International perceptions and approval of gene therapy

What do people think about genetic engineering? A systematic review of questionnaire surveys before and after the introduction of CRISPR

The advent of CRISPR-Cas9 in 2012 started revolutionizing the field of genetics by broadening the access to a method for precise modification of the human genome. It also brought renewed attention to the ethical issues of genetic modification and the societal acceptance of technology for this purpose. So far, many surveys assessing public attitudes toward genetic modification have been conducted worldwide. Here, we present the results of a systematic review of primary publications of surveys addressing public attitudes toward genetic modification as well as the awareness and knowledge about the technology required for genetic modification. A total of 53 primary publications (1987-2020) focusing on applications in humans and non-human animals were identified, covering countries in four continents. Of the 53 studies, 30 studies from until and including 2012 (pre-CRISPR) address gene therapy in humans and genetic modification of animals for food production and biomedical research. The remaining 23 studies from after 2013 (CRISPR) address gene editing in humans and animals. Across countries, respondents see gene therapy for disease treatment or prevention in humans as desirable and highly acceptable, whereas enhancement is generally met with opposition. When the study distinguishes between somatic and germline applications, somatic gene editing is generally accepted, whereas germline applications are met with ambivalence. The purpose of the application is also important for assessing attitudes toward genetically modified animals: modification in food production is much less accepted than for biomedical application in pre-CRISPR studies. A relationship between knowledge/awareness and attitude toward genetic modification is often present. A critical appraisal of methodology quality in the primary publications with regards to sampling and questionnaire design, development, and administration shows that there is considerable scope for improvement in the reporting of methodological detail. Lack of information is more common in earlier studies, which probably reflects the changing practice in the field.

Gene therapy: perspectives from young adults with Leber's congenital amaurosis

AIMS/PURPOSE

To investigate Leber congenital amaurosis (LCA) patients' expectations, decision-making processes and gene therapy-related concerns.

METHODS

Using a qualitative approach, we explored perceptions of gene therapy and clinical trials among individuals with LCA. Young adults with a clinical diagnosis of LCA were recruited through the Ocular Genetics Programme at the Hospital for Sick Children. Semi-structured interviews were conducted with ten patients and analysed following the principles of qualitative description.

RESULTS

Study participants were aware of ongoing gene therapy research trials and actively sought information regarding advances in ophthalmology and vision restoration. The majority of participants would enrol or were enrolled in a gene-replacement therapy trial, while a minority was ambivalent or would not enrol if provided an opportunity. Participants attributed different values to clinical trials, which influenced their willingness to participate. Intrinsic factors related to coping, adaptation to vision loss and resilience also influenced decision-making.

DISCUSSION

This study highlights the complex factors involved in gene-therapy-related decision-making and acts as a proponent for adopting patient-centred care strategies when counselling individuals considering gene therapy or clinical trial participation.

RESTORE Survey on the Public Perception of Advanced Therapies and ATMPs in Europe-Why the European Union Should Invest More!

Advanced therapy medicinal products (ATMPs) are potential game changers in modern medical care with an anticipated major impact for patients and society. They are a new drug class often referred to as "living drugs," and are based on complex components such as vectors, cells and even tissues. The production of such ATMPs involves innovative biotechnological methods. In this survey, we have assessed the perception of European citizens regarding ATMPs and health care in Europe, in relation to other important topics, such as safety and security, data protection, climate friendly energy supply, migration, and others. A crucial question was to determine to what extent European citizens wish to support public funding of innovations in healthcare and reimbursement strategies for ATMPs. To answer this, we conducted an online survey in 13 European countries (representative of 85.3% of the entire EU population including the UK in 2020), surveying a total of 7,062 European citizens. The survey was representative with respect to adult age groups and gender in each country. Healthcare had the highest ranking among important societal topics. We found that 83% of the surveyed EU citizens were in support of more public funding of technologies in the field of ATMPs. Interestingly, 74% of respondents are in support of cross-border healthcare for patients with rare diseases to receive ATMP treatments and 61% support the reimbursement of very expensive ATMPs within the European health care system despite the current lack of long-term efficacy data. In conclusion, healthcare is a top ranking issue for European Citizens, who additionally support funding of new technologies to enable the wider application of ATMPs in Europe.

