Genetic Research & Technology
Biblical Basis
Technical & Medical Basis
Pastoral Application
“And the Word became flesh and dwelt among us . . .”
—John 1:14 ESV
Understanding Genetic Research Through Scripture
Biblical Basis
In his essay against the Marcionite heretics, De carne Christi (On the Flesh of Christ), Tertullian of Carthage (ca 155-220 AD), declared, “Let us examine our Lord’s bodily substance, for about His spiritual nature we are all agreed.”
What shall we say of our Lord’s bodily substance? Well, first, that Jesus was embodied from conception in Mary’s uterus. We know the biological fact of embryonic embodiment more vividly than ever today through ultrasound technology, but they knew it in Jesus’s day too. Jesus was born a helpless baby who longed to be held against his mother’s body, skin-to-skin. Jesus was limited in time and place—in his earliest days in a cattle stall in Bethlehem. Jesus had human epidermis, a human vascular system, and human cardiac function with human blood pressure and pulse.
Christ’s body was not a generic body, but a particular body belonging to a particular mother, particular family history, particular people group, particular culture, particular tradition, and other particularities. He had a particular human DNA.
Christ’s body was an earthly body, “born of woman, born under the law” (Gal. 4:4), vulnerable to the challenges of infancy, injury, insults, powers of Rome, and death on a cross, just as any other human.
Jesus worked with his hands, human hands. Jesus cut himself, got splinters, and bled human blood. He sweated, human sweat, and got tired over time. He got hungry. He needed sleep. He went fishing. He experienced puberty. He grew facial hair and began to smell like other teenage boys, human teenage boys. He had bad breath, human bad breath.
Surely this is at least part of what St. John means when he exclaims, “And the Word became flesh and dwelt among us . . .” (John 1:14) and why in the same gospel accounts the people questioned his deity asking, “is not this Jesus, the son of Joseph, whose father and mother we know?” (John 6:42).
In his incarnation, Jesus revealed in palpable form the sacred nature of the human body. We have been made in the image of God (Genesis 1:26-28) and that includes the gift of embodiment. So St. Cyril of Jerusalem (313-386) can say in his Catechetical Homilies, “Let no one tell you that this body of ours is a stranger to God.”
The Documentary Foundations of the Anglican Church—The Thirty-Nine Articles, the Apostles’ Creed, the Nicene Creed, and the Athanasian Creed—all affirm without equivocation that “The Son, which is the Word of the Father, begotten from everlasting of the Father, the very and eternal God, and of one substance with the Father, took Man’s nature in the womb of the blessed Virgin, of her substance; so that two whole and perfect Natures, that is to say, the Godhead and Manhood, were joined together, never to be divided, whereof is one Christ, very God, and very Man . . .” (The Thirty-Nine Articles of Religion of 1571, Book of Common Prayer, 2019, p. 772).
This same Jesus “went throughout all Galilee, teaching in their synagogues and proclaiming the gospel of the kingdom and healing every disease and every affliction among the people” (Matt. 4:23; 9:35). Luke, the physician, testifies that one day “when the sun was setting, all those who had any who were sick with various diseases brought them to him, and he laid his hands on every one of them and healed them . . .” (Luke 4:40-41). In the same way as Jesus was motivated by compassion (Matt. 9:35-38; Mark 1:40-42) and brought healing to those who were suffering physical and spiritual ailments, we have warrant to use the art and science of medicine to bring healing to those who are suffering, including those who are suffering from inheritable genetic conditions.
Where is God in Human Genetics?
Although the writers of the Old and New Testaments did not envision a scientific project like the Human Genome Project, the omniscient God who inspired them certainly foreknew and gave humans the capacity for such knowledge. All truth belongs to God and is ultimately given to us for his glory and for our good. Scripture teaches that there are both good uses and evil uses of the knowledge God reveals or enables us to discover and our responsibility as stewards of this knowledge is to seek to use it in ways that will glorify God and bring good to humanity.
