> Doctor: So do you want the $500 edit to ensure your child won't have diabetes. How about the $2,000 Autism edit? Then the gender change edit is to late to perform. We could do artificial semination and guarantee the gender of your child.

That's a straight up violation of the Hippocratic oath and blackmail/racketeering combined. We should enforce it strictly, vigilantly, and put doctors who attempt to do this in jail away for a very long time.

I understand your main argument stems from affordability of the procedure and that's a valid concern, but keep in mind that current societies already ration health care, either by availability/wait times (UK?) or wealth (USA). You won't be able to prevent the wealthy from modifying their offspring anyway and the unfairness of having them do it vs 99% not being able to afford do is not enough of a reason to stop progress, not even close. The goal should be to make this procedure routine, as affordable as an ultrasound or a tooth extraction or a cancer screen.

How do you address this with policy? The same way we should be addressing inequality right now.

Let me posit this question to you: if genetic enhancement would be available to 100% of the population, would you still have ethics concerns?

> How do you address this with policy? The same way we should be addressing inequality right now.

How _will_ we address this with policy? The same way we already do: meaning that we do not, and in fact are thrall to an army of lobbyists and interest groups who would have us believe this inequality is not just necessary but in fact morally redeemable.

That just means you have bigger problems than a few genetically enhanced humans running around.

Which is, in fact, already happening without genetic enhancement: the Olympics are a pretty much a display of peak human genetic fitness, and no one loses their mind about it.

What would be a problem: genetically enhanced humans reach some critical mass and decide to purge the non-enhanced ones à la Eugenics wars in Star Trek (purely hypothetical)

> That's a straight up violation of the Hippocratic oath

So is abortion. And, so we're clear, allowing or in any way approving of abortion as a doctor is a far more direct violation of the Hippocratic oath than this is.

> How do you address this with policy? The same way we should be addressing inequality right now.

You mean not at all ?

I've realized though that doctors and pharmaceutical industries don't need to do anything other than save sick patients to make us utterly dependent on genetic modifications. Genetic treatments do not transmit from parent to child. So every parent you treat, the children will need to be treated as well. In some cases all of them, in other cases the chances are simply increased a bit of needing the treatment, which isn't much of a difference.

Even that is ignoring what happens when actual improvements over normal humans become available as genetic treatments. 1% bigger brain ? There is quite a bit of studies that give the impression that on average brain size does correspond to intelligence, even if there are no guarantees in individual cases. It should be an easy change in the DNA to make it a few percent bigger.

So really there's a number of choices we can do:

1) genetic modification is only allowed to be used to cure the sick

This results in the whole population becoming dependent and hostage to genetic modification. Slowly at first. Then, when we learn how to optimize humans, very rapidly.

2) genetic modification is available for parents to create embryos

This actually results in slower dependence: diseases get eliminated, including in the gametes, and any treatment does not need to be repeated in children. Still, improvements will create a class based society.

3) genetic modification is free, and not optional, at least for certain ailments (like vaccines)

This would rapidly eliminate dependence on genetic modification and would be much more fair towards everyone.

>You won't be able to prevent the wealthy from modifying their offspring anyway and the unfairness of having them do it vs 99% not being able to afford do is not enough of a reason to stop progress, not even close.

How is that not enough of a reason? The argument is the government has to step in and make it routine from the start. The alternative is to allow the wealthy to literally write superiority into their genes.

Well, we are not going to be able to stop that. Money rules the world. Furthermore, these technologies will appear, regardless of whether we want or not, be it legal or not, so why not do it from the start the right way, so that everyone can benefit from it? Reminds me of the age-reversing debate. It's going to happen, so we might as well bring it as soon as possible instead of letting people die.

I am definitely not 100% on board with editing embryos, but income inequality is the weakest possible criticism. You could argue against literally anything on the grounds that it could lead to inequality: IVF, adoption, education, medical care, technology, owning a computer, being on Hacker News.

Just because something is being doled out injustly doesn't mean it shouldn't be doled out at all.

This isn't an item that is doled out it is a fundamentally bases about humanity. The analogy doesn't fit.

Can we say "All Men are Created Equal?" Not anymore.

All men are created equal means that they all have equal rights, not that they all have equal ability. I have a daughter with a recessive genetic disease and two children without it. They're already genetically unequal. Your argument would prevent a potential treatment that would have removed this inequality.