Public Acceptability of Gene Therapy and Gene Editing for Human Use: A Systematic Review

Gene therapy and gene editing technologies are complex and it can be difficult for the public to understand their possible benefits or side effects. However, patient and public support is critical for the successful adoption of any new technology. Given the recent advances in gene therapy and gene editing, their potential clinical benefits, and the significant attention that has been given to the first-known successful attempt at permanent and heritable changes to the human genome, a systematic review was performed to assess beliefs and attitudes toward gene therapy and gene editing for human use, and to highlight the factors that influence acceptability. A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was undertaken in April 2018 to identify articles examining opinions and attitudes regarding the acceptability of gene therapy and gene editing. Overall, 1,561 records were retrieved from 4 databases (Ovid Medline, PsycINFO, Scopus, and Web of Science). Duplicates were removed, and titles and abstracts independently screened, leaving 86 full-text articles assessed for eligibility. Following full-text review, 33 were included, with 5 articles added after forward/backward searching. An additional three articles were added following an updated search in March 2019 (total n = 41). Findings from the studies were integrated according to common themes: the impact of demographics; risks versus benefits of success; treatment specifics (e.g., medical vs. other reasons; disease severity and status; somatic vs. germ line; and mode of delivery); moral or ethical issues; and changes with time. In general, perceptions were positive, particularly for medical reasons and fatal diseases, but were also influenced by perceived risk. Somatic therapies had higher levels of acceptability than germ line therapies. While available in various forms, limitations exist in the measurement of perceptions of gene therapy and gene editing. Treatment acceptability is essential for future clinical trials, so it is important for scientists and clinicians to be clear about the risks and benefits of these technologies, and how these are communicated to the public, while encouraging education about genetic therapies to a broad range of individuals.

Attitudes of Indonesian Medical Doctors and Medical Students Toward Genome Editing

Purpose

This study aimed to measure the attitudes of Indonesian medical doctors and students toward new technology in genome editing.

Materials and Methods

Online questionnaires regarding attitudes toward genome editing on health and non-health conditions, both in somatic cells and embryo, were distributed through researcher networks, email and social media specific to medical doctors and students. The data of 1055 valid questionnaires were processed; descriptive and association analyses between sociodemographic factors and attitudes toward genome editing were performed. Email in-depth interview was performed to explore the respondents’ answers.

Results

The results showed that Indonesian medical doctors’ and students’ knowledge of genome editing was limited and correlated with gender, place of residence, religion, education, marital status, childbearing and experience abroad. More than half of respondents supported genome editing for the treatment of fatal and debilitating diseases both in somatic cells and embryos, implying their consent to edited gene inheritance. However, this approval decreased when applied to non-health-related aspects, such as physical appearance, intelligence and strength. Factors affecting their attitudes toward genome editing included their status as medical doctors or students, gender, age, education, religion, economic status and place of residence.

Conclusion

Increasing knowledge and awareness of Indonesian medical doctors and students regarding genome editing is important. Even though its application in health-related matter was supported by a majority of the respondents, discussion from ethical and religious perspectives is necessary to ensure the acceptance.

Tampering with Nature: A Systematic Review

Tampering with nature has been shown to be a strong, and sometimes even the strongest, predictor of the risk perception and acceptance of various technologies and behaviors, including environmental technologies, such as geoengineering. It is therefore helpful to understand what tampering with nature is as a construct, to which factors it relates, and when a technology or behavior is perceived as such. By means of a systematic review, we show that very little systematic research has been conducted on tampering with nature. Because tampering with nature has not yet been clearly defined, no systematic operationalization of tampering with nature has been used in the current literature. We show that tampering with nature is often used interchangeably with other constructs, such as naturalness. Based on the literature, we suggest that tampering with nature is related to and possibly influenced by three other constructs, which are naturalness, morality, and controllability. We discuss the influence of tampering with nature on the acceptance and risk perception of various technologies and behaviors and make suggestions for future research needs in order to better understand this construct.

