Tuesday, Nov. 27, 2018

Part I

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As scientist claims first babies have been born using gene-editing technology CRISPR, the ethical implications are massive

Some headlines come with a sense of inevitability, others come after long expectation, some simply almost explode as if they’ve come from nowhere. An ominous kind of headline, as emerged yesterday, when it was announced in Hong Kong that the world’s first human CRISPR gene-edited baby had been born in China. Ed Yong for The Atlantic reported the story this way, “Last year, Jennifer Doudna, one of the pioneers of the gene-editing technique known as CRISPR said, ‘I’ve mentally prepared myself for the day when I open my inbox or answer my phone and realize that somebody’s going to be announcing the first CRISPR baby.’” Then The Atlantic says, “That day was yesterday.”

Indeed, it was. It was yesterday that the announcement of the first CRISPR baby was made, it was made at a conference in Hong Kong, a conference specifically called to address the ethical issues involved in the new gene editing technologies. The headline in The Atlantic was very clear, as was the words from reported Ed Yong, as similar language came from George Church, long one of the proponents of the CRISPR technology, which we should remember has existed only since 2012. George Church has been an apologist for continuing this kind of research, he said “I’ve been in contact with the team and have seen the data, the sequencing essays used are generally unambiguous, especially when done in multiple cell types at different developmental stages and in two children.” All that scientific language was to precede the words, “Is the genie really out of the bottle?” And his answer? “Yes.”

The story was broken by The Associated Press early on Monday. Marilynn Marchione was the reporter. She tells us, and I quote, “A Chinese researcher claims that he helped make the world’s first genetically edited babies, twin girls, born this month whose DNA he said he altered with a powerful new tool capable of re-writing the very blueprint of life. If true …” says The Associated Press, “… it would be a profound leap of science and ethics.” Well, it turns out that it appears the story is true. And what’s also true is the moral verdict made in The Associated Press release. Indeed, this does represent a profound leap of science and ethics. The AP story continued, “A US scientist said he took part in the work in China but this kind of gene editing is banned in the United States because the DNA changes can pass to future generations and it risks harming other genes.” The next sentence, “Many mainstream scientists think it’s too unsafe to try, and some denounce the Chinese report as human experimentation.”

Now let’s be clear about this, there is no question that what is happening here is human experimentation, there’s no other language for it. We’re talking about this kind of gene editing experiment that has now been extended not only with human embryos but actually to two human twins, twin girls in China, whose DNA, whose gene sequence has been altered in order to achieve what has been promised here as a kind of medical goal. But what we need to note is that, indeed, as The Associated Press reports, this kind of experimentation would be illegal, it would be forbidden in the United States, precisely because it has massive ethical ramifications. And also, the most important thing to keep in mind is that this is not merely altering the genes of an individual. By this technology, the entire heritable gene sequence is going to be affected for all future generations coming from these two now edited twin girls.

You heard that Associated Press report announced that some scientists, “Denounced the Chinese report as human experimentation.” Over the course of the day yesterday and through the night, the word denounce, it was basically materialized, realized over and over again. There was a sense of immediate scientific judgment which was, in essence, a moral judgment that this Chinese researcher had acted irresponsibly. The researcher in China, He Jiankui, who made the announcement on Monday, understood that there would be ethical criticism. He said that he had altered the embryos for seven couples during fertility treatments with one pregnancy resulting thus far. “He said his goal …” says The Associated Press, “… was not to cure or prevent an inherited disease but to try to bestow a trait that few people naturally have, an ability to resist possible future infection with HIV which is the AIDS virus.”

The story is actually more convoluted than that because the sperm cells in this particular set of twins was taken from a father who had already been infected with HIV. But what was intended was a kind of genetic protection for these girls and for their heirs from developing, if not an immunity against HIV, then a kind of immunity that would minimize the physical effects of the virus. But here you see something that is fundamental to the entire moral question which is at stake. How do you balance the opportunity for gain over against the thread of loss? How do you make that kind of evaluation? Here’s where you also need to notice something else, even as there has been mainstream scientific revulsion at the announcement coming from Hong Kong, we need to note that much of this is not actually over the fact that the experiment was done, that would come from a Christian worldview perspective, but rather from the perspective that the scientific experiment that was announced on Monday wasn’t done under the right authority, under the right circumstances, in the right context and by the right scientist.

