Gayle E Woloschak PhD DMin Northwestern University School of Medicine Zygon Center for Religion and Science Chicago Technology Issues Surveys about Scientists Views of children speak foreign language that no one can understand live underground wear white coats even when they sle ID: 598375
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Slide1
Orthodoxy and Pastoral Issues: Beginning of Life
Gayle E.
Woloschak
, PhD
DMin
Northwestern University School of Medicine
Zygon
Center for Religion and Science, ChicagoSlide2
Technology IssuesSlide3
Surveys about Scientists
Views of children: speak foreign language that no one can understand, live underground, wear white coats even when they sleep, wear glasses, don’t require food
Views of adults: speak language no one can understand, are anti-social, have cured diseases but only the rich people can get the curesSlide4
Science Impacts Humanity:
Understanding the world—education
Medicine—diagnosis, treatment, quality of life, end of life
Ecology—recombinant foods, environmental
issues
Genome science—genetic counseling, gene editing
Stem cells—new therapies, cloningSlide5
Example: Science drives the Ethics for HIV
Early considerations: quarantine, restrictions for interactions (including aid to those infected)
Science demonstrated route of viral transmission
Result
: Informed decisions
Knowledge gained from science impacted decisions so they could be made ethically.
Inclusion of scientists in discussions was important, made decisions timely and informed.
Facts shaped the understanding of the disease…and therefore the ethical treatment of patients.Slide6
“…science is a way of knowing, but it is not the only way. Knowledge also derives from other sources, such as common sense, artistic and religious experience, and philosophical reflection.”
Francisco Ayala (population geneticist, NAS member) in
Theology and Science
, 2003,
2:9-32Slide7
How Far is too Far? (or: Should we Limit Technology?)
New technologies are providing us with tools to manipulate the environment, nature, energy, etc.
Rapid movement from technology to discovery—makes it hard to limit the technology
Most limitation is done at the level of the application of the technology
Safety issues associated with technology take
second-place
Long term effects rarely considered or conceptualized
Positive and negative aspects to application of technologySlide8
Concerns about Technology and our Society
Conviction among general population that technology can cure all things afflicting humanity
Belief in technology over a belief in God
Little pause for reflection in culture about whether a technology should be used
Little testing of whether a technology is safe
Result: Attitude of entitlement, disappointment, high costs for medical interventionSlide9
Technology that is Available
Science and engineering are technology-driven.
Those that can use new technologies are the “can-dos” and ultimately become the “haves”
Those that don’t explore new technologies rapidly become obsolete.
Examples: cell phones, computers, earthquake-safe buildings, etc.Slide10
On Medical Knowledge as a Gift from God
“Medicine is a gift from God even if some people do not make the right use of it. Granted, it would be stupid to put all hope of a cure in the hands of doctors, yet there are people who stubbornly refuse their help altogether.”
“All the different sciences and techniques have been given us by God to make up for the deficiencies of nature…Not by chance does the earth produce plants that have healing properties. It is clearly evident that the Creator wants to give them to use to use.”
-St. Basil, The Greater Rules, 55Slide11
On the Source of Knowledge
“For it is he (God) who gave me unerring knowledge of what exists, to know the structure of the world and the activity of the elements; the beginning and end and middle of times, the alternations of the solstices and the changes of the seasons, the cycles of the year and the constellations of the
start,
the natures of animals and the tempers of wild animals, the powers of spirits and the thoughts of human beings, the varieties of
plants
and the virtues of roots; I learned both what is secret and what is manifest, for wisdom, the fashioner of all things, taught me.”