First, we must begin where the Bible begins—at creation. Human beings, like all of the universe, are the result of the creative activity of the Triune God. “In the beginning God created the heavens and the earth,” declares Genesis 1:1. The doctrine of creation is the foundation of the Christian theistic world view. Christians may not agree about or fully understand all of the particulars, but we begin with the presupposition that the universe, including human life, is not the result of random events, the luck of the draw, or blind chance, but the intentional action of an all-powerful, loving God. As the Nicene Creed affirms, “We believe in one God, the Father, the Almighty, maker of heaven and earth, of all that is, visible and invisible.”
Second, the Genesis account reveals that Adam and Eve, and all their progeny, were created in the image and likeness of God (Genesis 1:27). The human genome is, therefore, not only biologically unique, but spiritually (or metaphysically) unique. Human life has been invested by God with sacred value. Just as some ways of treating human lives are clearly unethical and immoral, some ways of treating the most basic biological building blocks of human life are unethical and immoral.
Third, the Scriptures declare that when Adam and Eve sinned in the garden of Eden, something tragic happened to the whole created order (Genesis 3:17-21; Romans 6:12). Though theologians characterize differently the results of the Fall, it is obvious to anyone who is observant that something is tragically awry in the world. Sin has brought with it suffering, disease, and death. Not only that, but the fact that we human beings are sinners means we often find ways to use good things for evil purposes.
Since disease is ultimately the result of the corruption of the world through sin, it is critical that we understand that genetics will not be a new messiah to redeem us from all bodily, mental, or spiritual ills. Reducing the human predicament to “bad genes” is tantamount to making the genetics into another utopian vision. That is not to say we ought not use genetic technology for the purposes of curing human disease where possible, but we must do so within the boundaries of clear ethical guidelines.
Fourth, what we are already able to accomplish through genetics is simply phenomenal. But genetic technology can be used as a potent weapon, as a means of eliminating the “unwanted” or “non-useful” or persons who are living “lives not worth living,” to echo a phrase used to justify the destruction of lives in Nazi Germany. Genetic information may be used as a method of high-tech discrimination against persons based on their genomic characteristics. For instance, in the 1970s mandatory sickle-cell screening among African-American children became a method of discriminating against black children because they were merely carriers of the sickle-cell trait. Today, genetic screening is even used in some cases for sex-selection.
Fifth, and more optimistically, we must acknowledge that all of God’s creation, especially we humans, are “fearfully and wonderfully made” (Psalm 139:14). Efforts better to understand the human body, the disease process, and the ways to fight those diseases should, all things being equal, be celebrated and encouraged. Discovering more about the profound complexity of the human body, mind, soul, and spirit points to the reality of the Creator and gives believers more cause to praise and worship him joyously. That our great God has permitted us to discover ways to relieve physical human suffering, save lives, and cure diseases is certainly a manifestation of his grace and mercy. Every good and perfect gift comes from God (James 1:17). That fact makes it imperative that we not misuse or squander the gifts He gives, including the gift of genetic technology.
Finally, we must face squarely the limits of the new genetics and not think more highly of it than it deserves. Genetics will not ultimately save us from death and the grave. Human beings have an “illness” that permeates us more completely and is unquantifiably more deadly than any genetic disease. Our predisposition to sin is a result of who we are as fallen creatures. If left “untreated” that fallenness will result in an eternity without hope and without God. The remedy for our sin is new life in Jesus Christ. He alone is Messiah. He alone is the Great Physician. Ultimately, in him, we will be cured of every disease, even our bent toward sinning. Soli Deo Gloria!
Jesus worked with his hands, human hands. Jesus cut himself, got splinters, and bled human blood. He sweated, human sweat, and got tired over time. He got hungry. He needed sleep. He went fishing. He experienced puberty. He grew facial hair and began to smell like other teenage boys, human teenage boys. He had bad breath, human bad breath.
Technical & Medical Basis
Genetic Research from a medical and technical perspective
Most of us are aware of the power of our genes. Eye color, hair color, and many other physical characteristics are linked to our genes. Genetic factors also have been linked to a host of major health problems and birth defects. Conditions such as cystic fibrosis, Duchenne’s muscular dystrophy, Down syndrome, Huntington’s chorea, Alzheimer’s disease, diabetes, cancer, and perhaps some forms of mental illness, may be traced to our genes.