George Church, that Harvard biologist and genetics pioneer who was quoted in the report from STAT, is himself a proponent of this kind of research, even the inevitability of this kind of technology, but when he said, is the genie really out of the bottle and answered his own question with yes, it’s hard to tell if he thought, at least according to this press release, that it was a good thing or a bad thing. This is where Christians need to understand the vast biblical worldview issues that are stake. We are talking about the very nature of humanity. For at least several decades now, going back to the genetic revolution that began especially in the 1950s and ’60s, came to full bloom in the ’70s and ’80s and then into technology in more recent decades, there has been an understanding amongst thoughtful Christians that what we are talking about here is not just a medical treatment. It is not just a new medical or bio-medical technology. It is, in essence, a re-definition of what it means to be human. It’s a re-definition that comes in at least three different ways.

First there is the genetic re-definition of what it means to be human. We are talking here about using this new CRISPR technology to alter the human biological germ line. That’s the basic genetic structure of every single human being. The second way this represents a huge re-definition is in the authority of human beings to affect their own genetic identity. That has been throughout almost all of human history, no it’s been throughout all of human history a given. It has not been an open question. The rise of this kind of technology then leads to that very pressing question that was answered to some extent yesterday in Hong Kong. If this kind of technology is used, how does it put in the hands of human beings the authority to re-define ourselves genetically?

The third big issue of re-definition that comes along is more subtle, it is theological. It is the fact that missing from the entire background of the discussion in the mainstream media is any consideration that human beings might be anything more than essentially biological. If you read the press reports it appears that this is a biological revolution that is leading to a new medical technology that could lead to a brave new future for human beings. But that’s entirely a biological future. This is a reflection of the kind of biological reductionism that affects so much of the secular worldview, to the extent we should know, that it’s not even acknowledged that there might be some other answer to the question, what does it mean to be human?

If you put together the mainstream media responses to the news story, it’s clear. For example, looking at Carolyn Y Johnson’s report in the Washington Post, that there has been an uproar. But again, much of the uproar is about the who, the what, the when and the where, not the basic use of this CRISPR technology and even the basic use of this technology when it comes to human subjects. What has happened in China is indeed causing an uproar for many reasons, at least some of them have to do with the fact that the scientist behind this is actually a physicist. Now that’s something of a concern because we’re talking about someone operating outside the kind of peer reviewed science that is the very pride and the privilege of the Western scientific establishment.

It also points to the fact that there is a very deep worldview divide between East and West here. That’s not an accident. In the United States, there is almost an unrestricted availability of many kinds of modern medical technologies, but not when it comes to the use of these germ line technologies, these germ line therapies such as CRISPR. But here, and with the background issue of the larger question of human cloning, we see something that is illegal in Europe and illegal in North America that is not only apparently legal but it probably happening with cultural in-state support in a nation like China. Now that might be explained by two different economic and political systems, that we as Christians know, is actually explained by a very deeper question, and that is what is the basic worldview? What is the basic theological disposition behind these two different civilization answers?

There are other big questions to be asked related to this announcement that came Monday in Hong Kong. There appears to be a growing consensus that the experiment actually did happen, that the CRISPR technology was used on these two twin girls, but there are huge questions about whether or not this germ therapy was actually even effective at the stated aims. And, as several scientific authorities had noted, by almost any ethical measure, even accepting the fact that CRISPR might be used and might be justified under certain conditions, when you look at this particular case, the risk to the babies appears to be far higher, even in the judgment of the secular scientific community, than whatever perceived benefit might have come from the therapy. But we need to notice, as Christians, something else. It is the argument of technological and scientific inevitability.

We hear this over and over and over again. For example, we’ve heard some North American and European scientists complain about the restrictions on this research here saying, “If we don’t do it and if we don’t do it the way it should be done, then it’s going to happen first elsewhere and it might be done in different terms.” That’s exactly what the new from Hong Kong announces. Yes, it has been done outside the scientific supervision, the political and government supervision in the United States and in Europe, it has been done where there were warnings it would likely first be done. But notice the argument, we need to do it because we need to be first. If we’re first, we’ll do it right. But notice that that is simply an argument that falls apart once you come to understand that, behind it, is simply an understanding of scientific inevitability. And we understand the pull of that argument. It is going to happen somewhere, but that inevitability does not come with the moral message that many North American and European researchers claim. That doesn’t justify our going ahead just because someone else is going to go ahead.

A final thought on this story, that headline in the article in The Atlantic was this, “A reckless and needless use of gene editing on human embryos.” That makes a moral verdict, but notice what’s absent in that moral verdict. Again the words, a reckless and needless use of gene editing on human embryos. What’s the problem here? Well, just consider how the headline might have been different. What if The Atlantic headline had been, a justified and necessary use of gene editing on human embryos. The problem is that our modern, secular worldview lacks any intellectual ammunition to avoid that headline coming in some day ahead.

