An ethical and moral dilemma has arisen within the past 20 years for both the medical and Christian community. Should we intervene at the genetic level to alter diseases or mutations that may be deleterious to an individuals health? In the summer of 2019 Dr. David Schreiner addressed this very question.
He asks: “How do the general moral imperatives to tend to the disenfranchised and vulnerable mentioned throughout Scripture implore us to pursue the betterment of life and deal with diseases that have a high mortality rate among the young and elderly? Do the Church Fathers, who used Scripture to comment on many experiences beyond the purview of the original authors, provide any insight on how to go beyond the plain sense of Scripture?”
Here is his work:
CRISPR/CAS9 and Editing the Human Genome: Moving Beyond the Text to Engage in Theological Discourse
On July 29, National Public Radio (NPR) published a story about Victoria Gray’s battle with Sickle Cell Disease (SCD).1 SCD refers to genetic blood disorders that affects a patient’s red-blood cells. Instead of the normal, squishy, round red-blood cells, which move effectively through the patient’s blood vessels, the red-blood cells are hard, sticky, and sometimes in the shape of a sickle. Most importantly, the mutated red-blood cells pool at certain junctures in the blood stream and cause an incredible amount of pain. In serious cases, the pain is incapacitating, and SCD has been linked to infections, strokes, and other life-threating events. In developed countries, patients with SCD often don’t live much past 40. In developing countries, patients can’t live more than a handful of years.
What makes Ms. Gray’s story so unique is that a major element of her treatment involves a DNA editing process called CRISPR/CAS9. CRISPR stands for Cluster Regularly Interspaced Short Palindromic Repeats, and CAS9 is the cutting enzyme necessary for the editing process to work. I know, all this sounds intimidating, and in many ways it is. However, bear with me as I try to do it justice.
The process begins with the human genome, that is a human’s genetic code. Scientists and doctors have long known that genetic defeats are caused by mutations in the human genome. However, only recently has a process been developed that can “fix” these mutations. First, doctors identify the part of the genetic code that is causing the problem. Then, doctors construct a molecule, called Guide RNA (gRNA), whose function is to proceed to the target cells so that the problematic genetic sequence can be “cut open.” This cutting is performed by the enzyme CAS9, and once this happens the problematic DNA sequence is either replaced or edited to reflect the proper sequence. This entire process has been described as a “genetic cut and paste system.”
To be clear, there are other documented cases of medical treatments involving CRISPR. Examples include a European treatment for beta thalassemia, another genetic blood disorder that involves an inability to produce the proper amount of hemoglobin. CRISPR is also beginning to be used on cancer patients and subjects with inherited blindness. Then there was the controversial case of the Chinese doctor who used CRISPR on embryos to ensure that two twins would be born with a resistance to AIDS. In all cases, CRISPR is being trumpeted as a technology that can potentially rid the world of its most terrible diseases. Painful diseases. Diseases that erode the quality of life to the point where people may opt for death. And all this makes sense! If we know the DNA sequence and the errors to that sequence that cause any of these diseases, and if a fix is a known process away, then isn’t it our moral prerogative to develop and use technologies that could fix the problems?
But let’s be clear. CRISPR is altering the genetic code with which people have been born or will be born. Let that sink in.
I have been having the CRISPR conversation off and on for some time now. My brother-in-law, Dr. Ben Brammell, has made a career teaching biology to university students, and his research involves genetics. In his mind, it’s our moral obligation to responsibly develop and utilize technologies like CRISPR to fight some of humanity’s most dreaded disorders. He also wonders if there be a time when it’s immoral to not use such technologies. My roommate from college, Dr. Kyle Anderson is a dermatologist, and he agrees. He confessed to me that when one sees the effects of certain genetic disorders your perspective is forever altered.
But where’s the line? Again, CRISPR is altering one’s genetic code. At what point does a noble effort become something else?