Genetic science is not entirely new. Farmers have used animal husbandry and agricultural means of altering animals and plants for millennia. In Genesis 30:37-39 we find the story of Jacob using additives to a watering trough to encourage the mating of sheep who would pass along heritable traits. The 19th century’s Austrian monk and plant scientist Gregor Mendel is called “the father of modern genetics” because of his work with the genetic analysis and manipulation of pea plants and their heredity.
More recently, in 1990, the National Institutes of Health (NIH) and the Department of Energy (DOE) officially began a jointly sponsored initiative known as the Human Genome Project (HGP). The HGP was a massive, 15-year “Big Science” project that had one of its goals to identify the sequence of the more than 3 billion base pairs of DNA that together form the complete human genetic blueprint. This genetic blueprint is known as a “genome.” There is a mouse genome, a plant genome, and a human genome. All living organisms have their own genome.
CRISPR
In 2012, another transformative development in genetic science made headlines. Jennifer Doudna and Emmanuelle Charpentier and their colleagues published a paper in the journal, Science, announcing a new technology known as CRISPR-Cas9. They later received the Nobel Prize for chemistry for their work. CRISPR is an acronym for Clustered Regularly-Interspaced Short Palindromic Repeats.
Unlike earlier methods of genetic modification, CRISPR makes it potentially possible to target and alter DNA anywhere in the genome. It is simpler, faster, and more versatile than previous methods.
The hope of being able to offer treatments and cures for genetically linked illnesses is a wonderful prospect. The relief of human suffering and the promise of restoring health to those persons who are debilitated and die from these diseases is a sufficient reason to endorse the project, generally speaking. Indeed, we should applaud and encourage scientists in their war against genetic illnesses. Yet, as with nearly every other medical technology, there are challenges.
For women, reproductive health conditions include endometriosis, adenomyosis, polycystic ovary syndrome (PCOS), blocked fallopian tubes, uterine fibroids, hormonal imbalances, body fat percentages (either too high or too low), and other lifestyle factors.
For men, reproductive health conditions include low sperm count, low sperm motility, erectile dysfunction, and diet, lifestyle, and environmental factors.
While it is common to think of infertility as a “woman’s problem,” men and women on the whole bear the burden of infertility equally, with one-third of cases due to women, one-third due to men, and the remaining one-third due to combined causes.
Studies estimate that a couples’ diagnosis of infertility results from four or more reproductive health conditions, underscoring the need for comprehensive diagnostic approaches. Indeed, there is no one-size-fits-all solution to infertility.
Challenges with Genetic Information
One challenge of genetic knowledge is knowing what to do with that information. For the foreseeable future we will face what is called the diagnosis/therapy gap. That is, we will be able to identify more genetic markers for disease conditions than we have therapies to treat. The limbo between knowing one has a potentially heritable condition without the ability to do anything about it can be debilitating emotionally.
Or, take the potential of false positive diagnosis. Women diagnosed with one of the genes associated with some forms of breast cancer, BRCA-1 or BRCA-2, sometimes undergo prophylactic mastectomy because of their fear of getting cancer. In some cases, there was either misdiagnosis or misunderstanding of the meaning of the tests. The result is that some women experience unnecessary physical and psychological trauma associated with mastectomy. On the other hand, many women have doubtless dodged breast cancer by having the procedure. So, knowing how to assess the benefits and harms of genetic intervention requires great wisdom.
Ways of Manipulating Human Genes
Somatic Cell Gene Therapy
In normal biological procreation, genetic material from human sperm and egg combine to generate at least one genetically unique member of the human species (twinning is possible). This genetically unique person has two types of cells in his or her body: germ cells and somatic cells. The somatic, or body cells, are unique to that individual and are not passed from one generation to the next. Skin cells are an example. Skin cells produce other skin cells and only in that person’s body, of course. Somatic cell gene therapies have the potential to treat and cure inherited disorders like cystic fibrosis, hemophilia, and sickle cell disease.