Attitudes of Members of Genetics Professional Societies Toward Human Gene Editing

Gene-editing technologies have improved in ease, efficiency, and precision. Although discussions are occurring around acceptable uses of human gene editing, limited data exist on the views of genetics-trained individuals. In 2017, we distributed an anonymous online survey to assess the attitudes of members of genetics professional societies toward gene editing (N = 500). Virtually all respondents were supportive of somatic editing in basic-science (99.2%) and clinical (87.4%) research on nonreproductive human cells. Only 57.2% were supportive of germline-editing basic-science research; 31.9% supported the transfer of viable embryos to humans for clinical research. While most favored future therapeutic uses of somatic (96.6%) and germline (77.8%) editing, there was little support for enhancement in somatic (13.0%) or germline (8.6%) cells. This study describes attitudes toward gene editing from genetics professionals worldwide and contributes to ongoing discourse and policy guidance in this domain.

Attitudes of Potential Participants Towards Molecular Therapy Trials in Huntington's Disease

BACKGROUND

Advances in molecular therapeutic approaches in the last decade are translating into the design of non-traditional clinical trials. In order to improve their feasibility, it is important to understand the attitudes of potential participants towards these trials, their motivations to get involved and acceptance of risks.

OBJECTIVE

We aimed to better understand the willingness of potential participants to participate in different molecular therapy trials for Huntington's disease (HD) based on their clinical and genetic status, trial design and goals of the treatment.

METHODS

An anonymous survey was distributed through the Huntington's Disease Society of America (HDSA) on-line portal/website. Various hypothetical scenarios were presented followed by a survey consistent of Likert scale responses ascertaining willingness to participate, collecting demographic, clinical and genetic information.

RESULTS

There were a total of 87 responses, including patients diagnosed with HD, pre-manifesting mutation carriers and asymptomatic participants at risk. The majority of participants indicated they were very likely or likely to participate in clinical trials independent of study design or goals of the therapy, with a more favorable view in premanifesting mutation carriers. However, more invasive procedures and trials including placebo were less favorably viewed across all diagnostic groups.

CONCLUSIONS

In summary, most individuals in the HD community would consider participation in novel molecular therapy trials, but study design and goals could impact patient recruitment. This data can be used to inform the recruitment and consent process into clinical trials and to address common concerns by potential participants.

Reasons for being in favour of or against genome modification: a survey of the Dutch general public

STUDY QUESTION

What are the general public's reasons for being in favour of or against the use of genome modification for five potential applications?

SUMMARY ANSWER

Overall, 43 reasons for being in favour, 45 reasons for being against as well as 26 conditional reasons for the use of genome modification were identified.

WHAT IS KNOWN ALREADY

Various applications of somatic genome modification are progressing towards clinical introduction and several recent studies have reported on germline genome modification. This has incited a debate on ethical and legal implications and acceptability. There is a growing plea to involve the general public earlier on in the developmental process of science and (bio)technology including genome modification.

STUDY DESIGN SIZE DURATION

In April 2016, a cross-sectional survey was launched online among the Dutch general public. A documentary on genome modification on public television and calls in social media invited viewers and non-viewers, respectively, to participate.

PARTICIPANTS/MATERIALS SETTING METHODS

The questionnaire introduced five potential future applications of genome modification: modified wheat for individuals with gluten intolerance; somatic modification for individuals with neuromuscular diseases; germline modification to prevent passing on a neuromuscular disease; germline modification to introduce resistance to HIV; and germline modification to increase intelligence. Participants were asked to indicate whether and why they would make use of genome modification in these scenarios. The reasons mentioned were analysed through content analysis by two researchers independently. The proportion of respondents that was willing to modify was described per scenario and associations with respondent characteristics were analysed.

