now possible to preserve PSCs artificially and induce them to turn into a desired type of human cell. However, obtaining PSCs from an adult human is tricky. There are various ways, and one is to use a technique from cloning. Extract a nucleus6 from the patient, insert it into an egg cell, and turn it into an embryo. The cells of this embryo will function as PSCs; they can be induced to turn into any type of human cell, including sperm or egg. These sperm and eggs could be used, in turn, to make a new embryo by I.V.F. However, this method still requires an egg to be retrieved from an adult human. As we said above, this is an invasive procedure and difficult for the patient. A much easier way to obtain gametes from an adult would be to use induced pluripotent stem cells (iPSCs). IPSCs are types of pluripotent stem cells that can be generated from somatic cells. That means PSCs could be obtained even from the skin cells of a person. That would preclude the necessity of obtaining an egg from a person to produce gametes. A skin cell donation, which could be done quite easily, would be enough. Skin cells would be turned into PSCs; PSCs would be induced to turn into sperm or eggs, and these gametes would be artificially fertilized by I.V.F. to create several embryos. At this stage, another crucial technique in Easy PGD would come into play. The genomes of these embryos would be sequenced to determine what kind of phenotypes they would produce. The parents would be provided with a catalog of embryos with their possible traits, and they would choose their children from this catalog.
As we can see, Easy PGD requires three technologies to be developed further: whole genome sequencing, DNA interpretation, and the ability to turn skin cells (or any other cell type that is easy to obtain from the patients) into gametes. The other crucial technology for Easy PGD, I.V.F., has been in mass use for several decades. In 2006, Shinya Yamanaka succeeded in de-differentiating mouse somatic cells into pluripotent stem cells. In 2007, he announced that he did the same with human somatic cells. However, this method has some uncertainties. The initial method to induce somatic cells to turn into PSCs was a gene therapy, and those genes are known to cause tumors in humans. So, iPSCs obtained with these genes could become cancer cells themselves. Later, a new technique was developed to de-differentiate somatic cells into PSCs. This method doesn't use genes; it uses proteins. According to Greely, “continuing research comparing hESCs7 and iPSCs has shown that iPSCs generally react, in gross terms, like hESCS.”8 On the other hand, the productive use of iPSC technology has only happened in mice. The team of Mitinori Saitou produced sperm and eggs both from PSCs (natural embryonic stem cells) and iPSCs. Although both methods worked, PSCs worked much better. According to Greely, “far more of the ESC (normal embryonic stem cells) colonies gave rise to sperm […] Even worse, although most of the mice born from ESC-derived sperm were healthy, two of the five mice born from the iPSC-derived sperm died young from odd cancers.” Greely claims, despite these problems, “several decades to work on it, [iPSC] should improve greatly.” He says that this improvement will not come for the sake of its reproductive potential. Other uses of this technology in treating numerous diseases (like its potential in organ transplants and its scientific potential in observing and analyzing various diseases) will provide enough incentives to develop this technology further.
The other crucial technologies for Easy PGD are DNA sequencing and profiling. DNA sequencing should be done more accurately, faster, and much cheaper. The cost of whole genome sequencing has dropped enormously. Sequencing the first whole human genome cost $ 500 million.9 In 2009, according to a report by Steve Quake, the cost fell to $ 48,000.10 In 2010, Complete Genomics, a private firm, announced that it would sequence whole human genomes for $ 5,000. By 2015, various firms sequencing human genomes were providing these services for $ 1,500 to 2,000 dollars. According to an article in 2022, “Ultima Genomics stated that its machine could sequence the genome for as little as $ 100.”11 Greely predicted in 2016 that the cost of sequencing would drop to $ 50 in 20 years.12 According to Greely’s prediction, 100 embryos could be wholly sequenced for $ 5,000 soon. Speed is also crucial because, after the sequencing, the phenotypes of the embryos should be determined to be chosen by the parents. Greely predicts that soon (twenty to forty years), the time to produce a whole genome sequence will fall to a few hours, and it will be possible to use five-day-old blastocysts for sequencing and implant the desired one on the sixth day.
What could a whole genome sequence reveal about the person? As of now, genome sequencing reveals five categories of conditions or traits linked to DNA: serious early onset genetic diseases, other diseases influenced by DNA variations, cosmetic traits, behavioral traits, and “boy or girl.”
Early onset genetic diseases such as Tay-Sachs disease, Lesch-Nyhan syndrome, trisomy 13, etc., are Mendelian13 or a result of chromosomal abnormalities. Since these diseases are directly associated with a single gene or an abnormality in chromosomes, they could be accurately diagnosed with whole genome sequencing. Easy PGD will be most effective against such diseases.
