Ética da edição genética no ser humano

Purpose/Context. This article discusses ethical aspects of gene editing in humans.Methodology/Approach. The main applications of genetic technology in the prevention, diagnosis and therapeutics of genetic diseases in recent decades, are described, culminating with genetic editing.Results/Findings. The main ethical aspects of somatic and germline gene editing in humans are discussed, including issues of safety, specificity, precision and certainty. Germline genetic editing and human "enhancement" are criticized for violating individual autonomy, for generating heritable genetic changes in the progeny and for accepting the fallacy of genetic reductionism that people's traits depend exclusively on genetic makeup, independent of the environment. Discussion/Conclusions/Contributions. Somatic gene editing can be ethical if the ethical standards of biomedical research are followed. However, germline genetic editing is not relevant nor necessary for the treatment of genetic diseases and, furthermore, it presents serious ethical conflicts. Therefore, prior to its application, a social consensus is necessary, obtained by democratic, broad and profound discussions among all the social players involved, followed by governance mechanisms with robust regulation by the state, which prevent the violation of fundamental human rights.Propósito/Contexto. Este artículo analiza aspectos éticos de la edición genética en seres humanos.Metodología/Enfoque. Se describe el desarrollo de las principales aplicaciones de la tecnología genética en prevención, diagnóstico y terapéutica de enfermedades genéticas en las últimas décadas, culminando con la edición genética.Resultados/Hallazgos. Se definen los principales aspectos éticos que presenta la edición genética somática y germinal en seres humanos, incluyendo cuestiones de seguridad, especificidad, precisión y certeza. Se critica la edición genética germinal y el concepto de “mejoramiento” humano por vulnerar la autonomía individual, generar cambios genéticos heredables en la progenie y aceptar la falacia del reduccionismo genético de que los rasgos de las personas dependen exclusivamente de la constitución genética, independiente del ambiente.Discusión/Conclusiones/Contribuciones. La edición genética somática puede ser ética si se siguen las normas éticas de la investigación biomédica. Por el contrario, la edición genética germinal no es pertinente ni necesaria para el tratamiento de enfermedades genéticas y presenta graves conflictos éticos, por lo cual, previo a su aplicación es necesario un consenso social por discusiones democráticas, amplias y profundas entre todos los actores sociales involucrados, seguido de mecanismos de gobernanza con regulación robusta por parte del estado, que impidan la vulneración de derechos humanos fundamentales.Finalidade/Contexto. Este artigo discute aspectos éticos da edição de genes em humanos.Metodologia/Aproximação. Descreve o desenvolvimento das principais aplicações da tecnologia genética na prevenção, diagnóstico e terapia de doenças genéticas nas últimas décadas, culminando com a edição de genes.Resultados/Descobertas. São definidos os principais aspectos éticos da edição de genes somáticos e da linha germinal no ser humano, incluindo questões de segurança, especificidade, precisão e exactidão. A edição genética da Germline e o conceito de "melhoramento" humano são criticados por violarem a autonomia individual, gerando alterações genéticas hereditárias nos descendentes e aceitando a falácia do reducionismo genético de que as características das pessoas dependem exclusivamente da sua constituição genética, independente do ambiente.Discussão/Conclusões/Contribuições. A edição somática de genes pode ser ética se os padrões éticos da investigação biomédica forem seguidos. Pelo contrário, a edição genética na linha germinal não é relevante nem necessária para o tratamento de doenças genéticas e apresenta graves conflitos éticos. Por conseguinte, antes da sua aplicação, é necessário um consenso social através de discussões democráticas, amplas e profundas entre todos os actores sociais envolvidos, seguidas de mecanismos de governação com regulação robusta por parte do Estado, que impeçam a violação dos direitos humanos fundamentais

Genetic Testing in Emerging Economies (GenTEE)