MAIN RESULTS AND THE ROLE OF CHANCE

The survey was completed by 1013 participants. Forty-three reasons for being in favour, 45 reasons for being against as well as 26 conditional reasons for the use of genome modification were identified. These could be categorized into 14 domains: safety of the individuals concerned; effectiveness; quality of life of the individuals concerned; existence of a clinical need or an alternative; biodiversity and ecosystems; animal homo sapiens (i.e. relating to effects on humans as a species); human life and dignity; trust in regulation; justice; costs; slippery slope; argument of nature; parental rights and duties; and (reproductive) autonomy. Participants' willingness to use genome modification was dependent on the application: most participants would eat modified wheat if gluten intolerant (74%), would use genome modification to cure his/her own neuromuscular disease (85%) and would apply germline modification to prevent passing on this neuromuscular disease (66%). A minority would apply germline modification to introduce resistance to HIV (30%) or increase intelligence (16%). Being young (odds ratio (OR) = 0.98 per year increase), being male (OR = 2.38), and having watched the documentary (OR = 1.82) were associated with being willing to apply genome modification in more scenarios.

LIMITATIONS REASONS FOR CAUTION

Inquiring for reasons through open questions in a survey allowed for a larger sample size and intuitive responses but resulted in less depth than traditional face-to-face interviews. As the survey was disseminated through social media, the sample is not representative of the overall Dutch population, and hence the quantitative results should not be interpreted as such.

WIDER IMPLICATIONS OF THE FINDINGS

Further public consultation and a more in-depth ethical and societal debate on principles and conditions for responsible use of (germline) genome modification is required prior to future clinical introduction.

STUDY FUNDING/COMPETING INTERESTS

Funded by the University of Amsterdam and University Medical Centre Utrecht. No conflict of interest.

TRIAL REGISTRATION NUMBER

Not applicable.

Survey of Attitudes and Ethical Concerns Related to Gene Therapy Among Medical Students and Postgraduates in China

Gene therapy is becoming an important treatment modality for gravely ill patients, and today's medical students and postgraduates are both potential consumers and future providers of gene therapy. Therefore, their attitudes and concerns about gene therapy may directly influence its long-term development and implementation in the clinic. We performed a cross-sectional survey of medical students and postgraduates at West China Medical School of Sichuan University. A custom-designed questionnaire was distributed to 600 students, and 579 were valid (96.98% response). Most respondents (84.46%) indicated little prior knowledge about gene therapy. The proportion of respondents considering gene therapy as acceptable ranged from 63.73% for serious illness to 17.72% for genetic enhancement. Adverse side effects were the most frequent concern among respondents when asked to imagine that they would receive gene therapy to treat a severe brain-related illness. These results suggest that medical students in China consider gene therapy's acceptability to be rather low, and are most concerned about its adverse side effects.

Prevailing public perceptions of the ethics of gene therapy

Gene therapy research is advancing rapidly, and hopes of treating a large number of brain disorders exist alongside ethical concerns. Most surveys of public attitudes toward these ethical issues are already dated and the content of these surveys has been researcher-driven. To examine current public perceptions, we developed an online instrument that is responsive and relevant to the latest research about ethics, gene therapy, and the brain. The 16-question survey was launched with the platform Amazon Mechanical Turk and was made available to residents of Canada and the United States. The survey was divided into six themes: (1) demographic information, (2) general opinions about gene therapy, (3) medical applications of gene therapy, (4) identity and moral/belief systems, (5) enhancement, and (6) risks. We received and analyzed responses from a total of 467 participants. Our results show that a majority of respondents (>90%) accept gene therapy as a treatment for severe illnesses such as Alzheimer disease, but this receptivity decreases for conditions perceived as less severe such as attention deficit hyperactivity disorder (79%), and for nontherapeutic applications (47%). The greatest area of concern for the application of gene therapy to brain conditions is the fear of not receiving sufficient information before undergoing the treatment. The main ethical concerns with enhancement were the potential for disparities in resource allocation, access to the procedure, and discrimination. When comparing these data with those from the 1990s, our findings suggest that the acceptability of gene therapy is increasing and that this trend is occurring despite lingering concerns over ethical issues. Providing the public and patients with up-to-date information and opportunities to engage in the discourse about areas of research in gene therapy is a priority.

Ethical consequences of the positive views of enhancement in Asia

There are positive views towards use of science and technology in all Asian countries, and positive views towards use of enhancement in China, India and Thailand. After considering of the widespread use of cosmetic surgery and other body enhancements in Asian countries, and the generally positive views towards letting individuals make choices about improvement of themselves, the paper concludes that we can expect other enhancements to also be adopted rapidly in Asia. There will be future ethical dilemmas emerging from this with concepts of preservation of nature, flow with nature, and definitions of human-ness, along with concepts of harmony and social justice. Japan is less willing to engage in genetic enhancement compared to China, India and Thailand, despite widespread cosmetic surgery across Asia.