Part II

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Why having absolute access to what we ‘want’ will never lead us to a new heaven of our own making

But next, we have to look at a development here in the United States. In this case, it is an editorial development with massive worldview and moral significance. Sunday’s edition of the New York Times included an opinion piece, a first-person piece with a headline, “Surgery, hormones but not happiness.” The author of the article is a man who is going to be undergoing what is defined as sex reassignment or gender reassignment surgery. The person is identified as Andrea Long Chu and the article begins with the announcement that this individual is, this week, going to undergo a surgical procedure for this gender or sexual reassignment.

What’s interesting in the first place is that I have before me both the print and the online editions of this article. It’s telling that on The Briefing I cannot, and don’t worry, I will not read the online headline. It’s just too sexually and biologically graphic. The headline in the print addition, again, “Surgery, hormones but not happiness.”

Within the article, the writer tells us, “This is what I want. But there is no guarantee it will make me happier. In fact, I don’t expect it to. That shouldn’t disqualify me from getting it.” Now, with incredible insight, this man writes about two different moral responses to the announcement that he is going to be undergoing this kind of gender reassignment surgery. “Many conservatives call this crazy. A popular right-wing narrative holds that gender dysphoria is a clinical delusion, hence feeding that delusion with hormones and surgeries constitutes a violation of medical ethics.” Just ask the heritage foundation fellow Ryan T. Anderson whose book When Harry Became Sally draws heavily on the work of Dr. Paul McHugh, the psychiatrist who shut down the gender identity clinic at Johns Hopkins in 1979 on the grounds that trans-affirmative care meant co-operating with mental illness. He cites Anderson as saying, “We must avoid adding to the pain experienced by people with gender dysphoria while we present them with alternatives to transitioning.” As the author says, “In this view, it is not only fair to refuse trans people the care they seek, it is also kind.”

But then, very interestingly, the writer tells us about the liberal counter-narrative. That counter-narrative, “… has become increasingly mainstream. Transgender people …” he writes, “… are not deluded, advocates say, but they are suffering. Therefore, medical professionals have a duty to ease that suffering. In this view, dysphoria is more akin to a herniated disk. A source of debilitating but treatable pain.” The writer then cites the statement known as standards of care from the world professional association for transgender health, stating, “Gender dysphoria can in large part be alleviated through treatment.” And then the writer states, “A gender affirmative model will almost certainly lead to more and higher quality care for transgender patients” but he says, “By focusing on minimizing patients pain, it leaves the door open for care to be refused when a doctor or someone playing doctor deems the risk too high.” Well now we’re entering into some very interesting new territory. It’s not entirely new, but it’s new in the pages of The New York Times. What is the bottom line in this article? Well it’s this. Here you have an individual demanding gender reassignment surgery even as acknowledging it might not alleviate pain, it might even lead to greater pain because this particular writer dismisses not only the conservative argument but also the liberal counter-narrative and is now arguing for a medical, ethical principle that this kind of surgery should be available to an individual simply, he says, because the individual wants it.

Now this is a stunning development, because it means the rejection not only of conservative medical advice but also of the most mainstream liberal medical advice. This is the statement, the absolutely Promethean statement, that a simple desire for gender reassignment surgery is all that is necessary. All that matters is that the patient wants it. Even when medical professionals believe that it will lead to medical and psychiatric problems, the demand here is that the patient wants it and thus it must be given. No further questions asked. Very sadly, this writer tells us about the experience of hormone therapy, also what’s called gender affirming to consider the Orwellian language and the patients tells us that he has gone from being less depressed to being more depressed to not being suicidal to now often being suicidal, but the argument is, “I want it nonetheless and thus you must give it to me.”

Chu, the writer gets right to the issue with these words. “As long as transgender medicine retains the alleviation of pain as its benchmark of success, it will reserve for itself with a dictators benevolence the right to withhold care from those who want it. Transgender people have been forced …” says the writer, “… for decades to rely for care on a medical establishment that regards them with both suspicion and condescension. And yet, as things stand today, there is still only one way to obtain hormones and surgery, to pretend that those treatments will make the pain go away.”

There is, in this article, the horrifying realization, the horrifying statement that this surgery and the hormones will not make the pain go away. Indeed there is the acknowledgment that both might lead to an even deeper pain, but then there is the demand, “I want the surgery and thus you must give it to me.” Just in case we missed the point, there comes this sentence, “But I also believe that surgeries only pre-requisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipated or continuing justifies it’s withholding.” That statement, that single short sentence is so important, I repeat it. “I also believe that surgeries only pre-requisite should be a simple demonstration of want.”

Now you might be saying, well, this is after all dealing with a very small percentage of total surgeries. We’re only talking about the very small and very tragic percentage of human beings who will seek this kind of so-called gender re-assignment surgery, but we need to recognize, as is so often the case, this is not where this argument begins, it’s certainly not where it will end. There are surgeons of various kinds of specialties who are presented with patients who do not have any need for the surgery that they want. Indeed, medical authority and medical ethics is held that surgeons should not perform surgery unless it is medically indicated by the fact that the surgery will either save or enhance a human life. Surgeons are not to perform surgery when they believe that it will cause harm. And that includes psychological or psychiatric harm.