-Wisdom of Solomon 7:17-22Slide12
Orthodox Perspectives on Technology
Technology can be good or bad depending on how it is used—ex/radiation
Wisdom and creativity are gifts from God
Medicine and medical intervention are appropriate for humanity because they are gifts from God
Knowledge should not be blinded by self-importance
or be
bent on self-perpetuation
Must know how to act when needed and abstain when appropriate—when to act, when to “let it be”Slide13
Human Responsibility
Technology comes with a responsibility: to oversee it properly, to protect those who might be harmed by it (including the earth and animals)
Must exert proper stewardship over technology
Must try to be humble – it is not possible to imagine all consequences of a technology – being watchful and willing to accept truth is necessary
Must use discernment: eliminating technology means the elimination of cures; accepting all technologies will leave ethical concernsSlide14
Beginning of Life and IVFSlide15Slide16
Newly fertilized egg
3
rd
day embryo in mouse: 16 cells,
beginning of implantation
FIGURE 12.3 During preimplantation, the embryo consists of a limited number of cells. A: Newly fertilized mouse egg. B: By the 3rd day, the mouse embryo consists of only 16 cells. About 5 days after conception in the mouse, which corresponds to about 9 or 10 days in the human, the embryo becomes embedded in the wall of the uterus, and at about this time, cells begin to differentiate to form specific tissues and organs. (Courtesy of Dr. Pedersen, University of California at San Francisco.) Slide17
In Vitro Fertilization (IVF)
Used primarily to treat fertility “disorders”: help infertile couple bear children
Originally called “test-tube babies”
Approach: isolate eggs from mother, sperm from father, mix in the test tube, let the embryo develop for several days and then implant into the mother
Left over fertilized eggs in test tube can then be used for embryonic stem cellsSlide18
How are IVF-embryonic stem cell lines established?
IVF-generated fertilized eggs are grown in culture using “feeder cells” from mice to provide growth factors.
The process is inefficient and not all cells established in culture will become an embryonic cells cell line.
Once a line is established it is tested for 2 features: absence of genetic abnormalities (hard to measure) and ability to grow without developing into any set (partially mature) cell type.
Cells are then harvested and frozen for future studies.Slide19
Standard Laboratory for
Stem Cell StudiesSlide20
Embryonic Stem CellSlide21
Why IVF and not adoption?
Many question whether IVF is based in the need to pass “my genes” on to the next generation rather than care for a child to be raised.
High costs of adoption, difficulty of adoption, problems with enculturation are issues raised by those who choose IVF.
IVF is also expensive Slide22
Unique Aspects of IVF: Manipulation of the Embryo (PGD)
Pre-implantation Genetic Diagnosis
Selection against certain genetic defects
Selection for an embryo that produces certain proteins
2009: Clinic in LA offers screening for gender and physical traitsSlide23
Pre-implantation Genetic ScreeningSlide24
Nature
445
, 479-480
Reproductive medicine: The first cutSlide25
Religious Perspectives: Roman Catholic
Two major issues:
Strong opposition to IVF: IVF eggs are embryos despite their not having been in the womb
(
based on Encyclical Letter of Pope John Paul II, 1995)
Opposition to separation of sexual and procreative act (Vatican, 1993)Slide26
Other Religious Perspectives
Supportive of IVF/stem cell research: Jewish, Anglican, some Lutheran, Presbyterian, others
Opposed: Southern Baptist, National Association of EvangelicalsSlide27
Orthodox Christians and Sanctity of Life
Strong belief in the sanctity of life
Do not have same attitudes toward procreation as the Roman Catholic Church
Do have a general acceptance of technologies that preserve and protect life provided that it does not extend meaningless life
Major questions: (1) does the Orthodox Church accept IVF and (2) are the IVF-generated embryos human life?Slide28
Orthodox Attitudes Toward IVF
Contradictory
Some bishops have given a blessing for a married couple who cannot have children to use IVF to assist them.
This is done on a case-by-case basis.
It is not clear what the bishops thought about the remaining IVF-generated embryos.
Other bishops have refused to give a blessing. The Church of Russia has not sanctioned IVF. The Church of Greece has been more ambiguous.Slide29
Stem Cell ResearchSlide30
What are Stem Cells?
Stem cells are immature cells that under the right conditions can be induced to give rise to mature (differentiated) cells.