If we truly want to eliminate disease though it's not enough to cure disorders, sometimes you have to be able to prevent them, and sometimes they're going to be genetic. Not allowing scientists to use every tool in their arsenal is condemning a lot of people to a lot of pain. I agree that humans aren't always going to make the right calls, but us doing our best might be better than doing nothing.

reverse this: https://www.youtube.com/watch?v=HqjhYmDDWlI

Is the gap between rich and poor really so important that we should refrain from curing diseases to avoid making it larger?

Making a rich child immune to diabetes or autism doesn't hurt poor people. It's strictly a net gain.

What's fundamentally different between this and, say, prenatal vitamins or good nutrition? Should we ban women from taking folic acid because it gives an advantage to people who can afford it?

Let's say an in-vitro preventive for diabetes could be developed but is blocked because of concerns about gene editing. That means thousands or millions of children will contract diabetes who wouldn't have if the preventive had been available and will die prematurely. How is that a good thing?

I can sort of buy the arguments for purely cosmetic changes like selecting sex or eye color or whatever. I can vaguely grasp the arguments against selective intelligence or physical strength enhancement. But to refuse to prevent diseases? Why?

It's sad the first comments are always stuff like this. So you want millions of people to suffer genetic diseases because income inequality?

This is like the premier example of a false dichotomy.

And this is a premier example of improper application of popular logical fallacy.

The dichotomy isn't false. Like it or not genetic diseases are easier to fix when there's fewer cells to modify. Modifying a few thousand cells will always be easier than billions.

This will mean diseases that can't be cured in adults can be prevented from childhood. Denying this is condemning untold numbers of victims to diseases we could have cured.

There is something significant about humanity no longer being bound by the tyranny of natural selection. We a species who have the power, however limited, to shape the landscape to our will and desire. Now we can also conquer our own biology. To be this is poetic, utopian even.

Or we will exacerbate our worst tendencies and create a nightmare dystopia

>Doctor: So do you want the $500 edit to ensure your child won't have diabetes. How about the $2,000 Autism edit? Then the gender change edit is to late to perform. We could do artificial semination and guarantee the gender of your child.

I don't have a problem with any of that.

ditto

Or we could socialize healthcare for all then treat gene edits like this as we do vaccination. We offer only those edits which would prevent chronic and termination disorders in life but leave anything else that's merely socially undesirable like neuroatypic "disorders." I know this suggestion isn't bullet proof, but it's better than letting crackpots do this in the shadowy corners of society creating all kinds of changes which lead to more suffering for the people that would bear these gene edits (I can imagine there being some weirdo rich couples that wouldn't mind turning their future kids into Nosferatus despite the adverse social impact that would have on them).

So instead you're fine with saying "your child will have cystic-fibrosis; she will grow up her entire life unable to breath without pain and likely die before the age 25".

Today rich people pay for better access to care through out all stages of life. That doesn't mean we should ban heart surgery (for example) because the rich can disproportionally afford to get it and catch conditions early enough to treat.

The "natural is ethical" argument disgusts me and I think you really should consider how much we already depend on progress before you argue for going back to the stone ages.

We ethically should.

Agreed 100%.

Why assume it's going to lead to some dystopian future when technological progress has shown that advances like this come down in cost immensely over time. Even an insurance system would want in on subsidizing these procedures if it meant an upfront cost versus long term or lifelong expensive treatments.

Edit: Why even assume it would be an insurance subsidy -- the government has a strong motivation to reduce health care costs for >= 65 year-olds and if you could eliminate or reduce costs through early genetic engineering the argument can be made that the government itself should subsidize as a public health initiative.

Just look at the past. Remember when doctors and scientists came up with ways to prevent polio, smallpox, measles, etc. and the result was just that rich kids enjoy immunity while the poor suffer?

Wait a minute....

Exactly. Treating chronic genetic disorders might require expensive biologics over the span of a long time to only partially treat. And since the disease is genetic, there is always the risk it comes back.

Ethically we should to born humans. Absolutely do the good and the great. Unborn embryos never except what is medically to save the live of the fetus. We are not talking about medical but genetic and equality. We could no longer say "All Men are Created Equal."

Exactly. Another reason why we need seasteading...

Ethics or not, some country will do this, and they'll leave everyone else behind economically in a few generations.