Other diseases are not early onset, highly penetrant, and serious. The predictability of such diseases ranges from strong to weak because they are not determined by a single gene. Huntington's disease or early onset Alzheimer's could be predicted pretty accurately by genome sequencing. But we can only say something about the risk of being diagnosed with juvenile or adult-onset diabetes, breast or colon cancer, or regular onset Alzheimer's. Greely says that the ability to predict diseases from DNA will increase in the future. And this progress will come not to perfect Easy PGD, but from the studies that will try to learn more about such diseases. The predictive power of genome sequencing will benefit from such studies.
We do currently know that skin, hair, eye color, hair type, nose shape, male pattern baldness, early gray or white hair, and many other traits are highly influenced or almost entirely determined by genes. However, the exact genes that determine such characteristics have not been found yet because these traits are not very important compared to the diseases mentioned above. As a result, they don’t attract much time and attention. We know that these traits are strongly determined by genes from the results of studies that have been conducted on some diseases like melanoma skin cancer. For example, studies on that disease uncovered a particular redhead allele that causes people to have red hair and a freckled complexion. We will know more and more about the relationship between cosmetic traits and DNA as sequencing becomes cheaper and more and more complete genomic sequences are produced to be compared and analyzed. The data on genes that determine certain cosmetic traits will be in the computer databases to be provided to prospective parents.
Behavioral traits are such characteristics as aptitude in mathematics, music, sports, IQ level, and personality types such as shyness, introverted or extroverted, diligent or carefree, etc. Today, behavioral genomics can only make strong associations with the genes at the pathological extremes (in cases like Lesch-Nyhan syndrome or pathologically low levels of intelligence). Our knowledge about the genetic variation in normal and above-normal behavioral traits is non-existent today. These variations are not straightforwardly determined by one gene. Their relationship with DNA is quite complicated because they are determined by the combinatorial effects of many genes and their relationship with the environment. Greely says that various studies indicate that a large part of the variation in IQ comes from genetic variations. However, demonstrating which variations are responsible has been impossible until now.14 In the coming decades, the interpretation of DNA for behavioral traits could become more accurate. However, according to Greely, even in 20 to 40 years, we won’t be able to predict the exact IQ level of an embryo. We will only be able to say something about the probability of having a certain amount of IQ. The sex of the embryo, on the other hand, could be easily and accurately determined by DNA analysis.
During Easy PGD, a certain number of embryos will be created (this number could be anywhere from ten to a hundred depending on how broad a choice you want to have and how much money you are willing to pay), and their DNA will be sequenced. Parents will be provided with a catalog of choices like the below:
Embryo 1
• No serious early onset diseases, carrier for Tay-Sachs, PKU.15
• Higher than average risk of coronary artery disease, colon cancer, type 1 diabetes.
• Lower than average risk of schizophrenia, breast and ovarian cancer, type 2 diabetes, asthma.
• Dark eyes and hair, graying early in life; moderately tall, straight hair, thin build.
• 55 percent chance of top half in SAT tests, much lower chance than average of being an athlete, good chance of above-average musical ability.
• Girl.
Embryo 2
• No serious early onset diseases, carrier for PKU.
• Higher than average risk of type 2 diabetes, cataracts, colon cancer, prostate cancer.
• Lower than average risk of asthma, autism, pancreatic cancer, gout.
• Dark eyes and light brown hair; male pattern baldness; medium height, straight hair, medium build.
• 40 percent chance of top half in SAT tests, likely to be introverted,
good chance of above-average musical ability.
• Boy.
Embryo 3
• No serious early onset diseases, carrier for PKU.
• Higher than average risk of bipolar disorder, rheumatoid arthritis,
lupus, colon cancer.
• Lower than average risk of leukemia, autism, gout, Alzheimer's disease.
• Blue eyes and light brown hair; medium height, curly hair, heavy build.
• 65 percent chance of top half in SAT tests, good chance of above average athletic ability, likely to be anxious.
• Girl.
Embryo 4
• No serious early onset diseases, carrier for Tay-Sachs.
• Higher than average risk of bipolar disorder, cataracts, autism,
prostate cancer.
• Lower than average risk of schizophrenia, Alzheimer's disease,
asthma, pancreatic cancer.
• Dark eyes and hair; early graying; above-average height, straight
hair, medium build.
• 50 percent chance of top half in SAT tests, average athletic ability,
above-average chance of exceptional musical ability.
• Boy
Embryo 5
• No serious early onset diseases, carrier for Tay-Sachs, PKU.
• Higher than average risk of coronary artery disease, type 1 diabetes, lupus, colon cancer.
• Lower than average risk of schizophrenia, leukemia, autism, pancreatic cancer.