I think the conversation can get some traction by making a distinction between healing and enhancement. Kyle suggested this, and while it’s a bit hard to define, I think it’s a promising starting point. Are we altering one’s genetic code to heal them from a known disorder that is undermining that person’s quality of life? Or, are we altering the code merely to enhance normal capabilities or qualities? Nevertheless, in the case of the former question, how do you define “quality of life”? And what exactly are “normal capabilities or qualities”? It’s potentially maddening, and the details need to be worked out. However, humanity, who has fallen so far from the intentions of creation, will undoubtedly push the envelope. There will be those who will lack any moral compass and seek unfettered usage for gene editing technologies. Yet the technology is upon us, and so the Church must develop a coherent response. It must respond to a contemporary issue that goes well beyond the plain sense of Scripture.
Historically, Christians have been deeply involved in cutting edge scientific research. From Isaac Newton, to Robert Boyle, to Stephen Hales, to William Dallinger, to George Washington Carver, and many more, many self-professing Christians have synthesized their scientific endeavors with the pursuit of knowing God. More recently, and perhaps most famously, Francis Collins, the current head of the National Institutes of Health (NIH), has offered a systematic account of how his work with the human genome has deepened his faith in ways that he could not have predicted.2 And specific to the discussion of CRISPR, Collins has been involved with a study on Type 2 Diabetes in Africa that has utilized CRISPR in their research.3 In one statement reflecting upon the diabetes study he is receptive to the role CRISPR is playing, but Collins has also sternly rebuked the Chinese doctor who used the CRISPR technology to edit the embryos of a set of Chinese twins—calling it deeply concerning and irresponsible.4 For Collins, then, CRISPR is something that can be wielded positively or negatively.
So, it seems that my roommate Kyle is in tune with the larger medical community when he suggested that we should be ready from some “tight regulations.” But what’s potentially fascinating is the role that ethicists will play in shaping the debate and the regulations that will follow. Remember the NPR story I mentioned above? At one point, it quotes Dr. Laurie Zoloth. She is a bioethicist who has two degrees from Graduate Theological Union (Berkley, CA) and a background in religious studies. In other words, theology and religion have a role, and will continue to have a role, in this discussion.
The hardest part of this conversation, particularly for our tradition, will be the realization that engaging it requires movement beyond the plain sense of the biblical text. Simply, the ethics of modern scientific research require a cognitive framework that would have been inconceivable to the original authors. Genes, enzymes, genetic mutations—all of it—would have been completely foreign to the original authors of Scripture. Consequently, we must construct paradigms rooted in the text of Scripture but malleable enough to address specific developments well beyond Scripture’s ancient frame of reference. Indeed, Jeremiah recounts the Lord knew him before birth (Jer 1:5). However, this is a statement on Jeremiah’s election as a prophet, not his genetic code. The Psalmist does declare in Ps 139:13–14 that he was made by the Creator with a reverent intentionality. However, these statements are in the context of a song that praises God for his omniscience and omnipotence. Again, it’s not a specific comment on humanity’s genetics.
Perhaps, then, elements of the Wisdom and Prophetic corpora offer potential insight. Job, the author of Ecclesiastes, and Habakkuk (as examples) push God to reveal his intentions surrounding their experiences. Does this push for insight have anything to say about how we can push for insight regarding all facets of the human experience? How do the general moral imperatives to tend to the disenfranchised and vulnerable mentioned throughout Scripture implore us to pursue the betterment of life and deal with diseases that have a high mortality rate among the young and elderly? Do the Church Fathers, who used Scripture to comment on many experiences beyond the purview of the original authors, provide any insight on how to go beyond the plain sense of Scripture? Hopefully you get my point.
I suspect that answers to the questions of the CRISPR debate will not come from any proof text, but rather from passages off the beaten path and resources not normally consulted. Answers will come from the essence of Scripture’s Canonical message and the worldview that’s derived from it. But if we can find these answers, we will demonstrate what intelligent, biblically grounded discourse looks like and potentially shape a critical debate moving forward.
David B. Schreiner, Summer 2019
Assistant Professor of Old Testament at Wesley Biblical Seminary | firstname.lastname@example.org
2 Francis S. Collins. The Language of God (New York: Free Press, 2006).
3 For Collins’ reflections, https://directorsblog.nih.gov/tag/diabetes/. For the study, https://www.nature.com/articles/s41467-019-10967-7.