handout - Torah in Motion

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14 Δεκ 2012 (πριν από 4 χρόνια και 6 μήνες)

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DESIGNING BABIES

PROF. AVRAHAM STEINBERG

PLANNING AND PROGRAMMING

PLANNING


Contraceptives

Abortion


Artificial insemination

In
-
vitro insemination

Clonning


PROGRAMMING


Genetic screening

Pre
-
implantation
genetic diagnosis


Genetic engineering

Genetic therapy

clonning



TECHNIQUES


GENETIC SCREENING



pre
-
marital



pre
-
implantation



pre
-
natal



post
-
natal


GENETIC ENGINEERING


GENETIC THERAPY


STEM
-
CELL MANIPULATION


CLONING



therapeutic



reproductive


ETHICAL ISSUES


Science and technology
per se
are
morally neutral



The determining factor from a socio
-
moral perspective is the
USE

of science
and technology


JEWISH APPROACH
--

GENERAL


Extreme caution of accepting scientific, social,
technological innovations and changes


הרותה ןמ רוסא שדח



תומחלמ לעב תושדח השוע


but


“Anything which we have no reason to prohibit is
permitted without having to find a reason for its
permissibility, for the Torah does not mention every
permissible thing but rather only those things which are
forbidden”


[
Tiferet

Yisrael
,
Yadayim

4
:
3
]


THEOLOGICAL ISSUES


KNOWLEDGE



PLAYING GOD’


INTERFERENCE WITH NATURE


THE TYRANNY OF
KNOWLEDGE

for in much wisdom is much grief,
and he that increaseth knowledge
increaseth sorrow


(Ecclesiastes
1
:
18
)


IMPORTANCE OF KNOWLEDGE

O Lord,
how abundant

are thy works, with
wisdom hast thou made them all, the earth is
full of thy riches

[Psalms
104
:
24
]

How

great

are Thou deeds, O Lord,
exceedingly profound are Thou thoughts

[Psalms
92
:
6
]

Maimonides’ Mishneh Torah, Yesodei ha’Torah
2
:
12


THEOLOGICAL ISSUES


KNOWLEDGE



PLAYING GOD’


INTERFERENCE WITH NATURE


‘PLAYING GOD’


genetic revolution


technical not
fundamental


genetic revolution


revealing existing
not creating new



where there is a plan


瑨敲t 楳⁡
planner


enhanced knowledge of macro
-

and
micro
-
cosmus enhances the belief in
the All
-
Mighty God


THEOLOGICAL ISSUES


KNOWLEDGE



PLAYING GOD’


INTERFERENCE WITH NATURE


INTERFERENCE WITH NATURE

Principally permissible, perhaps
required


verapo yerape,
from here one derives a
healer’s permission to heal
[
BK
85
a
]
,
and we do not say
--

God smites and
man heals
[
Rashi,
loc. cit.]


INTERFERENCE WITH NATURE

Principally permissible, perhaps
required


All His work which God created to make
,
is interpreted by the
Midrash

to mean
that world was left incomplete for man
to complete it


INTERFERENCE WITH NATURE

Principally permissible, perhaps
required


and subdue the earth

--

God gave
humans power and dominion on earth
to do as they wish with animals, and to
build, to uproot that which is planted,
etc.

[
Ramban,
Genesis
1
:
28
]


INTERFERENCE WITH NATURE

Qualifications



the actual act must not involve any
inherent halakhic prohibition


the act must lead to no unavoidable or
irreversible result which is halakhically
prohibited


derived benefit should surpass the
detriment


Good ethics start

with good facts.

GENETICS
--

FACTS


46
chromosomes, X Y


Dominant, recessive, X
-
linked


Homozygote, heterozygote


Genotype, phenotype


3
billion code ‘letters’