• Blue eyes and dark hair; average height, curly hair, heavy build.
• 45 percent chance of top half in SAT tests, above-average chance.
of exceptional athletic ability, likely to be extroverted.
• Boy.
Greely says that choosing from these alternatives will be difficult for the parents. There are many variables to consider. People will be at a loss in the face of these alternatives. What will these percentages signify for their children? Which alternative will have the best chance of success and happiness in his/her life? To answer these questions, Greely says, a new occupation will arise: Genetic counseling. “Experts” will counsel parents; they will guide them to choose the “best” possible embryo. That will, in fact, mean that the characteristics of the future generations will be chosen by “experts.” The evolution of humanity will end up being shaped according to the values and worldviews of these “experts.”
Direct Gene Editing
Another technology could be used during I.V.F., a technology that could produce even greater consequences: CRISPR/Cas9. CRISPR/Cas9 is a genetic engineering technique that makes it possible to change the genomes of organisms. This method signifies a substantial improvement on the previous genome editing techniques and makes the editing of genes cheap, easy, and fast. Greely discusses this technique in passing in his book, probably because CRISPR/Cas9 was relatively new when Greely’s book was published in 2016. CRISPR/Cas9 signifies a possibility of a more direct intervention into the founding blocks of living organisms; it makes it possible to create, from scratch, brand-new genes. Easy PGD, as Greely defines it in his book, is not about “designer babies.” During Easy PGD, various amounts of embryos are produced, their DNA is sequenced, and the “best” option from these alternatives is chosen. In this method, embryos will carry the genes of their parents; they will be already existing genes. Easy PGD, in other words, creates more than one possible embryo to increase the chances of producing a “better” combination of genes from existing DNA. With CRISPR/Cas9, on the other hand, it becomes possible to put into the genome of the embryos new genes that the parents don’t have. It even makes it possible to design totally new genes that don’t exist in Nature.
CRISPR/Cas9 needs to surmount some obstacles to become applicable in humans. First, there is the mosaicism problem. CRISPR/Cas9 may edit some cells successfully while leaving other cells untouched. That would create a mosaic of DNA within the same organism; the organism would have different DNA in its different cells. The other problem is that CRISPR/Cas9 doesn’t always edit DNA as intended; it sometimes creates different genes or edits untargeted neighboring genes. Perhaps a more complicated obstacle than those two is that many genetic traits (such as the behavioral characteristics discussed above) are expressed not by one gene but as a combination of many genes. Moreover, many of these traits cannot be explained by genetics only. Environmental factors heavily affect the genes that influence such characteristics. So, modifying a gene in the organism, let alone introducing a completely new gene, could create unexpected consequences.
One can apply CRISPR/Cas9 in two ways: germ-line editing and the editing of the somatic cells. The first kind of editing will make the changes heritable. The edited organism will transmit those changes to its offspring. If CRISPR/Cas9 is used during I.V.F. on the embryo, this will be germ-line editing. Such an intervention won’t be limited to the organism edited; the edited genes will spread through the gene pool as the edited organism reproduces. If the somatic cells are edited, the changes won’t be heritable. Germ-line editing seems more dangerous than the editing of the somatic cells because the introduced changes could spread through the gene pool. However, germ-line editing also presents some “advantages.” It could be done during I.V.F. at the embryo level. That could help surmount the mosaicism problem because, at this stage, the number of cells that will have to be edited will be low. Moreover, somatic editing won’t prevent genetic diseases before birth. The person will first be born with the disease, and the treatment will be done afterward to his/her somatic cells. In such a case, he/she will continue to transmit the deleterious genes. In contrast, germ-line editing will prevent the condition before birth and prevent the person from transmitting the deleterious alleles to his/her offspring. If it could be done successfully, it could eradicate these diseases at their root.
After the publication of Greely’s book, He Jiankui edited the genomes of three human embryos in 2018. He used CRISPR/Cas9 to delete the gene CCR5 when his subjects were only a single cell. That caused a great uproar in the field of biotechnology. His fellow scientists reprimanded him for being irresponsible. The Chinese government closed his lab, and he was placed under house arrest. In 2019, he was sentenced to three years in prison and fined half a million dollars. Don’t misread such reactions though. Those reactions of scientists and governments weren’t against the human genome editing per se. They didn’t criticize Jiankui because he violated the wild human nature or because they were repulsed by the idea of an artificially produced human. They were against the rushed use of this technology. Before being used on humans, the technology should become as perfect as possible. Problems mentioned above, such as mosaicism or the unintended editing of neighboring genes, should be solved. Otherwise, a spectacularly negative consequence of this technology on a human could tarnish the technology, create a backlash in public, erode the funding of research, and doom the further improvement and mass application of it.