Drivers, barriers and opportunities for genetic testing services in emerging economies: the GenTEE (Genetic Testing in Emerging Economies) project Background: Due to the epidemiological transition in the emerging economies of China, East Asia, India, Latin America, the Middle East and South Africa, these economies are facing (i) an increasing proportion of morbidity and mortality due to congenital and genetic conditions, (ii) a rising need for genetic services to improve patient outcomes and overall population health. These economies are facing the challenge how: (i) to ensure the successful translation of genetic/genomics laboratory and academic research into quality assured pathways, (ii) to develop a service delivery infrastructure that leads to equitable and affordable access to high quality genetic/genomic testing services. Objectives: (i) to document and compare current practices and the state of genetic service provision in eight emerging economies: Argentina, Brazil, China, Egypt, India, Oman, Philippines and South Africa, (ii) to identify current knowledge gaps and unmet service needs. The GenTEE international project is intended to inform policy decisions for the challenges of delivering equitable high quality genetic services and to promote international collaboration for capacity building. Methods: (i) a standardized survey that is the first of its worldwide that allows comparison of services internationally across a number of key dimensions by using a core set of indicators, selected by the GenTEE consortium for their relevance and comparability, (ii) capacity building demonstration projects. To date, the GenTEE project has completed its survey that maps the current state of genetic services in the participating countries and identifies current drivers, barriers and opportunities for genetic services development. Results: There is no equitable access to genetic services in all countries mainly due to financial barriers (underfunded fragmented public services, out-of-pocket expenses tend to be the norm for genetic testing services), geographical barriers (concentration of services in main cities) and skill gaps, resulting in inequitable services or delayed access. The development of services in the private sector is opportunistic and mostly technology and market driven. There is a marked lack of standard operating procedures and agreed quality assessment processes for new technologies. Discussion: International collaborative networks can provide support for capacity building and help to strengthen the provision of quality genetic/genomic services in emerging economies.JRC.I.1-Chemical Assessment and Testin

Bioética y tecnociencia

El desarrollo de la tecnociencia en los últimos decenios ha sido vertiginoso y los problemas y dilemas bioéticos que plantea a la humanidad son incontables. Sin embargo, el pensamiento bioético está recién comenzando a analizar la trascendencia de los adelantos científico-técnicos; particularmente en relación a problemáticas de frontera, tales como: las tecnologías de fertilización asistida, las investigaciones con células madre, el mantenimiento de la vida con técnicas artificiales, entre otras. Temas cardinales como la humanización de la medicina, el derecho a la salud, la influencia nociva de la comercialización y la medicalización excesiva no forman parte hegemónica del discurso bioético. Es preocupante que la formación de los profesionales de salud mayoritariamente ignora la importancia de la bioética secular fundamentada en los derechos humanos, que debiera ser el eje de la capacitación para prestar atención de salud. Éste artículo se focalizará en la genómica, una rama de la tecnociencia de gran predicamento actual

Genetics and human rights: Two histories: restoring genetic identity after forced disappearance and identity suppression in Argentina and after compulsory isolation for leprosy in Brazil

Over the past three decades, there has been an accelerated development of genetic technology, leading to its use in human genetic identification for many purposes. Additionally, it has been made explicit that identity is a fundamental human right. A number of historical circumstances have connected these developments. Personal identity is increasingly associated with the preservation and defense of human rights and is a tool to repair the violation of these rights, particularly the right to identity. In this article, we report the use of genetics to support the right to identity in two historical circumstances. First, we report the search, localization, DNA testing and genetic identification of 110 individuals who were appropriated as babies by the Argentine military dictatorship of 1976-1983 in the context of savage repression and egregious violations of human rights, including forced disappearance and suppression of identity. Second, we report on the repair of right-to-identity violations of hundreds of individuals that occurred during the process of compulsory isolation of patients with leprosy in Brazil through the Program "Reencontro", which has led to the genetic identification of 158 pairs of individuals who previously did not have proof that they were siblings. The high value placed on genetic identification by victims of identity suppression did not counter the prevailing view that genetic factors were not more important than other factors (social, emotional, educational, cultural, spiritual) in determining the complex phenomenon of personal identity. The use of genetic identification as a tool to redress and repair human rights violations is a novel application of human genetics for the benefit of mankind