There are five items on my list of basic human challenges posed by genetics and genetic medicine. I discuss them in the order of their urgency in my mind--others may have different items on their list and a different order of importance.
(1) We see now that we have both the technological capability and the desire to alter human persons, in some sense to alter even basic human nature. This is the most fundamental issue raised by genetics and genetic medicine. From the earliest days of the human species, we have attempted to shape human nature by social conditioning and education, and now we add the tools of biological, genetic alteration to our repertoire. We are able to alter individuals in what we call "somatic" gene intervention; in "germ line," interventions we will affect future generations as yet unborn. Is genetic engineering now an integral element in our human nature? Is this ability now a defining mark of what it means for us to be human? That is the bottom-line question raised by genetics for us today.
This is the first and most basic challenge that I bring to our attention today.
Every society at one time or another has to deal with the question of priorities in the accessibility of health care. In most cases, the priorities are governed by funding and the availability of competent care-givers. Now, however, since we possess techological means never before available, of which genetic medicine is a major component, we face a new kind of question: are illnesses and defects to be considered "sling and arrows of outrageous fortune,"the "roll of the dice," as previous generations of human beings have been compelled to say? Or are they targets in the process of developing cures, access to which is a basic...