The novel technologies sometimes need a seasoning period. The public should get accustomed to them. Some people’s concerns and natural aversion to controversial technologies generally erode over time through habituation. Biotechnologies, since they deal with the fundamental character of living things, are the epitome of such controversial technologies. There is something uneasy about tinkering artificially with living things. But people get used to them through time as these technologies spread and infringe more and more into their lives.16 People become convinced of their normalcy by propaganda, apathy, or sheer habituation. In the long term, such technologies could create, with total impunity and without any opposition, consequences that we would see as the most horrible and unacceptable with our current sensibilities. In the case of the reproductive technologies we discuss, they could turn humans and other organisms into totally artificial designed products shaped for the necessities of the large organizations that develop those technologies. However, their initial consequences are generally seen as mundane, and people gradually accept their ever-widening and deepening use. If the gradual spread of novel reproductive technologies is managed well, people might not see them as controversial. The recipe would be relatively simple: First, use those technologies in laboratory trials on mice and primates to be sure that they are effective and reliable. Then, use them on the somatic cells of humans to cure debilitating genetic diseases. After that, you can start using them on human embryos to cure the same genetic diseases in germ-line. After you pass such thresholds, it would be easier to apply them for the “enhancement” of humans. Start tinkering with debilitatingly low IQ levels or out-of-the-norm physical characteristics and emotional states, etc., and gradually include more normal levels of these traits into your repertoire. The scientific community would like to use this strategy of gradual habituation. Scientists got angry with Jiankui not because they were repulsed by the idea of modifying genes; they got alarmed because his haste could have ruined this process of gradual habituation.
Statements from the scientists in the field corroborate that attitude. In a 2015 article, Jennifer Doudna (the pioneer of CRISPR/Cas9) and her colleagues say that “In humans, [CRISPR/Cas9] holds the promise of curing genetic disease, while in other organisms it provides methods to reshape the biosphere for the benefit of the environment and human societies. However, with such enormous opportunities come unknown risks to human health and well-being.”17 These unknown risks include the “potential for unintended consequences of heritable germline modifications because there are limits to our knowledge of human genetics, gene-environment interactions, and the pathway of disease...”18 They recommend transparency in the field so that public continue to trust in science. They suggest that, for now, germline modification should not be attempted. They are not categorically against human genome editing; they just don’t want a cursory application of the technology to ruin the future of the field. Before applying this technology beyond the laboratory trials, scientists should eliminate its deficiencies. And what they say about “reshaping the biosphere for the benefit of the environment and human societies” shows that this technique will have a much broader scope than modifying human genes. It could be used to shape wild Nature for the benefit of the techno-industrial system.
Some other scientists fear that human germline editing could imperil their own field. In an article called “Don’t edit the human germline,” the authors caution that “genome editing in human embryos using current technologies could have unpredictable effects on future generations. That makes it dangerous and ethically unacceptable. Such research could be exploited for non-therapeutic modifications. We are concerned that a public outcry about such an ethical breach could hinder a promising area of therapeutic development, namely making genetic changes that cannot be inherited.”19 Of course, they are not categorically opposed to germline editing. “At this early stage,” they say, “scientists should agree not to modify the DNA of human reproductive cells. Should a truly compelling case ever arise for the therapeutic benefit of germline modification, we encourage an open discussion around the appropriate course of action.”20 In short until the editing becomes effective and safe, the field should limit itself to somatic modification lest it doesn’t receive negative publicity as a result of a hasty and faulty application of germline editing.
We see the same approach in a 2017 report by the U.S. National Academies of Sciences, Engineering, and Medicine. The report says that “Heritable germline genome-editing trials must be approached with caution, but caution does not mean they must be prohibited (emphasis added). If the technical challenges are overcome and potential benefits are reasonable in light of the risks, clinical trials could be initiated …”21 In our opinion, human genome editing will start with the editing of somatic cells to cure the most debilitating genetic diseases. Such diseases are so awful that when the techniques that can cure them are developed sufficiently, not using them for treatment will seem like cruelty. As they demonstrate their efficacy in somatic editing, a point will come for their germline application. As we said above, germline editing could solve the diseases at their root. Cured patients wouldn’t transmit faulty genes to their offspring. When the gene editing technology is sufficiently developed, using them only for somatic editing will seem like an enormous waste. The treatment of genetic diseases would be the first breach on the wall. As people become more and more habituated to genome editing and gene sequencing and editing techniques improve further, other traits will gradually come into the scope of gene editing.