Those familiar with this expanding and horrifying world of medical ethics know that there are patients who, for reasons perhaps known only to themselves, show up and demand of a surgeon a mutilation or an amputation. That is of course medically insane. But that then tells us that not only did a horrifying announcement come from Hong Kong on Monday, but a horrifying announcement came from New York City in The New York Times on Sunday. And that was, so far as I know, the first mainstream media publication of the argument that the only issue that matters is want. Seen in that light, we notice what’s absent from that statement. The write said, “I also believe that surgeries only pre-requisite should be a simple demonstration of want.” Notice what’s absent there, any modifier before the word surgery. This is not just an argument for this so-called gender reassignment surgery, simply on the basis of want, it’s an argument for any and every surgery simply on the principle of patient want.

Christians looking at this story understand just how haunting it is. We are looking once again at the re-definition of what it means to be human, reflected in a proposed re-definition of the most basic medical ethics. Even more ominously we understand that the secular worldview has no basic defenses against this kind of argument. That’s why it’s telling that it appeared in The New York Times this past Sunday. It won’t stay in The New York Times any more than it will stay related to this so-called gender reassignment surgery. But as Christians looking at this article and looking at this argument, we also understand the absolute poverty, the absolute insufficiency of the human issues of want, desire and demand. It turns out that we cannot trust ourselves to want, to desire or to demand even what is good for us. That’s one of the most horrifying realizations of the power and the delusion of human sin. We can’t even trust what we want. We have to be prevented sometimes from what we want. If we have absolute access to what we want, we will not be making a new heaven, we will be creating an altogether too horrifying new hell.

But one final note on this story, sometimes when you read an article like this, as much as the most important worldview analysis is pressed upon us, there’s another level of analysis as well. That analysis is simply the realization of heartbreak. There is so much human pain in this article, a virtually unspeakable pain. But there’s also the realization that the human medical establishment, humanity itself, can only respond to this pain with the inadequate. There is no way out of the trap described in this article. That is heartbreaking, but it also heartbreakingly honest.

Part III

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Architectural aesthetics and the Christian worldview: Why we don’t need courthouses that look more like high school hangouts

But finally, Saturday’s edition of the same newspaper, The New York Times, came with a very interesting editorial observation that was written by Jesse Wegman, and Jesse tells us about high school students in New York City who got their day in court. They weren’t in trouble, instead they were in a program intended to bring high school students in to the federal courthouse there in Manhattan in order to learn something about the dignity of the law and perhaps to discover in themselves a desire for a legal career. Wegman writes, “But to the average New York City teenager, the court house, home to the United States court of appeals for the second circuit and the district court for the southern district of New York must come off as less than welcoming. Set back on the open plain of Foley Square, it’s wide sloping staircase rises to a wall of massive Corinthian columns, behind which looms a forbidding 30 story citadel crowned with a pyramid of shimmering gold. A treat …” says Wegman, “… for fans of neo-classical architecture perhaps, but the overall effect is more a glowering fortress than a high school hang out.” Now notice the implication in this article. The implication is, we probably need court houses that look more like high school hangouts than like the temples of justice of that neo-classical age.

Here Christians need to remember that architecture is not by accident and every architecture resides on a worldview, the worldview of that kind of neo-classical architecture found in so many American court houses is the architecture of rational democracy. It is the architecture of formality. Indeed they are temples of justice, but they are temples of justice that belong to the people. They are separate from the monarchial seats of power in the historic empires of Europe. They are, instead, temples of the people’s justice.

Very, very interesting was a statement from Arianna Reyes, a ninth grader who was one of the students at the court house. She said, “I hadn’t ever been to a court, I’ve only seen pictures of it and read about it. I felt like I was kind of small and there was something really big going on.” Well in that respect that ninth grader actually got right to the point. That’s the very intention of that kind of architecture, to point to the individual as being kind of small. But the enterprise that goes on within such a building as being something really, really big. Nothing less than deliberative justice.

When George Washington, the nation’s first president, hired Pierre L’Enfant to design the new nation’s new capital, he told the architect that he was to design wide boulevards with huge buildings of majesty, intended to point to the majesty of democracy. The neo-classical architecture pointed to ancient Greece and Rome. Even those Corinthian columns, in pointing out, this is a long tradition of human beings trying to understand what it means to establish rightful government. There’s a reason why a federal courthouse doesn’t look like a high school hangout. And in this article, it took a high school student, a ninth grader, to understand why.