(Rabbi Dr. Jason Weiner is Senior Rabbi & Director at the Spiritual Care Department at Cedars’ Sinai Medical Center. He held an event, “The Wonder, and the Questions it Leaves Us Wondering About: Gene Editing and Ethics,” at Congregation B’nai David Judea in Los Angeles, CA.)
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) gene editing is a technology that can change an organism’s DNA by either adding, removing, or altering genetic material at particular locations in the genome. This technology was adapted by scientists based on a genome editing process that happens naturally in some bacteria as an immune defense by capturing small pieces of a virus’s DNA and inserting them into their own DNA. In that process, the bacteria learn how to recognize the virus and then cut it apart to disable it if it attacks again. CRISPR is a rapidly developing field that has been described as possessing “unprecedented potential to revolutionize” healthcare because of its ability to cure disease, and has thus been called “the biggest biotech discovery of the century.” A Nobel prize in chemistry was awarded to the founders of CRISPR gene editing in 2020. The ability to edit our own genetic makeup is certainly one of the most profound issues that humanity has ever faced.
It is important to distinguish between two general categories of CRISPR: “somatic” and “germline.” Somatic-cell editing is a much less controversial technique used to edit just some, but not all, aspects of a person who has already been born. These changes will not be inherited by future generations. The other form, germline gene editing, is when edits are made in reproductive cells (human eggs or sperm) or an early-stage embryo, thus making inheritable changes that will be passed along to all of the cells of all future generations of that individual. This process can thus completely alter humankind and is therefore much more controversial. While germline manipulation via CRISPR raises many concerns, there are three that warrant particular attention: therapy versus enhancement, safety concerns, and fairness concerns.
Therapy vs. Enhancement and Playing God
There is significant discussion in this field on distinguishing between medical therapy/treatments that are focused on fixing dangerous genetic abnormalities versus enhancements that are intended to improve human capacities or traits. Most ethicists argue that health treatments are more justifiable than enhancements, but they also recognize that it can become very difficult to distinguish between the two. Eliminating serious genetic illnesses may be an obvious medical treatment, but what about avoiding below-average height or IQ, or above-average weight? What about hair or eye color in a place where there is a social preference for one over the other? The distinction can get very blurry, the slippery slope moves quickly, and the exact point at which we have gone too far is difficult to know. Furthermore, not everything fits neatly into these categories.
Some genetic editing is more of a “prevention,” and some involves not just enhancements, but “super-enhancements,” such as developing new capabilities that humans have never possessed before, like the ability to see infrared light, hear super-high frequencies, or prevent aging, and other superhuman capabilities. Accordingly, the categories are helpful but insufficient, and other distinctions may be necessary as well.
Precedent for addressing this issue by leading rabbinic thinkers of previous generations can be found in the case of Pre-Implantation Genetic Diagnosis (PGD) and cloning. Rabbinic scholars permitted PGD for the sake of medical therapy but not enhancement, which was seen as too close to “playing God” (kavshei d’Rachmana), as will be discussed below. However, there are cases in which otherwise prohibited actions have been permitted for the sake of quality of life, such as removing corneas from a corpse in order to transplant them into a living person, even though it is not lifesaving per se. Therefore, it is possible rabbinic authorities may similarly permit not only medical therapies, but also some forms of enhancement, if these are deemed essential for basic quality of life. Amongst rabbinic authorities, the red line seems to lie with creating new capabilities that have never before existed naturally in human beings (“super-enhancements”). Such changes are seen as going too far in “playing God.”
The issue of “playing God” — the concern that it is wrong for humans to attempt to have the power to completely control the world — has been an objection to these innovations in some bioethics articles opposing germline editing. Although many in the scientific community do not identify with theological concerns, scientists cannot afford to ignore these issues. Since science relies on government funding, and this technology has the power to affect all of society, it requires widely held and well-informed public approval to legitimize it. Furthermore, not only religious people express this kind of concern; it is often articulated in secular terms as a risky deviation from the natural reproductive process by taking control of the human species in ways that could impact future generations without fully understanding what those ramifications will be. Abusing our power in this way is seen as irresponsible, since the evolutionary process is beyond human capacity to fully understand, making it likely that interference with our genes will result in negative outcomes. Some also worry that manipulating the mysterious and delicately interwoven forces of nature could impact society by undermining crucial traits of empathy, humility, striving for excellence, and appreciation for diversity.