Greely’s Easy PGD could play the role of a bridge here, a bridge between natural reproduction22 and direct genetic modification. Easy PGD initially will only be used to prevent genetic diseases. Easy PGD won’t involve gene modification. It will produce several alternative embryos, make it possible to screen the DNA of these embryos, and desired embryos will be chosen from these alternatives. It won’t directly modify the genes or introduce new genes into the human genome, and the genome combinations of embryos will be those of their parents. As Greely points out, it won’t (at least initially and in the short term) create a super-race that will be fundamentally superior to those who won’t use this technique for various reasons. Such traits will give Easy PGD an appearance of naturalness; it won’t feel like an abrupt and substantial break with natural reproduction. As a result, it will be a perfect transition that can habituate people to a more artificial reproductive technique that directly manipulates the genes.
Reception of Easy PGD
Greely thinks a ban on Easy PGD will be unlikely in the US. Constitutional rights regarding the reproductive process will make such a ban extremely unlikely. Even if a statute were to ban Easy PGD, it would be difficult to enforce it. First, Easy PGD would be a “victimless” crime. Nobody would be directly harmed by it. Second, one cannot imagine that any state that banned Easy PGD would kill a child who is born as a result of it or terminate an Easy PGD pregnancy to enforce that law. The law could only target the businesses that perform it, but that won’t be very effective. Some countries wouldn’t ban Easy PGD, and different countries would allow its different levels of implementation. Some would only allow curing genetic diseases, some would allow the enhancement of physical or personal characteristics, and some could even let “incest” parenthood or uni-parenthood.23 People would go to those countries that approve the “treatment” they would like to have. It would be very hard for a country that bans the procedure to prevent its citizens from obtaining the “treatment” from other countries.
Moreover, though some circles would oppose Easy PGD, the mainstream probably wouldn’t develop a strong opinion about it. The attitudes towards I.V.F. are an indication. Although I.V.F. is a highly artificial procedure that intervenes in natural or “god-given” processes of reproduction, virtually nobody, not even so-called conservatives, is against it. That is despite the fact that many embryos are destroyed during the process, and these embryos are regarded as “persons” by “pro-life” circles. I.V.F. helps people to have babies, and “conservative” people (who, in principle, would seem to have more potential to be against I.V.F.) regard them as blessings. That makes them overlook other problematic features of the procedure they would normally oppose from a conservative perspective. Most probably, the majority of the people in Western countries will be against an outright ban on Easy PGD. They will see it as a personal choice, and accept it as long as the states don’t coerce them to use it.24 They will regard Easy PGD (or CRISPR/Cas9) as a personal choice, just like they do with other technologies. However, in reality, such technologies will cease to be a personal choice when they begin to be used by large numbers of people, as is the case with other technologies. Even the reticent people will feel pressured to use those technologies for their children. They will experience social pressure from their family and friends. “Aren’t they concerned about their children?” “What if they are born with genetic diseases?” “Why they don’t guarantee their children’s health, especially now when there is an easy and cheap method for it?” When large numbers of people started to use new reproductive technologies, reluctant people will begin to be concerned about the competency of their children. If they don’t use such technologies, their children could be less intelligent, less hard-working, less social, etc. They will feel compelled to use them as a result.
An outright ban of Easy PGD will be unlikely. However, the states would surely try to regulate this procedure in Western countries. The questions about how to regulate Easy PGD will create many controversies. Which aspects of this procedure should be allowed or banned, and the polemics on how they should be implemented will enter into our daily political bickering and culture war spectacle. Leftists will surely want states to finance this procedure. Otherwise, they will argue, it could create a biological gap between rich and poor people. What about the developed and underdeveloped countries? Leftists will argue that if poor countries can’t find the resources to implement the procedure in their own countries, the rich ones should help them because this could create a biological gap between the citizens of rich and poor countries. What about the bizarre consequences of iPSCs? This technology will make it possible for a person to be both a “mother” and a “father.” It will be possible to create sperm and eggs from the same person and create an embryo using them. Should we allow this to happen? The same technology will make it possible for same-sex couples to have their own biological children. Should we allow this?25 What if some people liked to have deaf children? Should we allow people to have children with disabilities? How could we prevent them from making this decision? If we don’t allow such a choice, does this mean that we see deaf or other “handicapped” people less than the “normal” people? Isn’t it cruel not to cure low levels of IQ? What about people who are inclined to commit crimes? Why don’t we help them have more successful and happy lives?
