Heart transplants. IVF. The Genome Project. There’s even a rumour about a cure for the common cold.
The potential of medicine seems to grow by the day but the question for Christians remains the same: how much should human beings fiddle with God’s creation? How do we discern between Babel-building and faithfully stewarding the world God has given to us? Using the example of genetic engineering, theologian and ethicist Michael Hill gives us some guidelines for sorting out what kinds of medical activity Christians can welcome.
What is genetic engineering?
For thousands of years people have noticed that entities such as plants, animals and humans pass on certain features from one generation to another. While this knowledge has been utilised for many centuries in programs of selective breeding, the mechanism by which this inheritance is secured has only recently been clearly understood. Fortunately one does not need a detailed working knowledge of microbiology and genetics to appreciate the ethical issues spawned by this new capacity for control. However, a brief introduction to the field will help us to be clear about exactly what we are dealing with. (If you’re not a science-lover, please hang in there until we reach the ethical questions!)
All living organisms are made up of cells. These cells are miniature chemical factories. They contain fluid (cytoplasm) and a nucleus, which holds all the information for the operation of the cell. Inside the nucleus we find chromosomes which are like long strings of on/off switches which determine what the cell does. These on/off switches are called genes. Dominant genes ‘switch on’ certain characteristics (e.g. hair colour, skin pigment) while recessive genes ‘switch off’ other characteristics. Genetic engineering is the human intervention designed to produce changes in the genetic code and consequently changes in the organism.
Although the purpose of this article is to consider the application of this technology to humans, we need to make some comments about the broader issue raised by the employment of such procedures to the animal and plant kingdoms. Genetically manipulated cereal crops producing high yields have already been developed. Tomatoes which are resistant to bruising are apparently already on sale. Experiments aimed at growing chickens with a built-in resistance to chicken viral disease have taken place. ‘Transgenic’ pigs with lower than normal body fat have been bred using human and mouse genes. The possibilities seem endless and the benefits appear enormous. Genetic engineering may help humans address some of the massive problems facing the world. One writer sums up the hope:Redesigned organisms could offer us new ways to convert scarce sources of energy, including coal and industrial wastes, to substances we can use to make recyclable plastics. New organisms could provide new food sources, while new ultra-efficient plants and faster growing trees could be part of the world lungs of the future. Finally, altered microbes could offer complete cures to diseases such as AIDS and malaria.
There are very real dangers that accompany the enormous possible benefits to be derived from the genetic manipulation of plants and animals. But even if such dangers could be eliminated, from a Christian point of view, other ethical questions still need to be addressed. Is it right to change God’s order, albeit marred by sin? Does the dominion over creation given to us by the Creator (our ‘vice-regency’) entitle us to re-order creation in the ways envisaged?
How genetics could change your life
Setting aside the broader issue, let us focus on how this technology might impinge upon human existence. Consider for a moment your genetic make up. You have 22 pairs of chromosomes, together with two sex chromosomes. A chromosome is made up of thousands of genes; in the set of 46 chromosomes there are 100,000 genes or units of communication and heredity. Genes vary in size. The gene that codes for Factor 8 needed by haemophilia, for example, is considered a large gene and is 0.1% of one entire chromosome. When all the 3,000 million chemical bases found in the nucleus of a cell are strung together to form chromosomes they form an acid. The nucleic acid is called DNA (deoxyribose nucleic acid). The coiled structure of this acid (the ‘double helix’) was first discovered by Watson and Crick in 1953.
With the exception of some cells in your brain, human cells are continually being replaced; the old by the new. Replacement takes place by way of cell division. The double helix structure of DNA is something like a long ladder with numerous twists in it. When the cell replicates, it is as though the ladder is cut down the middle of each rung, like (to change metaphors) unzipping a zipper. As the DNA ‘unzips’, new double strands are formed, each identical to the other. Thus a complete set of genes is transferred from the old to the new. Genetic engineering involves manipulating or changing the genetic code in cells so that a new code is passed on when it replicates.
