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Chapter
6
Social and Ethical Implications
The Department of Energy and the National Institutes of
Health have allocated 3-5%, which is around £120 million
dollars of their budget to study, analyse and address the
ethical, legal and social implications surrounding the
availability of the genetic information. These informations
arise in speeding pace as the Human Genome Project reaches
its destination. The DOE and NIH also created the NIH-DOE
ELSI working group, which has a wide and diverse spectrum of
experts, including Molecular Biologists, Medical
Geneticists, Law experts, Ethical professors, Theologians
and consumers to explore and consider options for the
development of sound professional and public policies
related to the implications of the Human Genome Project.
“This endeavour represents the largest bioethics programme
in the world”.
The general interest of the public in Human Genome project
is directed primarily towards serious genetic disorders
within families or among friends. Nevertheless it is now
clear that genes are responsible for many other conditions.
Cancer for example, in most cases originated from
cancer-causing genes, collectively called “Oncogenes”. Also
numbers of other complex traits, such as Alzheimer and other
psychiatric disorders have genetic components. Recent
studies confirm that chromosome 21 had a gene or genes
responsible for certain Alzheimer’s cases.
To discuss these important issues, the following topics will
be covered in further details :
1- Historical and Political background to Human Genome
2- Privacy, Confidentiality and fairness in dealing with
genetic information
3- Reproductive implications
4- Psychological implications
5- Philosophical and conceptual implications
6- Bioethical and Islamic View
6.1. Historical and Political Background
to Human Genome
Large number of people from scientific and non scientific
circles are very concerned with the developments in genetic
sciences and are afraid of the memory of eugenic movements
in Nazi Germany, rest of Europe and United State during the
first half of last Century. If the development in modern
knowledge of Human Genome is aimed to benefit Human being
rather than harm them, there must be an awareness and
understanding of the lessons of history among the scientific
circles and society at large. Those lessons of Eugenics
movement, which used some, distorted scientific data to
justify its ideology and inflicted misery among wide
spectrum of people across the civilised world!
6.1.1. Eugenics Movement :
The word Eugenic taken from a Greek meaning, “noble in
heredity”, first used and refined by Francis Galton in 1883.
Francis was the first cousin of Charles Darwin and was
fascinated by his theory of Evolution in his famous book
“origin of species”, which many scholars acknowledged its
influence on Galton’s theory of Eugenics. This theory
proposed that Human race could be improved in the same
manner as plants and animals breeding. The improvement of
Human race is possible through controlled selective breeding
of individuals having desirable characteristics. By doing
so, Galton’s intention was to improve Human race by
multiplying the desirable and getting rid of undesirable
characteristics. Francis who founded the Eugenic society was
born into a wealthy Victorian family of gun makers and
bankers, with racist views and usually imposed his imagined
superiority on all who had the misfortune to meet him, in
particular black Africans (Jenkins, 1998).
The idea of selecting and breeding Human race goes back to
the time of Plato 427 BC, when he proposed to breed gifted
women to gifted men for the production of healthy race!!.
Aristotle’s politics in 384 BC advocated the abortion and
killing of the handicapped.
After 2000 years of civilisation, the racial attitude of
certain minds, which were considered the best of its time,
had not changed. Socialist play writer George Bernard Shaw
(1856-1950), towards the end of his life wrote, “If we
desire a certain type of civilisation, we must exterminate
the sort of people who do not fit into it… Extermination
must be put on a scientific basis if it is ever to be
carried out humanely and apologetically as well as
thoroughly”, (Garvin, et al 1995).
The work of Professor Pearson of Galton Eugenic Research
Laboratory at University college London, as well as the
works of Charles Davenport of Carnegie Institution of
Washington, who had been influenced by Galton’s work, had
fuel the extreme racial views at that time in Europe and
United states. The works of those scientists and others
alike, were influenced to great extent by preconceived idea
resulted in falsifying data regarding the biological bases
of intelligent and criminality (Kevles, 1985). Davenport and
his associates’ works, which appeared in his comprehensive
1911 book, Heredity in relation to Eugenics, and in later
publications, concluded that the traits must be biologically
inheritable. He attempted to fit the pattern of inheritance
into a Mendelian frame. He argued that patterns of
inheritance were evident in insanity, epilepsy, alcoholism
and criminality. The mental and behavioural characteristics
of different races were a major concern for Davenport, who,
like eugenic scientist elsewhere, held different national
groups and “Hebrews” to represent biologically different
races and to express different racial traits (Kevles and
Hood, 2000). Whereas the finding of Human Genome project
revealed that Human being are 99.9% similar in their genetic
materials and quite possible to find an African person more
similar biologically to European than to his native
African!. The scientific data produced by these two
laboratories were used extensively to its extreme limits by
eugenic movements to justify their racial and ill-thinking
motives. In addition, these data also influenced world
leader and decision-makers to institutionalise the eugenic
science. The followings are few examples of this extreme
attitude :
*
Carl Brigham, an American Psychologist, published an
analysis of huge amount of data in a book in 1923, the name
of the book was “A study of American Intelligence”. In this
book Carl concluded that Alpine and Mediterranean races were
intellectually inferior to the representatives of the Nordic
race, and that black American were much less intelligent
than the white American (Russo and Cove, 1995). This book
gave the “scientific” basis for the introduction in 1924 to
US law of an Immigration Act to restrict immigration. As a
congressman said “The primary reason for the restriction of
the alien stream … is the necessity for purifying and
keeping pure the blood of America”. The American president
who signed the law, Calvin Coolidge said when he was
vice-president “America must be kept American. Biological
laws show … that Nordics deteriorate when mixed with other
races”, (Russo and Cove, 1995). The works of Davenport, who
claimed that many social problems, alcoholism, criminality
and mental problems were inherited traits, were behind the
sterilisation law in Indiana in 1907. Davenport claimed that
there must be bad genes behind these traits, and if we
wanted a future without criminals, the criminals must be
prevented from procreation. The solution therefore is
sterilisation. One of the wide-ranging sterilisation laws
was passed in Iowa in 1911 (Russo and Cove, 1995).