Beneath the spectacle of polemics such hard questions will foster, the techniques of artificial reproduction will seep into more and more categories of traits and enlarge the scope of their application as long as they demonstrate their effectiveness, and in the not-so-distant future, Homo sapiens will turn into an artificially designed species. And, although their fate won’t receive such polemical attention, other species will also be exposed to these genetic interventions for various reasons: to make domesticated species more productive (inducing the cows to produce more milk, increasing the yield of cereals), to make them more resistant to diseases, to pesticides, to heat, to cold, etc.; to exterminate invasive species; to adapt wild species to changing ecological conditions (climate change, chemical and nuclear pollution, invasive species, the acidification of oceans, and for myriad other ways humans are affecting wild ecosystems) and “save” them from extinction; to restore extinct species; etc. Gene editing technologies could end up destroying the whole wild genetic heritage through such interventions.
Greely’s Confusion About the Naturalness of Easy PGD
Greely discusses some moral objections to Easy PGD. These are: God’s will, unnaturalness, ignorance, and repugnance. Greely says that there is not a convincing argument among them. We will focus here on his discussion of the naturalness argument because it seems similar to our position and will allow us to explain better why we are against Easy PGD.
In his discussion of the unnaturalness argument, Greely seems to confuse two different meanings of “nature” (“nature” that is defined as everything that exists with “Nature” that denotes the things that are not artificial) and use these different meanings wherever convenient for his argument. First, he says the unnaturalness argument comes from the “naturalistic fallacy.” Greely says that in the “naturalistic fallacy,” just because something “is,” it therefore “ought” to be (the “is-ought” fallacy). Here, he uses “nature” as everything that exists, and consequently, he mixes up the naturalistic fallacy with the is-ought fallacy. Some people could confuse the “is-ought” fallacy with our position that sees wild Nature as the most valuable thing. We are against Easy PGD, gene editing, or any other technology that could interfere with natural reproductive processes that evolved through natural selection because these interventions would restrict, subjugate, and control wild processes, processes that are not artificial and therefore natural.
Greely says he sees the “unnaturalness argument” as a fallacy. However, when we look closely into Greely’s refutation of the “unnaturalness argument,” we observe that he doesn’t oppose the argument itself; on the contrary, Greely tries to convince us that Easy PGD is natural. Greely says that “‘nature’26 (at least as we know it on earth) provides many forms of reproduction.”27 Then he goes on to enumerate different forms of reproduction we see in Nature: species that switch back and forth reproducing clonally and reproducing sexually; species that have a majority of entirely asexual individuals with only a tiny fraction of the individuals able to be either genetic mothers or fathers (bees and ants, for example); some species whose individuals could change from one sex to another during their lifetimes several times; some species that can only reproduce with the help of other species; species that make thousands of or even millions of offspring and pay no attention to them once launched; other species that make only a few offspring and lavish parental attention on them, species that regularly practice infanticide or fratricide; species in which some males hoard all reproductive possibilities by acquiring “harems;” some other species in which the males are tightly controlled by females; etc.; etc. He claims we cannot see Easy PGD as unnatural since Nature harbors such different reproductive forms. He seems to be confused about the meanings of “nature” and “naturalness.” Nature is the phenomena of the physical world collectively, including plants, animals, and the landscape, as opposed to humans and human creations. And natural would be those things that are not made, caused by, or processed by humankind. Wild Nature would be those aspects of Nature that have and follow their own autonomous processes. The different reproductive forms Greely enumerates are the products of a wild process, evolution through natural selection. They could involve many different reproductive strategies, but such diversity in Nature wouldn’t make Easy PGD natural, a procedure designed and implemented by humans.
Perhaps seeing the contradiction in refuting the naturalness argument by convincing his readers that Easy PGD is natural, he attacks the argument from a different angle, an angle more convenient and difficult to disagree with because it utilizes the holiest dogma of our society: technology. Greely says that if you refuse Easy PGD because it is unnatural, you should also refuse all the other technologies like clothes, crops and livestock, schools and learning, planes, cars, computers, antibiotics, modern childbirth, etc. Here, he dishonestly equates all sorts of technologies and puts them in one basket. That is a cheap trick frequently used by the promoters of technology. They equate all technologies without considering their effects (on Nature and society) and their place in the broader technological system. Reproductive technologies are not exactly like clothing and schooling. They could fundamentally change human reproduction and turn humans and other wild species into manufactured products.