The first human somatic cell gene therapy trial took place in 1990 and involved two young girls, 4 and 9 years old, with severe combined immune deficiency (SCID) a rare, inherited immune-system disorder. By introducing healthy genes into the somatic cells of the girls, their cells accepted the healthy genes, improving their immune response. Both girls are doing well today, though they continue to receive conventional therapy for SCID and their quality of life has improved.
Not every effort to offer somatic cell gene therapy has been as successful, however. In 1999, Jesse Gelsinger, an 18-year-old boy with a rare metabolic disorder experienced serious complications after receiving gene therapy, including blood clotting and multiple organ failure. Jesse passed away within four days of the trial, and his death was the first to be directly attributed directly to gene therapy.
As with any other novel medical treatment, careful ethical reflection must attend the experimental development of therapeutic genetic interventions.
Germ Cell Gene Manipulation
Research is also being done on germ cell or reproductive cell manipulation. Germ cells are sperm and egg. Human germline manipulation is highly controversial and currently banned in over 70 countries, including in the United States.
Germ cell manipulation is controversial, first, because of its potentially deleterious effects on future generations. Since any genetic modifications in the sperm or egg will be passed to the next generation, what if the modification results not in healing but in harm? What if in the effort to treat a genetic anomaly, the manipulation introduces another equally challenging anomaly, or worse, a lethal genetic condition that would be passed to the next generation? For example, the same gene associated with sickle cell trait also protects against malaria. If someone were to “knock-out” the sickle cell gene, they would at the same time make a person more susceptible to malaria. In this case, instead of healing, the intervention may exacerbate the harm.
Furthermore, once the deleterious gene has been introduced, it is unclear how one would ethically prevent that person from passing the gene on to his or her offspring. Mandatory sterilization would not be justified, not least because they themselves did not consent to the modification.
Another reason germ cell manipulation is controversial is because of its eugenic potential. “Eugenics” is a compound word from two Greek words meaning “good” and “genes.” The Western eugenics movement began at the turn of the twentieth century in England and the United States. In the pursuit of good health, we have begun to tread a fine line in “human selection.” We often choose to rule out certain diseases by eliminating certain human beings with those diseases.
Through pre-implantation genetic diagnosis (PGD), genetic anomalies like Tay-Sachs, Duchennes Muscular Dystrophy, or Down Syndrome may be identified. There is no treatment or cure for these conditions. The only decision is whether or not to carry the child with one of these conditions to term. Iceland, for instance, claims to have nearly eliminated Down Syndrome when, in fact, through prenatal testing, pre-implantation genetic diagnosis, and abortion, they have killed those who are diagnosed with the condition. The decision to abort because a child does not have “good genes” is often a tragic example of our culture’s discrimination against persons with disabilities and a reflection of a eugenic mindset.
PGD may also be used in combination with in vitro fertilization to select embryos for transfer to a woman’s uterus. Embryos with “good genes” could be transferred, embryos with “bad genes” would not. Those embryos who do not meet the “quality control standards” would eventually be discarded. Because human embryos are living members of the human species and imagers of God, the destruction of human embryos is ethically unjustifiable.
In the pursuit of good health, we have begun to tread a fine line in “human selection.” We often choose to rule out certain diseases or, more accurately, certain human beings with those diseases.
Clearly, it is a proper and meaningful desire to want to prevent fatal and debilitating diseases. Yet in pursuing this goal, we pay unobserved costs. In eliminating individuals with unwanted diseases, we also contribute to a mind-set that justifies the process of human selection. We forgo the idea of other therapeutic interventions (i.e., dietary changes or other forms of treatment) and opt instead for elimination. Individuals, then, are seen as flawed. It is easier to prevent their existence than to work for their survival.
Genetic Enhancement
Unhappy with the limitations of the human body some believe the role of medicine is not only to heal and care but also to enhance human capabilities. The same technologies, like CRISPR, that may be used for genetic therapy might be employed in an effort to make “better humans.”
