Is CRISPR human genome editing technology ethical?

CRISPR could amplify existing social inequalities

Question: Is CRISPR human genome editing technology ethical?
Position‹2 of 3›: Using CRISPR is unethical
Argument‹2 of 2: CRISPR could amplify existing social inequalities

CRISPR treatments are very expensive. If only wealthy families had access to using CRISPR, then the result would be that less wealthy families would be the only ones with children with genetic diseases.

The argument

Genetically modifying an embryo or adult is not a cheap endeavor. Dr. Mildred Cho, a Stanford bioethicist and professor of pediatrics and medicine, has stated that the financial cost of CRISPR will likely result in many patients being unable to use the technology. She points out that gene therapy is not like getting a prescription medication, but is instead like getting an organ transplant. Using CRISPR is a highly complex procedure, so its cost will reflect that. Other gene therapies cost around $500,000 to $1,500,000 per patient, so it is likely that the cost of a CRISPR treatment would be in that range. Additionally, until a substantial amount of studies have been done on the efficacy of CRISPR treatments, it's unlikely that insurance companies will help with the cost. If CRISPR use was allowed, but at a steep price tag, this would mean that only wealthy families would be able to afford CRISPR treatments. The result of this would be that wealthy families and individuals would not have genetic diseases, while those in lower socioeconomic standings would continue to have genetic diseases. This would obviously contribute to social inequality and a widening of the wealth gap. Additionally, this would likely result in less resources for treating genetic diseases being available (since there would overall be less people with genetic diseases), with less wealthy individuals and families being disproportionately affected.

Premises

[P1]CRISPR treatments will be prohibitively expensive, comparable to other gene therapies costing $500,000 to $1,500,000 per patient, and unlikely to be covered by insurance. [P2] At such prices, only wealthy families could access CRISPR, leaving genetic diseases concentrated among lower-income populations while resources for treating those diseases dwindle. [P3] Technologies that systematically widen the wealth gap and disadvantage the poor are unethical. [C] Therefore, using CRISPR is unethical because it would amplify existing social inequalities.

Counter-arguments

Just because CRISPR is currently expensive to use, that does not mean that it will always be expensive. A big reason why CRISPR is so expensive at the moment is because of licensing. One example is the Broad Institute, which currently holds patents to a few CRISPR tools and which has only given exclusive licenses to Editas to use CRISPR for medical purposes. Instead, if the Broad Institute issued more affordable CRISPR licenses and cut out the middle man (Editas), the cost of CRISPR treatments could go down substantially. If the price of CRISPR became more accessible, then we would not need to worry about CRISPR use exacerbating social inequality.

Rejecting the premises

[Rejecting P1] Current prices are a snapshot of a young technology under exclusive licensing, not a fixed property of it. Sequencing costs collapsed within two decades, and the patent arrangements the premise prices in are themselves changeable. [Rejecting P2] The distributional picture assumes both a permanently high price and no public provision. Where national health systems or insurers cover a one-off curative treatment — as they have come to for other high-cost therapies — the pattern described does not follow. [Rejecting P3] The principle proves too much. Dialysis, transplantation and antiretrovirals were all scarce and expensive at introduction and became widely available; unequal access is an argument about how a technology is distributed, not about whether using it is ethical.