Utilizing social media to study information-seeking and ethical issues in gene therapy

Background

The field of gene therapy is rapidly evolving, and while hopes of treating disorders of the central nervous system and ethical concerns have been articulated within the academic community, little is known about views and opinions of different stakeholder groups.

Objective

To address this gap, we utilized social media to investigate the kind of information public users are seeking about gene therapy and the hopes, concerns, and attitudes they express.

Methods

We conducted a content analysis of questions containing the keywords “gene therapy” from the Q&A site “Yahoo! Answers” for the 5-year period between 2006 and 2010. From the pool of questions retrieved (N=903), we identified those containing at least one theme related to ethics, environment, economics, law, or society (n=173) and then characterized the content of relevant answers (n=399) through emergent coding.

Results

The results show that users seek a wide range of information regarding gene therapy, with requests for scientific information and ethical issues at the forefront of enquiry. The question sample reveals high expectations for gene therapy that range from cures for genetic and nongenetic diseases to pre- and postnatal enhancement of physiological attributes. Ethics questions are commonly expressed as fears about the impact of gene therapy on self and society. The answer sample echoes these concerns but further suggests that the acceptability of gene therapy varies depending on the specific application.

Conclusions

Overall, the findings highlight the powerful role of social media as a rich resource for research into attitudes toward biomedicine and as a platform for knowledge exchange and public engagement for topics relating to health and disease.

The attitude of oncology physicians and nurses to the acceptance of new drugs for gene therapy

With the efficacy of gene therapy verified in phase III trials, cancer patients will consider whether to accept gene therapy sooner or later. The purpose of this study is to investigate the attitudes of oncology physicians and nurses regarding effective gene therapy. A questionnaire was administered to 368 oncology physicians and nurses. A total of 328 valid questionnaires were returned (response rate, 89.1%). Gene therapy was considered as very safe or safe by 256 (78.0%) participants. Regardless of the stage of cancer, participants who advised patients to enroll in clinical trials and considered gene therapy as safe tended to accept the effective gene therapy. Gene therapy is considered to be a safe treatment. Most participants are willing to accept effective and verified gene therapy on the assumption that they themselves suffer from cancers.

Human subjects protections in biomedical enhancement research: assessing risk and benefit and obtaining informed consent

The protection of human subjects in biomedical research relies on two principal mechanisms: assessing and comparing the risks and potential benefits of proposed research, and obtaining potential subjects' informed consent. While these have been discussed extensively in the literature, no attention has been paid to whether the processes should be different when the objective of an experimental biomedical intervention is to improve individual appearance, performance, or capability ("enhancement research") rather than to prevent, cure, or mitigate disease ("health-oriented research"). This essay examines this question in order to ensure that subjects in biomedical enhancement research receive adequate protection.

What choices should we be able to make about designer babies? A Citizens' Jury of young people in South Wales

BACKGROUND

Young people will increasingly have the option of using new technologies for reproductive decision making but their voices are rarely heard in debates about acceptable public policy in this area. Capturing the views of young people about potentially esoteric topics, such as genetics, is difficult and methodologically challenging.

DESIGN

A Citizens' Jury is a deliberative process that presents a question to a group of ordinary people, allows them to examine evidence given by expert witnesses and personal testimonies and arrive at a verdict. This Citizens' Jury explored designer babies in relation to inherited conditions, saviour siblings and sex selection with young people.

PARTICIPANTS

Fourteen young people aged 16-19 in Wales.

RESULTS

Acceptance of designer baby technology was purpose-specific; it was perceived by participants to be acceptable for preventing inherited conditions and to create a child to save a sibling, but was not recommended for sex selection. Jurors stated that permission should not depend on parents' age, although some measure of suitability should be assessed. Preventing potential parents from going abroad was considered impractical. These young people felt the Human Fertilisation and Embryology Authority should have members under 20 and that the term 'designer baby' was not useful.