Genetic enhancement refers to the aim of augmenting the human genome in such a way as either to enhance one person’s species-typical capacities and abilities or to enhance the entire species. Scientists might, for instance, manipulate the human genetic material in germ cells—sperm and egg. We know, for example, that a cleft chin is a single-gene dominant trait passed from one generation to another through normal procreation. That gene could potentially be “turned off” in the germ cell so that trait would stop being expressed at some point in a family line. But why? Purely cosmetic reasons do not seem worthy of altering the genetic legacy of a family line. And there does not seem to be any pathology associated with a cleft chin. Likewise, any gene for a desirable trait could be “turned on” in the germ cells so that trait would more reliably occur in the next generation. “Desirable” is the key term. Why is it desirable to alter this or that gene? Whose values make one trait desirable and another undesirable?
Similarly, any effort to use genetic modification to increase human intelligence or significantly extend human life-span is driven by certain values about the role of science and the meaning of human life and its limitations. For Christians, those values must be consistent with those of the God who has made us.
Pastoral Application
Even though genetic diagnosis and treatment are suffused with sometimes unfamiliar medical jargon, the care of souls is not markedly different than with other medical conditions and procedures. Helping parishioners navigate the sometimes murky waters of diagnosis and therapy can be a blessed part of shepherding God’s flock. Several reminders can help the church as we move forward.
- We are more than our DNA—Our culture’s implicit materialism tends to reduce the human condition to our biology, including our DNA. This sort of reductionism tempts us to see human beings as merely the sum of their genetic parts. But we are body/soul, material/immaterial creatures made in God’s image. We are more—much more—than the sum of our genetic parts. Tending to the needs of the whole person is not only the aim of the medical covenant, it is also the aim of faithful pastoral care. Genetic diagnosis and treatment like other medical procedures often provoke confusion, anxiety, and fear about the future.
- Medicine one tool under God’s sovereign care—Although we have a warrant to attempt to develop medical therapies and potential cures, we must ultimately trust the loving, sovereign, and benevolent God for its efficacy. Jesus alone is Savior, not modern medicine. St. John’s gospel includes a powerful reminder of this truth. When Jesus’s disciples encountered a man who was blind from birth, they were tempted to attribute his blindness either to his own sin or to sins his parents might have committed. “Rabbi,” they asked, “who sinned, this man or his parents, that he was born blind?” Jesus replied, “It was not that this man sinned, or his parents, but that the works of God might be displayed in him.” (John 9:1-3).
- Ethical limits should be carefully assessed and followed—Just because we can do something does not mean that we should. Human genetic intervention should only be undertaken when it is consistent with Christian theological anthropology and the goals of ethical medical care. Manipulation of human somatic cells may be done if appropriate medical ethical guidelines are followed (e.g., informed consent). Manipulation of human germ cells is a bridge too far.
- Human limitations are gifts of embodiment, not curses—Although Scripture teaches that disease and death are part of the curse of sin, the ultimate remedy will not come through medicine but through the benefits of Christ’s resurrection that belong to those who are united to him through faith. Other aspects of our humanity are gifts of embodiment, not curses. Just as Jesus’s body was limited by time, location, energy, dependence on others, and the need for rest, for instance, our minds and bodies share those gifts of the body. We should not abhor them but use them as opportunities to steward those goods for the love of God and the love of neighbor as ourselves. Helping parishioners learn to be grateful for these gifts is an important part of pastoral care.
- We will often find ourselves in the diagnosis/therapy gap—For the foreseeable future medicine will be able to identify more potentially debilitating and lethal genetic conditions than it will be able to offer therapies or cures. Helping parishioners trust the sovereign goodness of God in the midst of an unknown future may enable them to face each day with greater peace and joy instead of anxiety and fear.
- Human enhancement is eschatological—A Christian view of the future is informed by a Scriptural eschatology. Human perfection is not attainable in this present life, but because of what Christ has done for us “we believe in the resurrection of the body and the life everlasting” (Apostles’ Creed). Perfection, including the perfection of a resurrection body, is promised to all who are in Christ.