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Waltz M, Walker RL, Flatt MA, MacKay D, Conley JM, Juengst ET, Cadigan RJ. Challenging the Boundaries Between Treatment, Prevention, and Enhancement in Human Genome Editing. CRISPR J 2024; 7:180-187. [PMID: 38976494 PMCID: PMC11386990 DOI: 10.1089/crispr.2024.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
Traditional distinctions between treatment and enhancement goals for human genome editing (HGE) have animated oversight considerations, yet these categories have been complicated by the addition of prevention as a possible target for HGE applications. To assess the role these three categories might play in continued HGE governance efforts, we report on interviews with genome editing scientists and governance group members. While some accepted traditional distinctions between treatment and enhancement and rejected the latter as unacceptable, others argued that the concept of enhancement is largely irrelevant or not as morally problematic as suggested. Others described how preventive goals for HGE create gray zones where prevention and enhancement may be difficult to distinguish, which may stymie uses of HGE. We conclude by discussing the governance implications of these various understandings of treatment, prevention, and enhancement as HGE research moves beyond the treatment of serious disease to embrace longer range preventive goals.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rebecca L Walker
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Philosophy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael A Flatt
- Department of Sociology, Cuyahoga Community College, Cleveland, Ohio, USA
| | - Douglas MacKay
- Department of Public Policy and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John M Conley
- School of Law, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric T Juengst
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - R Jean Cadigan
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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2
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Badea AR, Feeney O. Genome Editing Dilemma: Navigating Dual-Use Potential and Charting the Path Forward. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-024-10358-8. [PMID: 39046699 DOI: 10.1007/s11673-024-10358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/16/2024] [Indexed: 07/25/2024]
Abstract
Contemporary genome editing techniques have made genomic intervention-from microorganism to human-more accessible, easier to use, and more accurate than previous methods. We argue that, notwithstanding its merits in treating and preventing disease in humans, genome editing represents a potential threat for domestic and international security, requiring an integrated approach in regulating, detecting, preventing, and mitigating the risk of its use for malicious purposes. Despite the global regulatory ambitions of the 2021 WHO framework, we see insufficient attention given to the future prospect of dual-use genomic technology. Drawing parallels with the nuclear field, we suggest tentative practical steps for a way forward in dealing with genome editing technologies, such as: 1) adapting national (bio)security and defence strategies to include genome editing as a possible threat (with conceivable WMD potential); 2) enhancing the international dialogue on genome editing and raising the issue at the highest level; 3) working towards a global, legally binding verification mechanism; 4) tracking genome editing technologies.
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Affiliation(s)
- Ana Ruxandra Badea
- University of Bucharest, Faculty of Philosophy, Splaiul Independentei 204, 060024, Bucharest, Romania.
| | - Oliver Feeney
- University of Tübingen, Ethics of Genome Editing Research Unit, Institute of Ethics and History of Medicine, Gartenstr. 47, 72074, Tübingen, Germany
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Döbler NA, Carbon CC. Adapting Ourselves, Instead of the Environment: An Inquiry into Human Enhancement for Function and Beyond. Integr Psychol Behav Sci 2024; 58:589-637. [PMID: 37597122 PMCID: PMC11052783 DOI: 10.1007/s12124-023-09797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
Technology enables humans not only to adapt their environment to their needs but also to modify themselves. Means of Human Enhancement - embodied technologies to improve the human body's capabilities or to create a new one - are the designated means of adapting ourselves instead of the environment. The debate about these technologies is typically fought on ethical soil. However, alarmist, utopian, and science fiction scenarios distract from the fact that Human Enhancement is a historical and pervasive phenomenon incorporated into many everyday practices. In the vein of disentangling conceptual difficulties, we claim that means of Human Enhancement are either physiologically or psychologically embodied, rendering the merging with the human user their most defining aspect. To fulfill its purpose, an enhancement must pass the test-in-the-world, i.e., assisting with effective engagement with a dynamic world. Even if failing in this regard: Human Enhancement is the fundamental and semi-targeted process of changing the users relationship with the world through the physical or psychological embodiment of a hitherto external object and/or change of one's body. This can potentially change the notion of being human. Drawing on a rich body of theoretical and empirical literature, we aim to provide a nuanced analysis of the transformative nature of this phenomenon in close proximity to human practice. Stakeholders are invited to apply the theory presented here to interrogate their perspective on technology in general and Human Enhancement in particular.