An exception to the above is found in the case of germ (or sex) cells: the female egg (ovum) and male sperm. Sex cells have only half of each unzipped chromosome and require a partner before they can divide and replicate. Fertilisation is the process by which each sex cell is joined to a partner. This distinction between normal body cells (called ‘somatic’) and sex cells is important because it permits two different kinds of genetic engineering. Somatic cells reproduce themselves within the organism with exactly the same genetic data as before. Sex cells are able to divide in a way which enables them to provide half the genetic material for a new individual. So, when a somatic cell is genetically altered, it only affects the individual organism. However, when a sex cell is genetic engineered, every cell in the new embryo gets reprogrammed. Moreover, these changes will be passed on from generation to generation and new genetic material will enter the gene pool.
The difference between these two types of genetic therapy is worth restating. Genetically altering most body cells will only affect the individual organism—the person undergoing the treatment. However, altering the sperm or ova will affect the whole genetic future of that person and their offspring.
Does God speak on these issues?
The ethical issues raised by genetic engineering are similar to others produced by the use of modern technology. The Bible simply does not address such topics. In such cases we have to go back to the Scriptures and get a general picture or world view. This vision or big picture will give us a sense of the general direction we ought to be heading. A biblical world view will give us broad moral guidance and set the parameters of our moral search and research. This methodology is the one to be adopted with other modern issues not directly addressed by Scripture; issues such as abortion, euthanasia and gamete donation, just to mention a few.
While the Scriptures comment on the nature of creation and its order, the overall focus is on the story of salvation history. This is the story of God’s activity in saving and preserving a people for himself, and it moves from creation through the Fall and on to redemption and consummation. This story and the theology it generates has implications for genetic engineering. We will not be able to bring the whole picture into view. However, three notions in particular are relevant and deserve our attention. These are the concepts of personhood, health and medicine.
1. Personhood
In the Bible, persons are on-going relational beings. We are defined by our relationships. Individuals come into the world because of personal relationships, and are born into families of various kinds. They are subjects whose history can be traced back into the womb. And part of any individual’s history is that he or she is born as an agent of the living God, placed on earth as a vice-regent to maintain the order God had established. Persons, therefore, find their meaning and significance in a right relationship with God, their fellows, and creation. Our meaning and existence cannot be explained by, or reduced to, regulations and achievements. Neither can our personhood be reduced to a bundle of properties which includes such assets as self-awareness and rationality. The subject’s history begins at conception and various capacities are accrued along the way. And at conception, we are creatures in relation to the living God. That’s who we are at the core.
2. Health
From a biblical perspective, disease, suffering and death are the manifestations of a fracture in the relationship between God and the people he created. Hence true health is only found in the restoration of a right relationship with God. Health is viewed holistically as part of a wider and deeper problem. Within the eschatological framework of salvation history, medicine is seen as restorative. It is a matter of restoring disturbances, disorders and diseases. Given the disorder and disease occasioned by the Fall, medicine is an expression of faith operating in love as we await the final redemption. The solution to the fundamental problem of sin is only found in divine intervention and does not emerge from human activity.
3. Medicine
This biblical perspective provides us with a criterion of moral evaluation. As one aspect of the working out of humankind’s responsibility as the image and representative of God, medical practitioners have a moral obligation to restore disturbances, disorders, and disease in the order of creation. Not all theologians will accept this conservative notion of the nature of medical science. Some liberal theologians have argued that God is always involved in redemption and creation and that we humans are invited to participate in the work of the new creation through the process of genetic engineering. For them human genetic engineering has the potential for being an extension of the work of God. Conceiving creation as an evolutionary and on-going process, they see genetic engineering as a way to bring creation to fulfilment and harmony. A careful study of the Scriptures will not endorse this merging of the materialist vision with the biblical hope. In the end the problem is not fundamentally a biological one and the role given to humankind is not that of co-creator. Nor are the purposes of God realised or achieved by the activity of his creatures. Everything is finalised in the person and work of Christ.
