January 31, 2020
Thanks to Alissa Simon, HMU Tutor, for today’s post.
“Genome engineered plants and animals are happening right now. And this puts in front of all of us a huge responsibility to consider carefully both the unintended consequences as well as the intended impacts of a scientific breakthrough.” – Jennifer Duodna, TED Talk
In January’s Quarterly Discussion, we looked at The Law by Hippocrates and also some videos and an article by Jennifer Duodna, co-creator of the CRISPR-Cas9. The Law (as translated by Francis Adams ) ends with: “Those things which are sacred, are to be imparted only to sacred persons; and it is not lawful to import them to the profane until they have been initiated in the mysteries of the science.” I think that this single line began my interest in combining it with gene-editing. While our conversation barely scratched the surface of gene-editing, what it is and its future capabilities, we did look thoroughly at The Law and what it means to be a sacred person. What follows are a few comments on some insights gained during this discussion.
First, sometimes discussions cover a great amount of material. However, this conversation focused primarily on two short texts: The Law, and an article by Jennifer Duodna. There is great pleasure in walking through something slowly to see it from another’s perspective, and I truly enjoyed the comments regarding The Law, which took up half the discussion. Though short, there is much to learn from this piece. For one, Hippocrates notes that society had no punishment for physician’s behavior “except disgrace.” He laments the many schemers who pretend, but in truth have no real skill, education or desire to cure: “physicians are many in title but very few in reality.” For whatever reason society did not yet value physicians, at least not in the way that contemporary society does. It also demonstrates Hippocrates’s desire for standards in what he terms the most noble art.
The difference between a science and an art is really interesting in light of these two pieces. For Hippocrates, surgeons gain scientific knowledge which requires a degree of art in order to practice medicine. He asks that students study the medicine (the science), but they also need time to contemplate, as well as a love of labor (the art is in the application). A surgeon becomes an artist in his practice only after careful, thoughtful consideration of problems combined with the education to create viable solutions. Hippocrates asks that a surgeon be educated, certainly, but more than that. He asks that a physician use their knowledge to serve and care for others, a noble art indeed.
Duodna never imagined the popularity of her lab experiment. Very quickly, however, her correspondence with other scientists who were using her invention led her to ask for a pause in applications of CRISPR-Cas9. In a 2015 article in Nature, she writes about her excitement at the success of the initial experiments. And yet, as she realized the immense potential of gene-editing, she became increasingly unsettled by ethical questions. In the few years after her invention became public, she traveled all over in hopes of discussing the ethics of such a powerful tool. She writes,
“Since the Napa meeting, I have given more than 60 talks about CRISPR–Cas9 — at schools, universities and companies, and at some two dozen conferences across the United States, Europe and Asia. I have spoken about it before the US Congress; talked to staff members at the White House Office of Science and Technology Policy, which provides science advice to the US president; and answered questions from the governor of California, among many others. These discussions have pushed me far outside my scientific comfort zone.
”I am a biochemist; I haven’t worked with animals, human subjects or human tissues, and there was a lot that I didn’t know about the ethical difficulties inherent in other areas of research such as cloning, stem cells and in vitro fertilization. I have relied on the generosity of colleagues who have helped to educate me — about how experiments involving human subjects or tissues are regulated in different countries, for example, and how ethical difficulties stemming from in vitro fertilization have been handled historically.”
Historically speaking, Duodna has been used to the lab, to designing and contemplating projects and problems, to understanding scientific principles and testing their capabilities. Now, however, her doubts, fears, and contemplative side compels action in an ethical arena. To me, this time spent in contemplation is one key feature of an art and I find it highly relevant that certain practitioners develop these skills.
According to Mortimer Adler, the great idea of Art requires time and contemplation. The Syntopicon explains: “The fine arts and the speculative sciences complete human life. They are not necessary – except perhaps for the good life. They are the dedication of human leisure and its best fruit. The leisure without which they neither could come into being nor prosper is found for man and fostered by the work of the useful arts. Aristotle tells us that is ‘why the mathematical arts were founded in Egypt; for there the priestly caste was allowed to be at leisure.’” Leisure here does not mean time spent at the beach reading romance novels, but rather time spent considering a problem. Leisure has more to do with thought experiments than with relaxation. Therefore, artists use leisure to contemplate problems, as do both Hippocrates and Duodna. It is interesting to note that in both cases, ethical questions arose which caused the practitioner to pause. It leads me to believe that perhaps ethics is an element in the art of a practice, and that understanding the complexity and gravity of ethical questions is what makes one a sacred person.
I would suggest that everyone would benefit from time spent in such “leisurely” contemplation. From this discussion, I am particularly excited (in both the positive and negative sense of the word) about gene-editing. The capabilities are massive, intense, and potentially life-altering for nearly everyone. If you missed the January Quarterly Discussion, I encourage you to spend time contemplating the sacred elements of Hippocrates’s Law and the ethical questions of gene-editing. The links below will help get you started!
Hippocrates, The Law, and what it means to practice medicine:
Jennifer Duodna’s Nature article about rising ethical questions of gene-editing:
Jennifer Duodna’s TED talk in which she asks for a moratorium on certain types of research until we better understand the consequences.
Unnatural Selection: a docuseries about gene editing:
To leave a comment, click on the title of this post and scroll down.