The embryo as a patient
Dr Aniruddha Malpani, MDwww.drmalpani.com
Logical next step in medicine
• Adult• Child• Foetus• Embryo
Precision medicine
• Prevention is better than cure• Treat at the genetic level – at the
root cause of the disease
We’ve come a long way, baby !
From PGS – preimplantation genetic selection to
PGT - preimplantation genetic therapeutics
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 ?
Two views
• Manipulating Nature is dangerous
v/s• Triumph of man's ingenuity
which can be used to overcome Nature's constraints.
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.
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
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 ?
Science Fiction
Different standards
Slippery slope !
Criticism
• Unnatural and artificial - Is nothing sacred ?• Money - Is everything for sale ?
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
• Actions have consequences. • Inactions have consequences
too• Fear of the unknown cannot
paralyse us into inactivity
Dr Frankenstein
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
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 ?
3 principles of medical ethics
• Autonomy• Beneficence• Non-maleficence
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 ?
Human Reproduction v 2.0
• Mother Nature is not always kind - millions of people die of preventable diseases, which we can treat today
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
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
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