Putting the principle to work
Accepting that we have a moral obligation to restore the balance of creation would mean the acceptance of somatic cell therapy, in principle, as a form of restorative medicine. But here secondary criteria have to be employed as well. The safety of any procedure has to be assessed. One problem with somatic cell therapy is the delivery of the genetic material to the relevant body cells. For example, one suggested method is the use of viruses to deliver the new code. There are obvious inherent difficulties with such a method. The side-effects of any method would need to be examined before it could be accepted. In practice every single procedure would have to be examined. A further complication arises in relation to the sex cells of the patient. If germ line (or sex cell) therapy was determined to be illegitimate, then the delivery method of somatic cell therapy must avoid altering the sex cells and making alterations that would be transmitted to offspring.
Putting into practice the principle of restoration has many complications. To conclude, we raise below some of the issues which need to be addressed.
1. What constitutes restoration?
Clearly somatic cell therapy used to enhance a particular trait of an individual would not be acceptable on this biblical criterion, for it would not be restorative. It would be difficult to argue that the Bible tells us the restored human being must be blonde-haired and blue-eyed, for example! The line between the treatment of disease (restoration) and the enhancement of capacities (human desire) may be difficult to draw in practice. The ethicist Gilbert Meilander astutely observes that the where the line is drawn depends on the understanding of health employed. Expansive definitions will blur the distinction. If health is ‘the complete physical, mental and social well-being, and not merely the absence of disease or infirmity’ then there will be no limit to what may be legitimised. A more common sense view of health based on the normal curve would fit the biblical understanding.
2. Risky side-effects?
Furthermore, our criterion would promote the acceptance of sex cell therapy for genetic diseases, at least in principle, as this is a form of restorative medicine. Yet again secondary criteria will need to be employed. In the 1970s, after scientists had learnt to use techniques such as restriction enzymes to cut the DNA chain at precise spots in the sequence and ‘ligase’ to reattach new fragments, a group of eleven leading researchers published a letter simultaneously in Nature and Science (two prestigious scientific journals) highlighting the risks. The letter expressed the fear that such procedures would result in the creation of novel types of infectious DNA elements whose biological properties could not be completely predicted in advance. Powerful destructive new entities might be unleashed.
3. Causing more problems than it solves?
In practice the problem is further complicated by the fact that not all diseases are single-gene disorders. Many involve multiple genes. It is likely that attempting to modify a number of genes would have adverse effects in other areas. Furthermore since germ line therapy would involve IVF and genetic screening, the far simpler and economically cheaper treatment would be to dispose of the defective embryo. Gene therapy might be overlooked purely for financial reasons. Moreover some have argued against the procedure of germ line therapy on the grounds that it no longer just treats the individual but changes the genetic make-up of the community. Is the task of changing human nature a job for medicine?
4. A Better Race?
The employment of our principle would necessitate the rejection of germ line therapy for eugenics (the science of improving the human race). The idea of a program for upgrading the physical and mental qualities of individuals or groups runs counter to the Christian ethic. Such a practice would encourage the valuing of people for their gifts alone. The Christian ethic teaches that people are to be valued as people and not for any properties or characteristics they possess. Central to the very concept of moral value is the worth given to kinds and to individuals as instances of the kind. An essential feature of Christian love is to welcome others because they are human and made in the image of God.
Bland new world
Both Aldous Huxley (Brave New World) and C. S. Lewis (the science fiction trilogy) have suggested powerfully that the practice of eugenics does not lead to the utopia imagined. Rather it leads to a bland dystopia where people are depersonalised. The argument is not that the employment of eugenics will give some people power over others. Many new technologies do that and we don’t object too strongly to their use. Rather the point is the enormity of the power; a power to change the pattern of human nature. What is at stake is the possibility of not being free to be a human being before God and to be for God.