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Affiliation(s)
- Niklas Alexander Döbler
- Department for General Psychology and Methodology, University of Bamberg, Bamberg, Germany.
- Research group EPÆG (Ergonomics, Psychological Æsthetics, Gestalt), Bamberg, Germany.
- Bamberg Graduate School of Affective and Cognitive Sciences (BaGrACS), Bamberg, Germany.
| | - Claus-Christian Carbon
- Department for General Psychology and Methodology, University of Bamberg, Bamberg, Germany
- Research group EPÆG (Ergonomics, Psychological Æsthetics, Gestalt), Bamberg, Germany
- Bamberg Graduate School of Affective and Cognitive Sciences (BaGrACS), Bamberg, Germany
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Nelson JP, Selin CL. Seven open questions in the futures of human genome editing. FUTURES 2023; 149:103138. [PMID: 37484876 PMCID: PMC10358607 DOI: 10.1016/j.futures.2023.103138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Scholarly discussion around the governance of human genome editing (HGE) recognizes that development and application of HGE techniques could result in unexpected societal outcomes. However, it contains few to no methodological models for how to anticipate, prepare for, or shape such outcomes. This article presents early-stage results from research guided by anticipatory governance, a framework for broad expert and public consideration of innovation processes and purposes. We present and discuss key themes emerging from a set of future-oriented interviews with genome editing practitioners and experts, designed to inform broadly scoped deliberations about plausible futures of HGE. We articulate our results as seven "open questions," the answers to which will be important components of HGE's eventual shape and outcomes. Some themes are perennial in studies of science and society, and others are more novel to HGE. Each helps to reframe HGE beyond a simple comparison of risk and benefit. Such reframing opens up new and important terrain for discussion among policymakers, academics, scientists, and publics. We suggest that discussion framed around broad and reflexive questions like those presented here will help governance efforts to better acknowledge and flexibly respond to the uncertainty and complexities of HGE developments.
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Affiliation(s)
- John P. Nelson
- School for the Future of Innovation in Society, Arizona State University, 1120 South Cady Mall, Tempe, Arizona 85287-5603
| | - Cynthia L. Selin
- School for the Future of Innovation in Society/Consortium for Science, Policy & Outcomes, Arizona State University, 1120 South Cady Mall, Tempe, Arizona 85287-5603
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Velasquez-Vasconez PA. Reflections about the Molecular Tool That Could Change the Course of Human History: Genome Editing. PERSONA Y BIOÉTICA 2022. [DOI: 10.5294/pebi.2022.26.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Genetic editing has many applications in almost all areas of society, but may also lead to unpredictable consequences. Genome editing to modify the human germline is at the center of global discussion. Owing to the increasing number of unanswered scientific, ethical, and policy questions, the scientific community agrees that it would be inappropriate to genetically modify embryos. A serious and open debate is necessary to decide whether such research should be suspended or encouraged. Here we show some bold arguments in favor of deleting deleterious genes from the human genome and the risks liberal eugenism poses.
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Waltz M, Juengst ET, Edwards T, Henderson GE, Kuczynski KJ, Conley JM, Della-Penna P, Cadigan RJ. The View from the Benches: Scientists' Perspectives on the Uses and Governance of Human Gene-Editing Research. CRISPR J 2021; 4:609-615. [PMID: 34406038 PMCID: PMC8392077 DOI: 10.1089/crispr.2021.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The advent of human gene editing has stimulated international interest in how best to govern this research. However, research on stakeholder views has neglected scientists themselves. We surveyed 212 scientists who use gene editing in their work. Questions captured views on oversight and use of somatic and germline human gene editing for treatment, prevention, and enhancement. More respondents were supportive of somatic than germline editing, and more supported gene editing for treatment compared to prevention. Few supported its use for enhancement. When presented with specific conditions, levels of support for somatic editing differed by type of condition. Almost all respondents said scientists and national government representatives should be involved in oversight, but only 28% said scientists are best positioned to oversee gene-editing research. These results can inform the development of sound approaches to research governance, demonstrating the importance of identifying specific gene-editing uses when considering oversight.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric T. Juengst
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Teresa Edwards
- H.W. Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gail E. Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristine J. Kuczynski
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John M. Conley
- University of North Carolina School of Law, Chapel Hill, North Carolina, USA
| | - Paige Della-Penna
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - R. Jean Cadigan
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Nelson JP, Selin CL, Scott CT. Toward Anticipatory Governance of Human Genome Editing: A Critical Review of Scholarly Governance Discourse. JOURNAL OF RESPONSIBLE INNOVATION 2021; 8:382-420. [PMID: 35281674 PMCID: PMC8916747 DOI: 10.1080/23299460.2021.1957579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/14/2021] [Indexed: 05/04/2023]
Abstract
The rapid development of human genome editing (HGE) techniques evokes an urgent need for forward-looking deliberation regarding the aims, processes, and governance of research. The framework of anticipatory governance (AG) may serve this need. This article reviews scholarly discourse about HGE through an AG lens, aiming to identify gaps in discussion and practice and suggest how AG efforts may fill them. Discourse on HGE has insufficiently reckoned with the institutional and systemic contexts, inputs, and implications of HGE work, to the detriment of its ability to prepare for a variety of possible futures and pursue socially desirable ones. More broadly framed and inclusive efforts in foresight and public engagement, focused not only upon the in-principle permissibility of HGE activities but upon the contexts of such work, may permit improved identification of public values relevant to HGE and of actions by which researchers, funders, policymakers, and publics may promote them.