DNA length
2
m, wide
2
billionths of a m


30
,
000
genes


5
,
000
genetic syndromes


GENETICS
--

FACTS


Genetic predetermination


来湥瑩挠
predisposition



Tendencies and traits


楲牥楳瑩扬b
urges


GENETICS
--

FACTS


Specific, determinant genes

eye color,
Tay

Sachs




specific, partially determinant genes

Down’s syndrome, epilepsy



specific, predisposing genes

BRCA, tumor suppressors


GENETICS
--

FACTS


Genes and environment

intelligence, toxins



inter
-
acting genes, multi
-
factorial


GENETICS
--

FACTS

ONCOLOGY


tumor suppressor genes
--

predisposition to cancer


BRCA
1
-
3
--

breast/ ovary malignancy

NEURO
-
DEGENERATIVE


Huntington’s disease


Alzheimer’ disease


Tay
-
Sachs disease


GENETICS
--

FACTS

NEURO
-
BEHAVIORAL / CHARACTER



‘aggression’ gene


‘Homosexual’ gene


‘Intelligence’ gene


TECHNIQUES


GENETIC SCREENING



pre
-
marital



pre
-
implantation



pre
-
natal



post
-
natal


GENETIC ENGINEERING


GENETIC THERAPY


STEM
-
CELL MANIPULATION


CLONING



therapeutic



reproductive


GENETIC SCREENING

Pre
-
marital screening



encouraged



Family history




Talmudic sources



Tay
-
Sachs

Resonsa
Iggrot Moshe, Even Haezer

4
:
10



Genetic screening (Dor Yesharim)




recessive diseases


GENETIC SCREENING

Pre
-
implantation
genetic diagnosis



Permissible



STATUS OF EMBRYO/FETUS



JEWISH VIEW

a) PROGRESSIVE ACQUISITION OF HUMAN STATUS
AND RIGHTS



PROGRESSIVE SHIFTING OF BALANCES BETWEEN
MORAL
-
LEGAL CLAIM OF THE DEVELOPING
EMBRYO FOR LIFE AND OTHER OPPOSING
VALUES AND MORAL
-
LEGAL CLAIMS


b) FUNDAMENTAL DIFFERENCE BETWEEN PRE
-
EMBRYO / PRE
-
IMPLANTATION

AND EMBRYO / POST
-
IMPLANTATION



PRE
-
IMPLANTED FERTILIZED
EGG

Respect as a human part and potential life

No human status


“he who spills the blood of
a human within a human
,
his blood shall be spilled
[
Genesis
9
:
6
]


a fetus within
its mother’s womb [
Sanhedrin
67
b
]



“until
40
days after conception the fetus is mere fluid”
[
Yebamot
69
b
]


Potential life very remote


PRE
-
IMPLANTED FERTILIZED
EGG

Respect as a human part and potential life

No human status


Consequently

pre
-
implantation genetic diagnosis (PGD) and
discarding defective pre
-
embryos



Permissible


research on stem cells via destruction of
blastocyte



Permissible


PRE
-
IMPLANTATION GENETIC
DIAGNOSIS = PGD


Rav Eliashiv principle approval = NF
1


Rav Halberstam and Rav Neuvirt
detailed approval and supervision


Review Committee

PRINCIPLES


Serious, single gene, diseases


Halakhically married couple


PRE
-
IMPLANTATION GENETIC
DIAGNOSIS = PGD

DILEMMAS



Methods to obtain semen:



condom during cohabitation




problems: risk of pregnancy







possibility of Niddah




solution: freeze sperm



other methods


PRE
-
IMPLANTATION GENETIC
DIAGNOSIS = PGD

DILEMMAS


Carrier state:





differentiate between X
-
linked



and recessive carrier state







摩晦d牥湴楡瑥t扥瑷敥渠䥖I⁦潲



fertility purposes and IVF for PGD







摩晦d牥湴楡瑥 扥瑷敥渠睨w汥捹捬c


of sick and carrier state and partial


PRE
-
IMPLANTATION GENETIC
DIAGNOSIS = PGD

DILEMMAS


Adult
-
onset disease, i.e. BRCA



HLA
-
compatible child



Sex selection



“Social” disease, i.e. homosexuality



Adult pregnant women, i.e., Down’s



Number of children in family

SCREENING

Pre
-
natal diagnosis



Debatable


Ultrasound


Markers


CVS


Amniocenthesis

GENETIC SCREENING

PRE
-
NATAL


ABORTION ISSUES

DELIVERY MANAGEMENT


TECHNIQUES


GENETIC SCREENING



pre
-
marital



pre
-
implantation



pre
-
natal



post
-
natal


GENETIC ENGINEERING


GENETIC THERAPY


STEM
-
CELL MANIPULATION


CLONING



therapeutic



reproductive


GENETIC THERAPY

FACTS AND PURPOSES



Somatic gene therapy


来牭
-
汩湥
瑨敲t灹


diseases


灨p獩捡氠捨慲a捴c物獴r捳


physical


浥湴慬n


扥桡癩v牡r


GENETIC THERAPY

Genetic therapy is no different than any
other medical therapy. Hence, it is
included in the permission of
Heal he
should heal

and the obligation to
enhance health and to save life.