At the risk of being too simplistic, I'd say that Nazi Germany tried doing this, to little avail.

That's like saying the nazis tried rockets so SpaceX will fail

Or they won't, or they'll get worse somehow, or we'll all drown first.

So would it be ethical if it was done in a single payer healthcare system?

There is a reason why the initial papers are coming out in China. Granted, China's biotech is young and getting better every year, but there is a cottage industry of trials initiated in China due to laxer review and ethical standards there; a trial like this in the US would have taken years of paperwork to clear the FDA.

Granted... the FDA and other pharmas do spend a lot of time, money and manpower to monitor clinical trials in China because eventually, the pharmas attempt to use these trials, conducted "over there" at lesser costs, to get approval for clinical use in the US through the FDA...

Bioethicist like you are literally the worst people on earth.

>We ethically shouldn't do this. We should not edit human embryos.

That ship may have sailed in a society where you can legally kill the embryo or cut 1/3 of the skin off a newborn infant's penis.

Does anyone really want to give birth to a baby with down syndrome?

Not the Danes apparently.

"The number of children born with Down Syndrome (DS) in Denmark has fallen drastically in recent years – so much so that the disorder could be a thing of the past in 30 years.

Since 2004 all pregnant women have been offered a DS scan – called a nuchal scan – and the number of abortions involving DS children has increased dramatically. Last year, 98 percent of pregnant women who were revealed to be carrying an unborn child with DS chose to have an abortion."

http://cphpost.dk/news/down-syndrome-heading-for-extinction-...

Personally, I think we absolutely should. We know of genetic defects that cause disabilities and by leaving them there through deliberate inaction we essentially inflict a disability on a child. We also prevent potential advancement of our species.

Cost is a terrible reason to prohibit this and your argument can be applied to nearly all other medical procedures. They all cost money and sometimes that makes them inaccessible to people who need them. This is a different problem to genetic modification.

As for your article, going through the "cons" section, it mainly raises things that need to be thought about rather than reasons not to do it. My opinions on a few sections:

- "making irreversible changes [to people and] all their descendants would constitute extraordinarily risky human experimentation": The changes are only irreversible to the first generation, the same process that introduced the change can removed it in the offspring. The change being irreversible isn't alone a good reason to prevent it. Again, there's precedent for this in existing medicine. If a limb or organ has to be removed, that certainly isn't reversible. If there's a choice between my child definitely being born with a known defect and a child maybe possibly being born with an unknown one, I'd likely take the latter. However I do believe we should understand things better before we go making frivolous modifications to hair colour and such without understanding the consequences.

- "By definition, germline gene editing would not treat any existing person’s medical needs": You're going to refuse to treat someone simply because they're not born yet? Again, acting through inaction. The same benefits brought by treating infants are brought by treating them before they exist.

- "Would germline gene editing be justifiable, in spite of the risks, for parents who might transmit an inherited disease? It’s certainly not necessary. [...] They can do [PGD] too [...]": PGD and CRISPR differ in process but as I understand it, not in result, so I don't believe you can say one is okay but not the other. As for the other section here suggesting you can use third-party sperm or eggs, yes, you can. It isn't strictly necessary to use gene modification techniques if you're happy having someone else's child but it still amounts to selecting for desirable traits.

- "PGD itself raises social and ethical concerns about what kind of traits should be selected or de-selected. These questions are particularly important from a disability rights perspective (which means they’re important for all of us).": I'm not sure I quite get the disability rights perspective. I believe this only really applies to people who believe that life begins at conception, who would argue that selecting candidates that don't have a disability over ones that do amounts to some kind of genetic genocide. Personally I don't buy that. Why should we leave things to chance when we can give the parents the choice to do what they think best for their child?

- "From a policy perspective, how would we draw the distinction between a medical and enhancement purpose for germline modification? In which category would we put short stature, for example? We know that taller people tend to earn more money. So do people with paler skins. Should arranging for children with financially or socially “efficient” varieties of height and complexion be considered medical intervention?": Again, there's precedent for this in existing medicine. Treatment for things like dwarfism and albinism are covered as medical procedures while treatments for mild sunburn and not being able to reach the top shelf are not.

Ultimately the article raises a lot of things to think about but I don't believe any of them are good reasons not to pursue genetic modifications to humans at all.