Two types of stem cells: adult and embryo
Applications for adult stem cells: bone marrow transplants, blood transfusions; other applications have not proven successful
Applications for embryonic stem cells: currently banned in the USSlide31
What are
Embryonic Stem
Cells?
Currently being developed for use in human disease; difficult because of potential for graft rejection
Concept: Some diseases lead to loss of cell function. Can we replace lost cells with embryonic stem cells?
Possible applications: diabetes, Parkinson Disease, Alzheimer Disease, spinal cord injury, othersSlide32Slide33
Lisa
M Hoffman & Melissa K Carpenter
. Characterization
and culture of human embryonic stem
cells.
Nature Biotechnology
23, 699 - 708 (2005) Slide34
Lisa M Hoffman & Melissa K Carpenter . Characterization and culture of human embryonic stem cells.
Nature Biotechnology
23, 699 - 708 (2005) Slide35
Pros and Cons of Embryonic Stem Cells
Cons: Sacrifice of embryos cannot be justified; use of embryos for stem cells could be used to “justify” abortions or even increase abortion
rates; embryonic stem cells can be rejected by the host
Pros: Stem cells may cure many diseases for which there is currently no treatment
Solution: Obtain stem cells from other
sources—some of these have been successful and mitigate problems of graft rejectionSlide36
Possible Sources of Embryonic Stem Cells
Embryo—obtain stem cells
from therapeutic
abortions
Cells remaining from IVF—fertilized eggs never implanted into a mother
Cloned cells—nucleus from adult cell transplanted into an egg cell
Oocytes that have been induced to have 2 nucleiSlide37
Adult vs. Embryonic Stem Cells
ADULT STEM CELLS
Used for decades: for example, bone marrow transplants
Orthodox Church has supported their use
Currently developed for additional therapies including cardiac diseases, with some limited successes
Reprogramming adult cells to be stem cells for different organs
Can match for compatibility from one person to another much like transplantation
EMBRYONIC STEM CELLS
Derived from other sources: fetal sources are NOT used; IVF is main sources
IVF-embryo stem cells use not supported by Catholics and some Protestants (groups against birth control); supported by Judaism, Episcopalian, Presbyterian, etc.; Orthodox have not expressed a view
Less limiting because embryonic stem cells develop into many cell types; more promising clinically
Experimental: no applications now
State limitation: transplantationSlide38Slide39
Isolate donor cells
Introduce virus
to express stem
cell genes
Add in feeder cells that
are “inactivated”
Small subset of cells
become
iPS
and
generate ES-like
colonies
Scheme for
iPS
Generation from Adult CellsSlide40
Pros and Cons of induced Pluripotent Stem Cells (iPSCs
)
Cons: Requires reprogramming of adult stem cells to be pluripotent: low efficiency, genomic insertion comes with risks, can go on to develop tumors, incomplete reprogramming sometimes occurs
Pros: does not need embryonic cells, do not need to worry about graft rejection
Some risks may be mitigated with newer technologies: gene editing is being improved, work with improved viruses as vectors may reduce cancer risksSlide41
Orthodox Perspectives
Opposed to use of embryos for stem cells
Perhaps opposed to the use of cells remaining from IVF—questionable
Questions about cloning- and oocyte-derived stem cells
Current discussions by
several Orthodox groups
No opposition to use of stem cells that are NOT derived from stem cells (but this is not well-discussed)Slide42
Technologies and Pastoral Care
Biotechnologies increase the number of decisions and turning points in life.
Challenge for pastors is to be equipped with sufficient understanding and insight to help individuals, couples, families address these issues.
Examples: marriage/pregnancy when genetic issues arise; guilt or blame or denial in decisions when a genetic condition results; questions about new forms of contraception, conception, and beginning of life questions.