TECHNIQUES


GENETIC SCREENING



pre
-
marital



pre
-
implantation



pre
-
natal



post
-
natal


GENETIC ENGINEERING


GENETIC THERAPY


STEM
-
CELL MANIPULATION


CLONING



therapeutic



reproductive


STEM CELL RESEARCH

What are stem cells and
why are people so
interested in them?

Pluripotential cells

Unlimited divisions

STEM CELLS
--

APPLICATIONS


Treatment of degenerative diseases

i
.e. Parkinson’s, Alzheimer, diabetes, stroke, infarct


Organ transplantation


Basic research of cell differentiaiton

i.e., malignancy, congenital defects


Applied research

i.e., testing new drugs


STEM
-
CELL RESEARCH


APPLICATION (
1
)

superfluous fertilized eggs after fertility
treatment (IVF)

YES


directly created for purpose of stem
-
cell


NO


therapeutic cloning

YES





STEM
-
CELL RESEARCH


APPLICATION (
2
)

miscarried fetus

YES


abortion for purpose of stem
-
cell

NO


Adults

YES



TECHNIQUES


GENETIC SCREENING



pre
-
marital



pre
-
implantation



pre
-
natal



post
-
natal


GENETIC ENGINEERING


GENETIC THERAPY


STEM
-
CELL MANIPULATION


CLONING



therapeutic



reproductive


Human Cloning:

Two Distinct Applications


Reproductive

cloning

-

a

clonal

pre
-
embryo

is

implanted

in

a

woman's

womb

with

intent

to

create

a

fully

formed

living

child
.


¾
Therapeutic

cloning

-

a

clonal

pre
-
embryo

is

produced,

but

instead

of

being

implanted

in

a

womb,

it

is

used

to

generate

stem

cells
.



THERAPEUTIC CLONING

ADVANTAGES

Immunological identity


no rejection

Specifically designed

No emitting of sperm


PROBLEMS

Many eggs required

Sources of eggs


volunteers, identified,






danger to donor, sale

REPRODUCTIVE CLONING


Renew functioning of damaged cells, or
replacement of dead cells

[
i.e., Parkinson,
Alzheimer
]


Halt uncontrolled reproduction of cells
[
i.e., malignancy
]


Animals/people with similar immune
systems
[
i.e., organ donors
]


Solution for infertile couples


POTENTIAL MEDICAL BENEFITS

POTENTIAL PROBLEMS AND
DAMAGES


Eugenics


Identical people, no
individuality


Absence of genetic
variability


Undesirable
changes in mature
cells



“Black market” of
fetuses



Who is the Father?
Mother?


People becoming
means rather than
ends


Radical changes in
world’s social order,
parenthood, family


POTENTIAL PROBLEMS
--

AMELIORATING FACTORS


Influence of development
--

learning
and environment


Time factor


Mitochondial DNA


Interaction of genetic material


ETHICAL vs MORAL

Questionable moral issues


Currently definitely ethical issues


Undesirable damaged offspring


HALAKHIC ISSUES


Witchcraft
--

as a transformation in the
order of creation


Cross
-
breeding animal and plant
species [
kilayim
]


Three partners in the human being
--

father, mother and G
-
d


HALAKHIC
ISSUES


Anything done as a natural activity is
not included in the prohibition of
witchcraft. Even if we knew how to
create creatures without natural
procreation … we may engage in this
activity, since anything natural does
not fall under the rubric of witchcraft



[
R. M.
Ha’Meiri
(
1249
-
1316
), Sanhedrin
67
b
]


HALAKHIC

PROBLEMS


Is the clonee a
‘golem’
?


Does one fulfill the commandment to
“be fruitful and multiply”?


How is fatherhood / motherhood
defined in a cloning situation?


HALAKHIC
PROBLEMS
--

FATHERHOOD / MOTHERHOOD


Mature cell, ovum and womb of same woman



Mature cell from husband, ovum and womb
of wife



Mature cell from a first
-
degree relative



Mature cell from a female, ovum and womb
of another female



THANK YOU !