There are religious thinkers who see “playing God” as categorically or intrinsically wrong regardless of any consequences, but most recognize that engaging in technology and innovation can also be seen as a form of partnering with God in creation. In Jewish thought, “playing God” can be a good thing as long as the action itself isn’t prohibited and doesn’t lead to a prohibited act, and the benefits outweigh the risks. We don’t just accept imperfection in the world, but are required to intervene with nature in order to treat illness and make the world a better place. Indeed, the Gemara states that after the first Shabbos, God granted Adam “creative knowledge similar to Divine knowledge,” which he used to create the first fire and then to mate a female horse and a male donkey to create a mule. These actions reflect the notion that God granted humanity creative capabilities within nature and the knowledge to be able to harness those powers for the good. As long as we don’t take it too far (such as “super-enhancements”), using our creative capabilities can be a blessing.
It thus is not “playing God” that is objectionable, but rather the “playing around” with these God-like powers that is problematic. Talk of God in relation to these incredible scientific advancements should evoke reflections on wisdom, love, and altruism. When using the phrase “playing God” regarding these incredible powers, the emphasis should be put on the word playing. Being God-like, within reason and in a responsible manner, is good. “Playing” is not.
Safety Concerns
As with any new technology, such as those detailed above regarding AI, and certainly with one as powerful and influential as germline gene editing, there are significant risks of very profound unintended “off-target” consequences and side effects, some of which may not be perceived for decades. When it comes to gene editing, we are faced with the fact that despite the incredible advances that have been made in understanding the human genome, we still have a very limited understanding of the many and precise roles of each of our genes, both individually and in combination with other genes and other parts of the entire genome, and hence what may happen when an individual gene is edited out or changed. Moreover, malicious individuals or states could take advantage of this technology, perverting it to intentionally harm others. Rogue doctors or biohackers could use it in irresponsible ways that could cause permanent damage on a very large scale. However, these concerns are not intrinsic to CRISPR, and could theoretically be addressed with very careful experimentation, ethical research, and very strict guidelines and oversight (in much the same way as has been done with other scientific advances).
Fairness Concerns
In addition to safety concerns, there is also a social justice argument that gene editing will increase inequality since these procedures may be so expensive that only the very wealthy will have the opportunity to benefit from them. This could exacerbate existing inequalities and permanently genetically encode them into humanity, creating a subclass of enhanced elites and completely undermining contemporary values of equal opportunity for all people. This technology could also lead to social pressure to edit one’s children simply because many others are doing so, raising fears of creating “designer babies,” “dehumanizing our species,” and a slippery slope leading to eugenics (the selected breeding of the human race, which has included racial hygienics).
On the other hand, new technologies tend to start out expensive and difficult to obtain but gradually become much more accessible to all. Furthermore, in our consumer-driven society, if this technology is overly restricted, scientists will simply move elsewhere, such that only the very wealthy and connected will be able to take advantage of it, exacerbating inequalities even more. Indeed, many feel that it is an ethical and irresponsible “sexual roulette” to not improve our children’s health and well-being by preventing their suffering and editing their genes when we have the ability to do so.”
Furthermore, the argument goes, society allows investing in other sorts of advantages for our children — such as private tutors or coaches — because we have a moral responsibility to look after future generations, so why is it problematic to give them beneficial genes others have inherited naturally? There have been some public policy suggestions to attempt to combat the inequality concerns, and more protections to mitigate this risk are likely needed.
The Precautionary Principle
How might rabbinic authorities respond to these developing concerns? Although CRISPR and AI are extraordinary advancements, many forms of risky and controversial cutting-edge research have taken place for many years, such as dangerous experiments to develop a smallpox vaccine using the cowpox virus or studies of pathogens that can kill or sicken masses of people, and we have learned that such research can result in enormous benefits for humanity. We have similarly learned that such endeavors can also have terrible consequences. Pharmaceutical companies constantly debate with patient advocates and regulatory agencies over the “right to try” by accelerating approvals of new drugs in the hope of helping individuals suffering from imminently life-threatening conditions (even when there is very low likelihood of success), versus the cautious goals of first ensuring robust data collection, safety, and efficacy in order to help the most people possible over the long term.