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Affiliation(s)
- John P. Nelson
- School for the Future of Innovation in Society, Arizona State University, 1120 South Cady Mall, Tempe, Arizona 85287-5603
| | - Cynthia L. Selin
- School for the Future of Innovation in Society/Consortium for Science, Policy & Outcomes, Arizona State University, 1120 South Cady Mall, Tempe, Arizona 85287-5603
| | - Christopher T. Scott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030-3411
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Abstract
PURPOSE OF REVIEW Continued development of gene editing techniques has raised the real possibility of clinical application of germline gene editing. These results, as well as reports of an unethical experiment which resulted in the birth of at least two children from edited embryos in 2018, have highlighted the urgency and importance of ethical issues about translational pathways for editing of human germline cells. Charting responsible translational pathways for germline gene editing requires tackling some significant and complex ethical issues. RECENT FINDINGS A literature on development of clinical applications of germline gene editing is emerging, and several key ethical issues are coming into focus as major challenges for responsible translational pathways. SUMMARY Potential clinical utility, clinical justification, and human subjects research for germline gene editing raise outstanding ethical questions. Work on these questions will help provide guidance to researchers and clinicians and direct translational projects toward justifiable applications.
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Affiliation(s)
- Bryan Cwik
- Philosophy and University Studies, Portland State University, Fourth Ave Building Suite 175, 1900 SW 4th Ave, Portland, OR 97201 USA
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Kleiderman E, Stedman INK. Human germline genome editing is illegal in Canada, but could it be desirable for some members of the rare disease community? J Community Genet 2020; 11:129-138. [PMID: 31420817 PMCID: PMC7062950 DOI: 10.1007/s12687-019-00430-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/07/2019] [Indexed: 01/25/2023] Open
Abstract
Human germline genome editing may prove to be especially poignant for members of the rare disease community, many of whom are diagnosed with monogenic diseases. This community lacks broad representation in the literature surrounding genome editing, notably in Canada, yet is likely to be directly affected by eventual clinical applications of this technology. Although not generalizable, the literature does offer some commonalities regarding the experiences of rare disease patients. This manuscript seeks to contribute to the search for broader societal dialogue surrounding human germline genome editing by exploring some of those commonalities that comfort the notion that CRISPR may hold promise or be desirable for some members of this community. We first explore the legal and policy context surrounding germline genome editing, focusing closely on Canada, then provide an overview of the common challenges experienced by members of the rare disease community, and finally assess the opportunities of germline genome editing vis-à-vis rare disease as we advocate for the need to more actively engage with the community in our search for public engagement.