CONCLUSIONS

Perspectives on the acceptability of this technology were nuanced, and based on implicit value judgements about the extent of individual benefit derived. Young people have valuable and interesting contributions to make to the debate about genetics and reproductive decision making and a variety of innovative methods must be used to secure their involvement in decision-making processes.

Public, Experts, and Acceptance of Advanced Medical Technologies: The Case of Organ Transplant and Gene Therapy in Japan

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3,000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine.

Emergence of a Scientific and Commercial Research and Development Infrastructure for Human Gene Therapy

A research and clinical subfield known as "human gene therapy" has grown rapidly since 1990, when the first human trials were approved in the United States. Using quantitative data, this paper describes and analyzes the research and commercial infrastructure, including academic centers, publications, intellectual property, and biotechnology firms, that has developed around the goal of discovering clinical applications for the modification and transport of DNA to somatic cells. Despite setbacks and few documented successes, the subfield of human gene therapy continues to serve as an influential clinical paradigm for the treatment of inherited and noninherited diseases.

Warranted concerns, warranted outlooks: a focus group study of public understandings of genetic research

This paper discusses how the American public accounts for the concerns that they have about genetic research and the benefits that they foresee. We develop a general framework for discussing public claims about genetic technology based on Stephen Toulmin's model of warrants in argumentation. After a review of the results from public opinion polls about genetic research, we present a focus group study of public understandings of genetics. We outline the warrants, or publicly accepted "good reasons", that this group offers for accepting some aspects of genetic technology and for rejecting other aspects. The warrants presented by the public in their discussion of genetic research indicate that the public has a complex, informed understanding of genetic research, albeit a non-technical one. The paper concludes with a discussion of the importance of public participation in debates over genetic research and the ways that researchers and policymakers could adapt to public concerns about genetics.

Germinal choice technology and the human future

This paper examines the likely impacts of emerging technologies that will give prospective parents the potential to directly influence the genetics of their offspring. My primary focus is on advanced prenatal genetic diagnosis (PGD) for both disease and non-disease traits, since this is likely to emerge before such possibilities as direct germline engineering. I place these technologies within the larger context of today's revolution in the life sciences and consider the progress likely to occur in this realm in the next few generations. I take a common sense look at the types of screening choices people are likely to make once these possibilities become possible, their broad consequences for human society, and the advantages and disadvantages of plausible regulatory paths in this realm. I also reflect upon today's debate about cloning and other such issues in the life sciences, looking at the driving forces behind these discussions and the tensions likely to develop in the next few decades.

Non-professionals' evaluations of gene therapy ethics

Although the moral responsibilities of clinicians and researchers in the new genetics are exhaustively reflected upon, much less attention has been paid to the factors affecting the moral reasoning of non-professionals when they reflect on genetic issues. In this paper, we compare the moral evaluations of somatic gene therapy (SGT) made by some of its potential consumers (patients) and its providers (medical professionals). The results highlight significant differences between professional opinion and non-professional evaluations. Medical professionals shared a moral evaluation of SGT that (a) based its acceptability on a strong therapeutic imperative, (b) grounded this in an unproblematic separation of identity and disability/illness, and (c) generally did not see SGT as ethically different from other medical interventions. Prospective patients (a) often questioned the effectiveness of "therapeutic" interventions, (b) could derive a strong sense of identity from disability/illness, and (c) sometimes saw genetic interventions as changing a person's identity, either directly (through the genes) or indirectly (through altered life experience). We discuss the implications of these differences for the professional and public debate on the ethics of gene therapy. Our results highlight the need to take into account non-professionals' views of SGT.