As science increasingly gains the ability to change the world and our genome, the stakes intensify. There is often a culture within the world of science that focuses on provocative research, national scientific competitiveness, achieving celebrity, and being first to discover something. However, the risks become very difficult to calculate, and knowing how far to go with newfound capabilities and how to best serve the good of humanity become challenging and polarizing questions. “Bioliberals” approach technological advancement enthusiastically, with the belief that we must have the freedom to encourage and speed up the process as rapidly as possible to aid innovation, develop the economy, and improve health and well-being. “Bioconservatives” worry about the potential negative consequences and risks of new developments and sometimes find new activities to be morally or “intrinsically” objectionable.
Somewhere between these extremes is an approach favored by most bioethicists, known as “the precautionary principle.” Initially articulated at a 1992 United Nations Conference on Environment and Development regarding genetically modified agriculture and food, this is the view that when new therapies and technologies can cause unknown harm to the world or potentially negative consequences for generations to come, the burden of proof regarding their safety must be thoroughly demonstrated by those advocating for the new therapy or policy before moving forward with it.
This is especially so in the case of CRISPR, since science has demonstrated that the human genome is more complex than previously thought, and our capabilities may thus proceed faster than our knowledge about the precise outcomes of applying this new technology. Similarly, many worry that if not advanced wisely, AI can become more intelligent and skilled than humans. Therefore, if not aligned with human goals and values, it could become motivated to do negative things, such as taking control of the future from humanity for its own interests, resulting in an existential threat to humanity. Some have articulated the precautionary principle as, “Rather than march forward and risk falling off a cliff, the burden of proof requires that we locate all the cliffs before marching.” This approach, based on the value of “non-maleficence,” seeks to limit harm while at the same time recognizing that research should move forward — but only when we are ready and can proceed with caution. The precautionary principle is thus temporary, with the goal of eventually creating permanent benefit (“beneficence”) for humanity. This perspective seeks a “prudent path forward” that does not require us to say “no” to all new innovations, even as it does not always encourage saying “yes” right away either. It is trying to find the proper balance between the two, a yellow light that can say, “Yes, but not yet.”
This seems to be the approach to medical innovation that many rabbinic thinkers take as well. For example, the first generation of rabbinic leaders to address the issue of living organ donation did not give it enthusiastic support, but expressed much caution for many years, gradually becoming more supportive as the procedure became safer and more beneficial, eventually praising and even encouraging it. A similar evolution occurred regarding rabbinic attitudes toward IVF. When it was new, many rabbinic authorities forbade it, whereas today, most permit and even encourage it. Some rabbinic thinkers explain that their rulings changed in these areas specifically because it is important for authorities in Jewish law to start by cautiously monitoring how new technology works and what it leads to, making sure that it is proven to be safe and beneficial before permitting and adopting it. As our technical capabilities rapidly increase, it may be crucial to slow down progress in order to give us time and space for our wisdom to catch up.
In a conversation on this topic with R. Asher Weiss, he argued that many of these rabbinic authorities displayed excessive caution. He suggested that when the goal is saving life, we should seek to encourage new technologies to progress as quickly as possible, but nevertheless with many of the precautions mentioned above. He compared this to driving an ambulance to save a life. The ambulance should be driven as speedily as possible to reach the patient in need. However, it would be irresponsible to drive recklessly, since that would in fact jeopardize the ambulance’s likelihood of saving the life.
Conclusion
To ensure that we take a prudent path forward, it is important that appropriate clinical evaluation is undertaken — especially by establishing guidelines for safety and efficacy. Ethical issues need to be resolved as effectively as possible, and a social consensus must be formed regarding whether this is an acceptable way for medical technologies to evolve. These consequential issues must be settled by society as a whole, not by individuals or the scientific community alone. Public debate and scrutiny is essential, as it can help educate broader society and improve public confidence. It is thus especially crucial to include religious communities in the conversation, because they can help develop broader buy-in and facilitate reflections related to meaning, values, and diverse perspectives.
