Interventions in the human germline
Targeted germline intervention is prohibited by law in Germany and many other countries. The ban is firstly based on the unforeseeable consequences for possible offspring, since, for example, undesirable changes in the genome cannot be reliably ruled out and could be passed on over generations. Secondly, research into such a procedure would result in a high consumption of embryos and human experiments with possibly unconscionable processes could not be completely ruled out. Even if the goal of germline intervention is fundamentally justifiable, the research required for it would not be ethically warranted at present. In addition to the incalculable safety risks, there is also concern that the development of such methods could prepare the ground for targeted, improper modifications of the human genome. Even a legally very limited authorization of germline therapy for certain serious diseases would probably not adequately control the risk of misuse, as it is questionable according to which criteria a line should be drawn between serious and less serious diseases and disabilities. A broad, controversial debate on this topic has never really died down within the scientific community. There are approaches that reinforce the prohibition of germline intervention, as well as those that consider germline therapy not only permitted but even necessary under certain conditions, i.e. if a safe and reliable technique were available.
Chinese scientist He Jiankui caused outrage in the scientific community and the general public when he announced in November 2018 the birth of two babies that he had genetically modified. He Jiankui claimed to have used CRISPR/Cas9 to modify the embryos' CCR5 gene to make them immune to the HI virus transmitted by the father. Jiankui allegedly implanted the two edited embryos into a woman who then gave birth to two living girls. He Jiankui's actions were roundly condemned for several reasons: On the one hand, it cannot be ruled out that the modification of the CCR5 gene could have other, more serious effects, since not all functions of this gene are fully known at present. On the other hand, the necessity of this intervention is highly controversial, as safe methods already exist to prevent the transmission of the HI virus from father to child. With his experiment, Jiankui also knowingly circumvented a number of ethical and scientific guidelines. He was suspended from the Southern University of Science in Shenzhen, where he worked. As the genetic editing of human embryos for the purpose of reproduction is also prohibited by law in China, Jiankui was prosecuted and convicted.
The case prompted many researchers to call for a global moratorium on germline interventions, according to which all nations should voluntarily commit themselves to refrain from the clinical use of germline modifications to sperm, oocytes and embryos. As early as 2017, the German Ethics Council (Deutscher Ethikrat) issued an ad-hoc recommendation calling for an international political discourse and international regulations on germline interventions in humans. This was followed in May 2019 by a detailed statement by the German Ethics Council on “Intervening in the Human Germline”, which also advocated an international moratorium on the clinical application of germline interventions until the safety and efficacy of the technologies used had been ensured. It stated that although ethical analysis did not show any categorical inviolability of the human germline and that although there are "no categorical reasons for prohibiting such interventions”, germline interventions were currently considered ethically irresponsible because of their incalculable risks. On March 3, 2020, the German Ethics Council published the “Joint Statement on the Ethics of Heritable Human Genome Editing” together with Ethics Councils of France (Comité Consultatif National d’Éthique pour les sciences de la vie et de la santé) and Great Britain (Nuffield Council on Bioethics). In this joint statement the councils call for “[putting] ethical considerations at the core of any future discussion and of the development of global governance of heritable genome editing.”
Specifically, four demands are put forward:
- Genome editing is to be brought within the control of the relevant public authorities and its abuse is to be subjected to an appropriate sanction.
- No clinical trials should be conducted without prior public debate.
- No further clinical trials are to be conducted until the potential risks have been significantly reduced.
- A comprehensive risk assessment of the adverse effects of clinical applications, both for individuals and groups as well as for society as a whole, is to be done prior to approval.
Joint Statement on the Ethics of Heritable Human Genome Editing
Comité Consultatif National d’Éthique pour les sciences de la vie et de la santé / Deutscher Ethikrat / Nuffield Council on Bioethics (2020): Joint Statement on the Ethics of Heritable Human Genome Editing. Published 3 March 2020. Online Version
On the opinion of the German Ethics Council:
Deutscher Ethikrat (2019): Eingriffe in die menschliche Keimbahn. Stellungnahme vom 9. Mai 2019. Online Version
On the ad-hoc recommendation of the German Ethics Council:
Deutscher Ethikrat (2017): Keimbahneingriff am menschlichen Embryo: deutscher Ethikrat fordert globalen politischen Diskurs und internationale Regulierungen. Ad-hoc-Empfehlung. Online Version
On the demand for an international moratorium:
Lander, Eric S. / Baylis, Françoise / Zhang, Feng / Charpentier, Emmanuelle / Berg, Paul / Bourgain, Catherine / Friedrich, Bärbel / Joung, J. Keith / Li, Jinsong / Liu, David / Naldini, Luigi / Nie, Jing-Bao / Qiu, Renzong / Schoene-Seifert, Bettina / Shao, Feng / Terry, Sharon / Wei, Wensheng / Winnacker, Ernst-Ludwig (2019): Adopt a moratorium on heritable genome editing. In: Nature 567, 165–168. doi: 10.1038/d41586-019-00726-5 Online Version
On the legal ban on germline therapy:
Duttge, Gunnar (2013): Rechtliche Aspekte. In: Baum, Christopher / Duttge, Gunnar / Fuchs, Michael: Gentherapie. Medizinisch-naturwissenschaftliche, rechtliche und ethische Aspekte. Bd. 15 der Reihe Ethik in den Biowissenschaften – Sachstandsberichte des DRZE. Freiburg i. B.: Verlag Karl Alber, 64–66.
Michael Fuchs provides an overview of the ethical discussions on germline intervention:
Fuchs, Michael (2013): Ethische Aspekte. In: Baum, Christopher / Duttge, Gunnar / Fuchs, Michael: Gentherapie. Medizinisch-naturwissenschaftliche, rechtliche und ethische Aspekte. Bd. 15 der Reihe Ethik in den Biowissenschaften – Sachstandsberichte des DRZE. Freiburg i. B.: Verlag Karl Alber, 100–107.
Christoph Rehmann-Sutter and Traute Schroeder-Kurth also offer an overview of the various arguments in the debate:
Rehmann-Sutter, Christoph (2003): Politik der genetischen Identität. Gute und schlechte Gründe, auf Keimbahntherapie zu verzichten. In: Rehmann-Sutter, Christoph / Müller, Hansjakob (Hg.): Ethik und Gentherapie. Zum praktischen Diskurs um die molekulare Medizin. 2., überarb. Aufl. Tübingen: Francke (Ethik in den Wissenschaften: 7), 225–237.
Schroeder-Kurth, Traute (2000): Pro und Contra Keimbahntherapie und Keimbahnmanipulation. Eine Literaturübersicht mit Kommentaren. In: Bender, Wolfgang / Gassen, Hans G. / Platzer, Katrin / Seehaus, Bernhard (Hg.): Eingriffe in die menschliche Keimbahn. Naturwissenschaftliche und medizinische Aspekte. Rechtliche und ethische Implikationen. Münster: Agenda Verlag (Darmstädter interdisziplinäre Beiträge: 1), 159–181.
Website of the German Ethics Council
Deutscher Ethikrat Online Version
Website of the Nuffield Council on Bioethics
Nuffield Council on Bioethics Online Version
Website of the Ethics Council of France
Comité Consultatif National d’Éthique Online Version