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Affiliation(s)
- Erika Kleiderman
- Centre of Genomics and Policy, McGill University, 740, Dr. Penfield Avenue, suite 5200, Montreal, Quebec H3A 0G1 Canada
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Kleiderman E, Ravitsky V, Knoppers BM. 'Serious' factor-a relevant starting point for further debate: a response. JOURNAL OF MEDICAL ETHICS 2020; 46:153-155. [PMID: 31694871 DOI: 10.1136/medethics-2019-105832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/07/2019] [Accepted: 10/23/2019] [Indexed: 06/10/2023]
Abstract
In this reply, we wish to defend our original position and address several of the points raised by two excellent responses. The first response (De Miguel Beriain) questions the relevance of the notion of 'serious' within the context of human germline genome modification (HGGM). We argue that the 'serious' factor is relevant and that there is a need for medical and social lenses to delineate the limits of acceptability and initial permissible applications of HGGM. In this way, 'serious' acts as a starting point for further discussions and debates on the acceptability of the potential clinical translation of HGGM. Therefore, there is a pressing need to clarify its scope, from a regulatory perspective, so as to prevent individuals from using HGGM for non-therapeutic or enhancement purposes. The second response (Kalsi) criticizes the narrow interpretation of the objectivist approach and the apparent bias towards material innovations when discussing the right to benefit from scientific advancements. As an in-depth discussion of the objectivist and constructivist approaches was beyond the scope of our original paper, we chose to focus on one specific objectivist account, one which focuses on biological and scientific facts. We agree, however, with the critique that material innovations should not be the sole focus of the right to benefit from scientific advancements, which also incorporates freedom of scientific research and access to scientific knowledge scientific freedom and knowledge, including the influence of these on ethical thinking and cultures.
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Affiliation(s)
- Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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Kleiderman E, Ravitsky V, Knoppers BM. The 'serious' factor in germline modification. JOURNAL OF MEDICAL ETHICS 2019; 45:508-513. [PMID: 31326898 PMCID: PMC6820154 DOI: 10.1136/medethics-2019-105436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 06/10/2023]
Abstract
Current advances in assisted reproductive technologies aim to promote the health and well-being of future children. They offer the possibility to select embryos with the greatest potential of being born healthy (eg, preimplantation genetic testing) and may someday correct faulty genes responsible for heritable diseases in the embryo (eg, human germline genome modification (HGGM)). Most laws and policy statements surrounding HGGM refer to the notion of 'serious' as a core criterion in determining what genetic diseases should be targeted by these technologies. Yet, this notion remains vague and poorly defined, rendering its application challenging and decision making subjective and arbitrary. By way of background, we begin by briefly presenting two conceptual approaches to 'health' and 'disease': objectivism (ie, based on biological facts) and constructivism (ie, based on human values). The basic challenge under both is sorting out whether and to what extent social and environmental factors have a role in helping to define what qualifies as a 'serious' disease beyond the medical criteria. We then focus on how a human rights framework (eg, right to science and right to the highest attainable health) could integrate the concepts of objectivism and constructivism so as to provide guidance for a more actionable consideration of 'serious'. Ultimately, it could be argued that a human rights framework, by way of its legally binding nature and its globally accepted norms and values, provides a more universal foundation for discussions of the ethical, legal and social implications of emerging or disruptive technologies.
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Affiliation(s)
- Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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Ormond KE, Bombard Y, Bonham VL, Hoffman-Andrews L, Howard H, Isasi R, Musunuru K, Riggan KA, Michie M, Allyse M. The clinical application of gene editing: ethical and social issues. Per Med 2019; 16:337-350. [DOI: 10.2217/pme-2018-0155] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gene-editing techniques have progressed rapidly in the past 5 years. There are already ongoing human somatic gene-editing clinical trials for multiple diseases. And there has been one purported scenario of human germline gene editing in late 2018. In this paper, we will review the current state of the technology, discuss the ethical and social issues that surround the various forms of gene editing, as well as review emerging stakeholder data from professionals, the ‘general public’ and individuals and families dealing with genetic diseases potentially treatable by gene editing.
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Affiliation(s)
- Kelly E Ormond
- Department of Genetics & Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yvonne Bombard
- Institute of Health Policy, Management & Evaluation, University of Toronto; Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada
| | - Vence L Bonham
- Social & Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD 20892, USA
| | - Lily Hoffman-Andrews
- Penn Center for Inherited Cardiac Disease, Penn Medicine, Philadelphia, PA 19104, USA
| | - Heidi Howard
- Centre for Research Ethics & Bioethics, Uppsala University, Uppsala, Sweden
- Society & Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Rosario Isasi
- Dr J T Macdonald Foundation Department of Human Genetics, Institute of Bioethics & Health Policy, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kiran Musunuru
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, PA 19104, USA
| | - Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Marsha Michie
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Megan Allyse
- Biomedical Ethics Research Program & Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
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