From a Jewish perspective, many of these innovations can be embraced for reasons detailed above. But maintaining humility and recognition of our limitations becomes increasing crucial as our capabilities increase. Traditional Jewish sources thus caution us to take the risks very seriously by recognizing that even if we are allowed to “play God,” we should not “play” with God-like powers.
Oxford philosopher and ethicist Toby Ord makes a very profound and startling point about the place society now finds itself in his book, The Precipice. He suggests that considering human civilization is only about 5,000 years old — but has the potential to continue for millennia longer — in the life cycle of humanity, we may now just barely be in what is comparable to an adolescent phase. This is the age at which a child begins to rapidly develop physical abilities and appetite for risk but does not yet have adequate self-control, wisdom, or insight about their long-term future. When it comes to our own children, we can design socially recognized limitations on what children can and cannot access to protect them from their own still-undeveloped capacities of discernment.
Perhaps, Ord argues, humanity should also have such safeguards. The problem is that unlike with children, there are no wise adults to decide these rules for us. Instead, God has empowered us to use the Torah to figure out how to govern and control ourselves without yet possessing the wisdom to adequately do so. Put slightly differently, our unprecedented power requires us to take unprecedented responsibility. Part of the expectation of the Jewish People to be “a light unto the nations” includes sharing Jewish wisdom on consequential matters with all of humanity.
Even if gene editing techniques can eventually enhance our human intelligence, or AI gives humanity easy access to much more data, these alone do not lead to wisdom, which requires much deeper understanding of consequences and intricacies of the human condition. Wisdom is often found in the ability to recognize that just because we can do something does not mean that we should. Precedent can be found for this attitude in the actions of King Chizkiyahu, who was praised by Chazal for hiding the Book of Remedies (Sefer Refuos), even though it could be used to cure people, since it was leading to a lack of humility and reliance on God.
The challenges may prove to be much more complex than we could ever imagine. For instance, concerns related to “off-target” impacts of manipulating our genome were addressed above, but there are also potential moral off-target effects that some thinkers warn us about. If the human body is “perfected” to the point at which it does not age and slow down, what incentives would there be for the old to make way for the young? If the young are not given a chance to lead, might this lead to a prolongation in the young of functional immaturity? Enhancing the vitality of the old may thus slow or prevent the maturation of the young. If the young have no incentive to lead, and the old have no desire to pass the baton to a new generation, what will happen to human progress and social advancement? If people knew they could live very long lifespans, might there be less motivation to accomplish and innovate in the first place? In this way, concerns about the speedy advance of CRISPR may be seen not only as a bioconservative perspective, but may also be ultimately understood as concern about encouraging human fulfillment, flourishing, and progress.
As AI is increasingly utilized in medical decisionmaking, it may eventually recommend CRISPR in various scenarios. However, since Jewish law may accept utilizing gene editing technologies for some medical therapies but not for enhancements (as discussed above), deep learning models may not be able to discern the moral difference between gene editing for health optimization and gene editing for human enhancement more generally, thus further blurring ethical lines. Similarly, questions such as what it means to be human create a central role for religious, philosophical, and ethical thinkers. AI tools and genetic enhancements may prove helpful if harnessed properly, a task that will take much wisdom, and no doubt some Divine blessing, to accomplish.
(This post is part of Sinai and Synapses’ project Scientists in Synagogues, a grass-roots program to offer Jews opportunities to explore the most interesting and pressing questions surrounding Judaism and science.
“The Wonder, and the Questions it Leaves Us Wondering About: Gene Editing and Ethics” was an “Nosh N’ Drosh” event held by Rabbi Dr. Weiner at Congregation B’nai David Judea in Los Angeles, CA on June 29, 2024. This post is an except from his article about the topic in Touro University New York Medical College’s Medical Halachah Annual. Footnotes have been omitted for clarity and can be found in the original.)
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