Requires more collaboration between pastors and health professionals.Slide43
Genetic Counseling and PregnancySlide44
Genetic Counseling During Pregnancy
Often use small amount of amniotic fluid to examine genetics of the child (15-20
th
week of pregnancy)
Purpose is not always for aborting the child—can be to prepare the family for a difficult birth, treat the child at birth for a disease or abnormality, etc.
Risk of amniocentesis is 0.06% or lowerSlide45
Some diseases diagnosed by amniocentesis
Down Syndrome (Trisomy 21)
Trisomy 13, Trisomy 18
Fragile X Syndrome
Neural tube defects (
spina
bifida, anencephaly)
Other rare inherited disorders
Prediction of fetal lung maturitySlide46
Site for amniocentesisSlide47
Amniotic fluid:Slide48
Perform amniocentesis under ultrasound guidanceSlide49
Insertion of the needleSlide50
Orthodox Perspectives on Amniocentesis
Motivation is important
Appropriate motivations: to prepare the family for the coming child (particularly if a physical abnormality is predicted for birth), to help the child at the time of birth
Inappropriate motivations: abortion of a child
Motivations that involve selection of particular traits in children (male vs female) would not be considered acceptableSlide51
Gene EditingSlide52
What is CRISPR and what does it do?
CRISPR-Cas9
is a protein – nucleic acid complex that can be used to snip DNA at the precisely determined location
Why is that impressive?
There are billions of possible addresses for DNA cutting in a genome – CRISPR advances genome editing by leaps and bounds
.
CRISPR gives more precise cleavage and insertion with fewer off-target effectsSlide53
Cell. 2014 Feb 27;156(5):935-49.Slide54
By Boghog2 - Own
workThis
image was created with
PyMOL
, Public Domain, https://
commons.wikimedia.org
/w/
index.php?curid
=9027117
Structure of the
homodimeric
restriction enzyme
EcoRI
(cyan and green cartoon diagram) bound to double stranded DNA (brown tubes).[37] Two catalytic magnesium ions (one from each monomer) are shown as magenta spheres and are adjacent to the cleaved sites in the DNA made by the enzyme (depicted as gaps in the DNA backbone).
EcoRI
cuts
DNA
What sequence will be cut?
GTATAC
Repeated
thousands of times in
a genome
Probability of a correct replacement “fix” occurs is miniscule; wrong “fix” can cause cancer.Slide55
A CRISPR-Cas9 targeted double-strand break. Cleavage occurs on both strands, 3
bp
upstream of the NGG proto-spacer adjacent motif (PAM) sequence on the 3’ end of the target sequence.
https://
www.thermofisher.com
/us/en/home/life-science/genome-editing/genome-editing-learning-center/crispr-cas9-technology-information.html
CRISPR cuts DNA What sequence will be cut?
A target that is 20 nucleotides long and may be UNIQUE in the
genome. Majority of “fix” events that happens will happen at a correct place!Slide56
Improving accuracy
: Engineered high-fidelity CRISPR-Cas9 with no detectable off-target effects
High-fidelity CRISPR-Cas9 nucleases with no detectable genome-wide off-target effects.
Kleinstiver
BP,
Pattanayak
V,
Prew
MS, Tsai SQ, Nguyen NT, Zheng Z, Keith
Joung
J. Nature. 2016 Jan 6.
doi
: 10.1038/nature16526.Slide57
Naturally encoded CRISPR/Cas9 inhibitors efficiently block genome editing in cultured human cells providing a much needed “off-switch”.
Pawluk
, A., et al., Naturally Occurring Off-Switches for CRISPR/Cas9. Cell 167, 1829-1838 (2016)
Developing programmable shut-off
: Developing inhibitors of Cas9Slide58
DIY CRISPR cloning kit $150
Josiah
Zayner
was a postdoc at NASA when he first started thinking about do-it-yourself biology. Using
crowdfunding
,
Zayner
raised $71,036 by December 2015 and created The ODIN. The ODIN now sells genetic engineering kits, such as the CRISPR kit, that contain everything one needs to perform a sample experiment. With a full-time staff of four,
Zayner
and his team make the components of the kit or purchase them from overseas wholesale manufacturers; they then assemble the boxes in
Zayner’s
Palo Alto garage and mail them to customers.