Without putting them into the same basket, we should evaluate different technologies based on the criteria of whether they unavoidably belong to an integrated complex system that rapidly subjugates and destroys wild Nature or not. Some technologies are simple and could exist without complex social systems (wooden spears, stone cutters, clothes made locally from locally existing materials). Others are unavoidably large organization-dependent (planes, automobiles, antibiotics, modern childbirth, Easy PGD, CRISPR/Cas9) and cannot exist without complex integrated systems. Such large organization-dependent technologies cannot be evaluated separately. They are unavoidably the integral parts of a global system that has enormous effects on wild Nature and forces us to live a particular way of life, and they preclude the “choice” Greely wants us to believe we have. Greely says that he could accept the naturalness argument of those who also reject other modern technologies, especially such technologies as modern contraception, artificial insemination, fertility treatments, or I.V.F. Greely says that such people should have the right not to use Easy PGD, but not force their refusal on other people who will want to use it. Using or not using Easy PGD should be a personal choice. Here, Greely commits a typical error; he sees modern technologies as personal choices. As we said, modern technologies are integral parts of the techno-industrial system. This system changes our living conditions so fundamentally that it becomes practically impossible to live our lives without its influence. Once a technology is integrated into this system and becomes widespread, it becomes impossible for nearly everyone not to be influenced by it or even not to use it. What starts as a choice initially becomes a necessity eventually. As Greely himself predicts, Easy PGD has the potential to become extremely widespread. If it becomes successful, the vast majority of people will use it. The same is true for the genome editing technologies. In such a case, people who refuse to use these will become outcasts. It could become practically impossible not to use these technologies, just like it has already happened with smartphones and the Internet. On the other hand, it is futile to oppose large organization-dependent technologies individually and through personal choice.28 As long as the integrated system of which such technologies are part exists, they will only increase in number and expand their scope of application.
The logic Greely employs here is so similar to the thinking process of a drug addict: Since we accepted antibiotics, modern childbirth, infertility treatments, and I.V.F. we could also very well accept Easy PGD. We perfectly know where this logic will lead us: Since we accepted Easy PGD, we could also accept genome editing for genetic diseases. We already edited our genomes, so why don’t we also treat low IQ? And then, since we already meddled with IQ, why don’t we enhance our IQ, physical features, etc., etc.? We already fucked up our genome, so why don’t we merge ourselves with machines? And so forth.
Conclusion
New reproductive technologies harbor enormous potential to stir evolution (not only for humans but for all life forms) enormously in a very short period from an evolutionary perspective. Assuming we won’t be substituted by machines in the coming decades, to which direction such technologies will lead us? We cannot predict in detail how the artificial design of organic life will shape us. We can only make rough guesses by considering the necessities of the societies that will make such transformations. Biotechnologies are developed by organizations (companies, research institutions, etc.) that are part of human societies. These societies need to acquire energy, materials, and space from Nature to function and perpetuate their existence. Especially since the advent of agriculture, human societies have become more complex. They have developed more and more technologies that enabled them to expand their space of operation, and using these technologies, they have acquired more and more energy and materials into their metabolisms. Such material needs produce emergent qualities in human societies that make them behave like superorganisms29 with their own needs and goals. On the other hand, human societies are subject to Darwinian selection. Societies that have the best qualities to acquire the material needs to perpetuate their existence are the ones that end up continuing to exist.
So far, social systems need humans to function. Humans are actuators of these superorganisms, and the relationship between humans and superorganisms is similar to mutualism. Social systems satisfy the needs of humans, and humans undertake the functions that are necessary for the existence of such systems. Here, we encounter the paradoxical and tragic reality of human existence after the advent of agriculture. The enormous difference between the speed of biological and cultural evolution threw us into an existence we are not biologically adapted to. As humans, we evolved in and adapted to fundamentally different conditions than we experience in societies that emerged after the advent of agriculture. Our physical and psychological capabilities, needs, tendencies, and desires evolved for a much less collectivistic existence in wild Nature as members of small groups. However, due to our rapid cultural evolution, immensely complex and collectivistic superorganism-like social systems emerged. These systems make us live in artificial environments we are not evolutionarily adapted to, and they need us to behave in ways that clash with our natural inclinations. The history of humanity since the advent of agriculture is, in a way, the history of our uneasy existence in such superorganisms. Humans don’t have the exact qualities superorganisms need for their effective functioning, and they even have some tendencies that disrupt the smooth functioning of the superorganisms: Humans get tired; they need to eat and sleep; they have erratic moods; they could get demoralized and need to be entertained and encouraged; they are prone to laziness; they slack off at work, get bored, or lose motivation; most of them hate school, they don’t want to study academic subjects; they have individualistic tendencies that are not at all suitable for a complex collectivistic society; they are generally and primarily concerned with themselves and their loved ones; they steal and take graft; they are inclined to nepotism; they hate or envy each other; they could become aggressive and use violence uncontrollably; they are inclined to xenophobia; etc.
