This document discusses the ethical issues surrounding genetic engineering and manipulation of human embryos. It argues that as medicine has progressed from treating adults to children to fetuses, the next logical step is also treating embryos. However, this raises debates around playing God, the rights of embryos, and unintended consequences. The document considers both allowing genetic engineering to progress human evolution versus banning it due to safety concerns. Ultimately, it concludes that qualified doctors working with oversight and under principles of medical ethics should be able to offer genetic therapies to embryos if chosen by informed consent of the parents.

1. The embryo as a patient
Dr Aniruddha Malpani, MD
www.drmalpani.com

6. Logical next step in medicine
• Adult
• Child
• Foetus
• Embryo

7. Precision medicine
• Prevention is better than cure
• Treat at the genetic level – at the
root cause of the disease

8. We’ve come a long way, baby !

10. From PGS – preimplantation
genetic selection to
PGT - preimplantation genetic
therapeutics

12. Playing God ?
• Familiar debate !
• Is IVF ethical ? When does life begin? what
are the rights of an embryo?
• Can human embryos be used for harvesting
embryonic stem cell lines ?
• Should cloning be
allowed ?

13. Two views
• Manipulating Nature is
dangerous
v/s
• Triumph of man's ingenuity
which can be used to overcome
Nature's constraints.

14. Who decides ?
• Top-down – scientists,
philosophers, activists,
government, doctors.
• Bottom up - Leave the decision
to each individual couple, who
provide the reproductive
apparatus to create the baby.

16. Challenges
• Both technical and ethical
• Assilomar Conference. Recombinant
DNA. 1975. Moratorium , need time to
evaluate the risk reward ratio
• Transhumanism - Logical next step for
human progress . Humans engineer
their own evolution, rather than depend
on nature

17. Challenges
• Cells are still a black box . Worry about
unintended consequences
• Gene Drive
• Gene Flow across species
can lead to interbreeding
• Dare we open Pandora’s
box ?

18. Science Fiction

20. Different standards

21. Slippery slope !

22. Criticism
• Unnatural and artificial - Is nothing
sacred ?
• Money - Is everything for sale ?

23. Knee Jerk Reflex - Ban genetic
engineering !
• It’s too dangerous, so let's prohibit it !
Easy to do, but will backfire. Throw the
baby out with the bath water.
• Other countries will steal a march on us
and we will be left behind
• Drive it underground ?
• Need sensible guidelines and regulation

24. • Actions have consequences.
• Inactions have consequences
too
• Fear of the unknown cannot
paralyse us into inactivity

25. Dr Frankenstein

26. Should human embryo
research be banned ?
• We are not mad scientists trying to play
God
• We are doctors trying to do the best for
our patients

27. Doctors are trusted
professionals
• If we trust doctors to make life
and death decisions in the ICU,
then why can’t they be trusted
to make decisions about genetic
engineering responsibly in
partnership with their patients ?
• Could set up a multidisciplinary
committee to review each
request ?

28. 3 principles of medical ethics
• Autonomy
• Beneficence
• Non-maleficence

29. Evolution 2.0 ?
• Human reproduction is not efficient. Hit
and miss affair. Why not improve it ?
• Natural Selection is a biological fact of
life
• If humans can do a better job, then
why shouldn’t we ?

30. Human Reproduction v 2.0
• Mother Nature is not always kind -
millions of people die of preventable
diseases, which we can treat today

31. The problem with regulations
• Rules vary so much from country to
country means there are no right
answers.
• Rigid and inflexible. Get outdated
• Isn’t it better to allow doctors the
freedom to select what is best for their
patients ?
• This conference shows we are
responsible and sensible

32. Solution ?
• Let patients decide for themselves – it’s
their life and their baby
• A democracy empowers people to make
their own choices
• It’s unethical to interfere in their
personal family-building plans
• Need to individualise and personalise
the care we provide