Introduction

The field of genetic engineering is one that is vehemently debated with regard to ethics. We, therefore, must strongly consider the ethical aspects of our project, and make a case as to why this technology should be implemented.

The four moral principles

A good place to start is the four moral principles, as set out by Tom Beauchamp and James Childress. They are non-hierarchical and must be equally examined against each other when we are thinking about a medical treatment.

• Respect for autonomy: The patient should be able to choose their treatment (assuming they are able to consent).
• Beneficence: We should provide treatment that benefits the patient.
• Justice: Health resources should be distributed fairly according to need, fairness and equality.
• Non-maleficence: The patient should not be harmed or injured.

A lot of these seem very obvious, but there are examples when the moral principles come into conflict and we must decide on the correct course of action. For example, Jehovah’s witnesses will refuse blood transfusions due to their religious beliefs, even if it means they will die. This scenario brings the principles of autonomy and beneficence into conflict. If we administer the blood transfusion then we will save the patient and abide by the beneficence principle; however, the patient’s autonomy will be compromised. Conversely, if we do not the give them the transfusion, the patient’s autonomy is respected; but they will die and we will not be providing benefit.

Respect for autonomy

In medicine, a patient must always give informed consent if possible. Their decisions should be voluntary, intentional and based on an understanding of any treatment. They should also be able to refuse the treatment and be able to withdraw if possible.

A possible problem with GM probiotics is that a person could accidentally ingest the probiotics if they are found in the environment. This could particularly be a problem in countries with poor sanitation. The bacteria will consequently be given safety features to prevent them from entering the environment. They will have auxotrophies, an environmental kill switch and a network of toxin-antitoxin systems to avoid bacteria or modified genes from leaving the gut.

Another issue is patients wishing to end their treatment. With all medical treatments, there is a risk of adverse side effects or unforeseen complications. The capacity to stop treatment at any point is preferred for any new technology. A reduction in the ability to reverse or stop treatment is one of the reasons why genetic engineering is distrusted as a treatment. We have accordingly designed an inducible kill switch which will provide the patient with the ability to selectively kill the GM probiotics at any point, and leaving the rest of microbiome intact.

Beneficence

Beneficence is the principle of acting in the best interests of the patient. Our design attempts to cure autoimmune diseases of the gut. It should have fewer side effects than the current drugs which are used for these conditions. The probiotics should, therefore, benefit the patient and be a better alternative to current treatments.

Justice

The principle of justice involves distributing healthcare fairly. It is fairly cheap and easy to culture the bacteria for use as probiotics. Production costs are not too expensive like many gene therapies, which means that the treatment could be utilised in the developing world. The inducible kill switch is also designed to be cheap and easy to use across the world. We were considering using a deadman switch, which would require regular intake of a supplement to keep the bacteria alive. This was decided to be too inconvenient, especially in areas where it is difficult to get medical supplies.

Non-maleficence

It is important that any treatments do not harm patients unless there is no alternative. Current treatments for many autoimmune diseases have side effects such as weight gain, diarrhoea and nausea. Probiotic treatments should have fewer side effects, and if there are any we can eliminate the bacteria from the immune system with the inducible kill switch. The kill switch was created as an alternative to using antibiotics. It has been shown that antibiotics can have an adverse effect on the microbiome and they can lead to AAD (antibiotic-associated diarrhoea). Our kill switch is a better alternative which does less harm to the patient.

Ethical theories

In philosophy, there are three main ethical theories: consequentialism, deontology and virtue ethics. While these ideas are very different, they all agree with the use of our technology as a moral act.

Consequentialism

Consequentialism can be summarised as the consequences of an act being the most important feature to consider. When we make a decision, we must weigh up the good and bad consequences of an action. The action is morally right if the positive consequences outweigh the negatives.

Our project has the potential to improve the lives of thousands of people and alleviate a great deal of suffering. While there is a potential risk of something going wrong, we have also designed safety precautions to minimise the risks. Overall, we would argue that our project brings a net positive benefit to the world and hence it abides by the principles of consequentialism.

Deontology

Deontology is seen as the opposing theory to utilitarianism. Deontologists believe that it is the acts themselves that dictate the morality of an action, not the consequences. Deontology is the belief that there are specific rules we have a duty to abide by, no matter the consequences.

There are many duties that we should abide by, according to deontological ethics, for example, beneficence and nonmaleficence (principles that we have already seen in medical ethics). Giving our treatment to patients is a moral act according to deontology as we are alleviating suffering and adhering to moral rules of helping others.

Virtue ethics

Virtue ethics is a relatively old philosophical tradition. Instead of following rules or considering consequences, we must instead develop good characteristics or virtues. We must act courageously, compassionately or honestly.

The use of our technology demonstrates the virtues of compassion and justice among others. It is therefore moral to use our genetically modified probiotics.

Appeal to nature

When discussing genetic engineering, there is a tendency for people to engage in a fallacy called the appeal to nature. The appeal to nature is when people state that something is inherently good because it is natural, or inherently bad because it is unnatural.

It is a viewpoint that many of us are taught to believe, companies will often parade a product as natural to make it more desirable to customers.

There are many examples that can be used to counter this logical fallacy. Diseases, natural disasters and poisonous plants are all natural, yet very few people would view them as good. Conversely, there are a lot of things in our world which are unnatural but give great benefit to humans such as medicine, electricity and artificial fertiliser.

People often equate genetic engineering with unnatural tampering of organisms. However, humans have actually been modifying organisms for thousands of years through selective breeding. Modern crops and farm animals are very different from their ancestors. Genetic engineering is actually just a more deliberate way of changing organisms to suit our needs.

While our genetic engineering project may be unnatural, that does not make it inherently bad. We should judge the pros and cons based on whether it will help people and improve their lives. It would be wrong to disregard a technology with a large potential for helping others simply because it is unnatural.

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