http://
www.biotechniques.com
/news/
biotechniquesNews
/biotechniques-365397.html#.WLr_DBIrJqxSlide59
In US…
There was some interest in a moratorium on use of CRISPR-cas9
Many scientists called for a “world-wide moratorium”
Top scientists called it “essential”
In DC, an international summit was held (including EU and Asian countries):
1. Basic and preclinical research: necessary
2. Clinical use somatic cells: promising
3. Clinical use germline: great potential but risk because of potential off-target effects, implications for future generations, could lead to permanent genetic “enhancements” and more
4. Need for continued discussion
…
.Slide60
Heritable Genome Editing Perspectives (NAS report)
Advantages: Preventing transmission of inherited disorder; treating diseases that affect multiple tissues
Limitations: Mosaicism; alternative routes to heritable edits (sperm precursors, e.g.); effect on the human gene pool
Ethical concerns: Balancing individual-level and societal-level benefits (cures vs. unintended risks); natural vs edited genome; human dignity vs. fear of eugenics; economic and social justice; slippery slopeSlide61
Orthodox Perspectives
No discussion on gene editing is on-going
Several panels exist among non-Orthodox Christian groups: Lutheran, Anglican/Episcopalian, Presbyterian in US
THERE NEEDS TO BE DISCUSSION ON THIS!! It will become a pastoral issue.Slide62
Concluding ThoughtsSlide63
Technology in the Light of Humility: Job 38
4
“Where were you when I laid the foundations of the earth? Tell me, if you have understanding.
5
Who determined its measurements? Surely you know! Who stretched a measuring line across it?
6
On what were its bases sunk, or who laid its cornerstone—
7
when the morning stars sang together and all the sons of God shouted for joy?
8
Or who shut up the sea behind doors when it burst forth from the womb,
9
when I made the clouds its garment and thick darkness its swaddling band,
10
and prescribed bounds for
it and
set its bars and doors,
11
when I said, ‘This far shall you come and no farther; here is where your proud waves be stayed’?
12
“Have you ever given orders to the morning, or shown the dawn its place,
13
that it might take the earth by the edges and shake the wicked out of it?
14
The earth takes shape like clay under a seal; its features stand out like those of a garment.
15
The wicked are denied their light, and their upraised arm is broken.
16 “Have you journeyed to the springs of the sea or walked in the recesses of the deep? 17 Have the gates of death been shown to you? Have you seen the gates of the deepest darkness? 18 Have you comprehended the vast expanses of the earth? Tell me, if you know all this.Slide64
Humility
No technology should be used primarily to exalt the achievements of humanity or to prove human ”mastery” over death, disease and aging.
Through science we may seek to gain knowledge about God’s creation, but we must realize the limits of our comprehension and utter impossibility of applying our cognitive powers to an understanding of God that penetrates to the depths of His Being.
Nevertheless, if humans develop the ability to treat a disease with technology, it should be viewed as a gift from God.
Slide65
Humans as Microcosm and Mediators
“Because the human person is both microcosm and mediator, unifying the creation and offering it back to God in thanksgiving — because more particularly, we humans have the ability consciously and by deliberate choice to modify and refashion the world — there is imposed upon us a grave and daunting responsibility. The fact that we are made in the divine image and so endowed with freedom — creators after the image of God the Creator — carries with it a terrible risk. We can use our creative power both for good and for evil. We can illumine and transfigure, but equally we can pollute and destroy.”
-from Bishop
Kallistos
(Ware) or
Diokleia
, “Through the Creation to the Creator”Slide66
Metropolitan Anthony of Sourozh
:
“Our task is not merely to imitate what was done by the saints of previous eras, but somehow to appropriate at a much deeper level the way in which they engage their own historical environment, seeking to respond as they would have responded had they lived in our day.”