When norms normalize: the case of genetic "enhancement"

As the possibility of genetic intervention becomes more concrete, defining and regulating ethically permissible interventions must include a consideration of the implicit as well as explicit consequences. These include the moral implications of defining "enhancement" by reference to a standard of normality. Some authors have called into question the standard ethical concerns about genetic enhancement, but the distinction between enhancing and therapeutic interventions is still structured as relatively unproblematic. However, determining the boundary between therapy and enhancement will have feedback effects on the socially implemented definitions of what counts as normal in human embodiment. Positioning the interface between permissible and nonpermissible interventions at the same place as the boundaries between therapy and enhancement, and between normal and abnormal embodiment, (1) uses biology to justify a moral evaluation, (2) privileges the single standpoint of the genetically canonical person, and (3) enhances the dichotomy between "normal" and "not normal". Assuming that the limit of permissibility along the interventional continuum is coterminous with the definitions of enhancement and of normality, distracts from the work of uncovering the real grounds to setting limits to genetic manipulation.

"What do you think about genetic medicine?" Facilitating sociable public discourse on developments in the new genetics

An important aspect of any meaningful public discussion about developments in gene technology is the provision of opportunities for interested publics to engage in sociable public discourse with other lay people and with experts. This article reports on a series of peer group conversations conducted in late 1996 and early 1997 with sixteen community groups in Perth, Western Australia, interested in gene therapy technology. With the case of cystic fibrosis as a particular focus, and using background resource material as a stimulus for discussion, the participating groups explored a range of value issues arising from the new genetic medicine. This more discursive context enabled participants to express a number of background or life-world concerns about genetic medicine, concerns that are often obscured by the dominant biomedical and bioethical discourses.

Support for the availability of prenatal testing for neurological and psychiatric conditions in the psychiatric community

Faculty and residents of the University of Michigan Department of Psychiatry, members of the Alliance for the Mentally Ill (AMI), and university students were surveyed to elicit attitudes toward the availability of prenatal testing and genetic therapy or enhancement for early- and late-onset psychiatric diseases compared to neurological disorders and human traits. They were asked to complete a written questionnaire designed to assess their opinions as to whether prenatal testing and genetic therapy or enhancement should be applied to 16 selected "disease" phenotypes or human traits: eight early- and late-onset psychiatric conditions, four neurological disorders, and four human traits. Twenty-two percent returned the written survey. The majority of all respondents supported the availability of prenatal testing for well-defined, serious psychiatric or neurological phenotypes and found testing for human traits less desirable. The percentages of respondents supporting availability of testing increased if in utero curative gene therapy was available. Response to the survey differed on the basis of gender and age, as well as personal versus professional familiarity with the condition. The results of this pilot study suggest that a majority of the population, including psychiatrists, will support the public availability of prenatal diagnosis for serious psychiatric or neurological phenotypes, even if no in utero curative therapy is available. Support for testing for human traits was not strongly endorsed.

Genes for human personality traits

This article considers three major problems with the concept of genes for human personality traits: (1) uncertainty about what human personality is; (2) what we mean when we say there is a gene "for" a mental attribute; and (3) the complexity of interactions between genes and environment, and among the genes themselves. It then draws on examples from empirical human genetic studies by the author and his colleagues in order to suggest that the concept of genes for human personality traits nevertheless does have some validity, and also that we may be on the brink of discovering genes with major effects on human personality. This possibility, in particular its ethical aspects, has aroused some public concern. It is suggested that confidential information about an individual's genes does not differ in principle from other confidential information about him or her, and that the ability (currently theoretical) to affect genes and their expression, temporarily or permanently, does not differ ethically from our current ability to affect other aspects of an individual's physical and psychological functioning. Genes for potential offspring, contained in ova and sperm cells, constitute a special case.

Genetic engineering: moral aspects and control of practice

Present-day scientific advances have made it possible to use somatic cell gene therapy for the treatment of serious human genetic disease. Gene therapy is enormously important for curing some diseases, otherwise untreatable. The technical ability to perform germline gene alteration is also under way. Society must determine its attitude toward germline alteration and toward intervention for the purpose of genetic enhancement. Eugenic genetics is purely theoretical at present and is likely to remain so for a long time. Articles in the press, sometimes influenced by specific pressure groups, generate public fear that is in most cases unfounded, due to the lack of feasibility of performing the claims voiced in them. Still, society must be concerned about the possibility that gene therapy will be misused in the future. Gene therapy should only be used in ways that maintain human dignity. The best insurance against misuse is a public well informed and not unnecessarily frightened. With proper safeguards imposed by society, gene therapy can be ethically used.