Superorganisms have used various methods such as direct violence, oppression, physical surveillance, propaganda (religions that preach collectivistic attitudes, the belief about all seeing omnipotent gods, modern collectivistic ideologies and moral systems, etc.), encouragement through material rewards, psychological palliatives like entertainment, etc. to make humans behave “properly.” However, such methods cannot completely solve the problems of discrepancy we mentioned. Thousands of years of biological evolution would be necessary for humans to adapt to the life of a member of a superorganism. Societies could use the new reproductive technologies to eliminate that mismatch. They will try to fashion supersocial human beings. Of course, they won’t do this with a conscious effort. That outcome will come about as a result of the Darwinian selection pressures that operate on social systems. Those systems that will make their members more beneficial to themselves will gain an evolutionary advantage over the systems that will be less successful in that regard. Forced to follow that logic, they will make humans more and more social, meek, cooperative, and sacrificial. They will try to eliminate the natural individualistic tendencies of humans to habituate them to the rigid, bureaucratic, controlled conditions of life superorganisms create. The continued existence of the techno-industrial system could consummate a real eusocial society. If biological human life continues and not eventually be replaced by purely inorganic machines, human societies will turn their members into ant-like, self-sacrificial, collectivistic, supersocial organic peons.
Notes
1 Henry T. Greely, The End of Sex and the Future of Human Reproduction, Harvard University Press, 2016.
2 Ibid, p. 199.
3 Ibid.
4 When we consider that humans have reached enormous numbers and were able to colonize the whole globe, Greely’s observation doesn’t seem apt.
5 Such a control of the evolutionary pathway wouldn’t be possible even if we developed effective reproductive technologies and gene modification methods. Blind Darwinian pressures will shape the long-term trajectory. Although we could speculate broadly on the tendency, the exact result would be something nobody anticipated. We discuss these issues at the end of the review.
6 The part of the cell where genetic information is stored in chromosomes.
7 HESCs are human embryonic stem cells. They are the original and natural stem cells that occur in embryos and can turn into any human cell.
8 Greely, p. 128.
9 Ibid, p. 111
10 Ibid.
12 Greely, p. 111.
13 Mendelian diseases are thought to be caused by an abnormality of a single gene and obey Mendelian Law in expression. They could be autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive, or Y-linked.
14 Greely, p. 118.
15 Phenylketonuria is an inherited genetic disease that is caused by mutations in the PAH gene. It can lead to intellectual disability, seizures, behavioral problems, and mental disorders. https://en.wikipedia.org/wiki/Phenylketonuria
16 Back in the time when it first came out, I.V.F. was as much controversial. Robert Edwards, the scientist who pioneered I.V.F, was a scandalous figure. As time passed, I.V.F. has become an uncontroversial, “normal” procedure, and Edwards won a Nobel in 2010.
17 David Baltimore et al., A prudent path forward for genomic engineering and germline gene modification, National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394183/
18 Ibid.
19 Edward Lanphier et al., Don’t edit the human germline, Nature. https://www.nature.com/articles/519410a#additional-information
20 Ibid.
21 National Academies of Sciences, Engineering, and Medicine; Summary of Principles and Recommendations; in Human Genome Editing: Science, Ethics, and Governance. https://www.ncbi.nlm.nih.gov/books/NBK447280/
22 In fact, I.V.F. and the associated techniques like the pre-implementation genetic screening have already started to play that role.
23 The combination of iPSC and I.V.F. could create some bizarre consequences. Since stem cell technology makes it possible to produce gametes from any cell type, it could be possible to produce both sperm and eggs using the skin or any other type of cells of the same person. So, this person could be both a biological father and a mother. Greely calls this uniparenthood. The same would be true for siblings, parents, and children. These would be “incest” parenthood.
24 We don’t think states would coerce people to use Easy PGD or genome editing techniques for “social health.” However, the state policies during COVID-19 should make us consider how long Easy PGD or other methods of designing humans will remain a “choice,” especially if they demonstrate their effectiveness in reducing health costs or creating the type of individuals the society desires.
25 The answer will be an obvious yes in most Western countries and will be a strong motivation for leftists to support this technology.
26 Scare quotes at “nature” are Greely’s.
27 Greely, p. 277.
28 Like all the other technological developments, only a tiny minority would refuse to use reproductive technologies like Easy PGD and CRISPR/Cas9. Due to the habituation, the propaganda, and the lack of foresight and concern, the vast majority would use such technologies without developing a strong opinion about them. They would simply let themselves be dragged by the current. Since such technologies would directly affect the capabilities of future generations, the reticent tiny minority would only hinder its own survival without generating any appreciable benefit for themselves and Nature.
29 For a more detailed discussion of this concept, see John Gowdy, Lisi Krall; The ultrasocial origin of the Anthropocene; Ecological Economics 95 (2013). https://www.researchgate.net/publication/276163744_The_ultrasocial_origin_of_the_Anthropocene
Karaçam
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