*
Adolf Hitler, in his fascination with Aryan race, which he
believed is the best race said, “It is outstandingly evident
from history that when the Aryan has mixed his blood with
that of inferior peoples the results of mixed breeding has
invariably been the ruin of the civilising race”. In the
year he was elected in 1933, a eugenic sterilisation law was
passed and was only the beginning of the Nazi programme.
Hitler description of Aryan is tall, slim, and blond with
blue eyes, athletic and intellect with leadership qualities.
He considered these qualities as a pure breed and should not
mixed with other qualities! When a Black American athlete
won 4-gold medals in 1936 Olympic games in Berlin, Hitler
refused to present him with the Medals, and this incidence
turned his ideology of Eugenics into total nonsense. These
extreme views of Nazi eugenic movement were supported and
encouraged by Hitler’s regime, who passed the radical racial
hygiene law in 1933, and by 1945 about 2 million young
Germans had been forcibly sterilised most between 15-17
years old (Burleigh and Wipperman, 1991).
*
Winston-Spencer Churchill, in 1910 when he was home
secretary said, “The unnatural and increasingly rapid growth
of the feeble-minded and insane classes constitutes a
national and race danger, which is impossible to exaggerate.
I feel that the source from which the stream of madness is
fed should be cut off and sealed off before another year is
past”. Churchill’s comments were considered so outrageous,
especially in the light of subsequent events, that they were
not made public until 1992 (Garvin, et al 1995).
Sterilisation was fiercely opposed in Britain, and requires
parental consent, despite a lot of enthusiasm expressed from
other sectors in the society. Sterilisation appears to be
much less frequent than in other European countries, and
instead family planning through contraception was
advocated.
*
Swedish newspaper has revealed that over 60000 people were
forcibly sterilised in Sweden between 1932 and 1976, for
eugenic reasons. Sterilisation was performed legally under
the 1926 eugenics law, and the programme was a matter of
public records. It has also been revealed that there were
widespread compulsory sterilisation programmes in Finland,
Norway and some Swiss cantons. In Austria it appears that
the practice is still continuing (GenEthics, 17, 1997).
Finland sterilised 9000 people and Norway 2000. It has been
reported that 15000 women have been illegally sterilised in
France. In Japan 16000 women were sterilised between 1949
and 1995, under the eugenic protection Act of 1947. In
Austria, sterilisation of mental patients is still legally
permitted, and although there are no clear statistics, the
Green Party alleges that 70% of women with learning
difficulties have been operated upon. The practice also
appears to be continuing in Switzerland (GenEthics, 19,
1997).
*
China’s Law in 1995 on maternal and health care has been
widely viewed as eugenic. The law has been stipulated that
where a serious genetic disease affects one member of a
couple, the couple may not marry unless they agree to
sterilisation or long term contraception. Another part of
the law says that where a foetus is diagnosed with a genetic
disease, the couple must follow the doctor’s advice (GenEthics,
25, 1998).
There are two forms of eugenics : positive eugenics and
negative eugenics. Positive eugenic, means manipulating
Human genetic materials for the purpose of enhancement of
the Human potentials to produce superior people, as recently
stated by the president of the International Association of
Bioethics (IAB), Hyakudai Sakamoto of Nihon University. He
claimed that in Asia, there is no fixed distinction between
the natural and the artificial, and that in Buddhist though,
everything is constantly changing. Therefore genetic
engineering should be used for what he called the
“artificial evolution” of Human kind”! (GenEthics, 17,
1997). On the other hand negative eugenics, Implied the
elimination of the biologically inferior people either by
sterilisation laws or preventing others through immigration
laws.
It is quite frightening, and the society has the legitimate
concerns with regards to rapid development in what people
currently refer to as genetic era. If scientists like
Davenport and Galton who were so arrogant and knew little
scientific self-doubt, reappear again, armed with this real
powerful knowledge. It might be possible that they would
recommend the application of their scientific knowledge to
the social problems and offered their expertise to policy
makers to pass a range of laws like those of Eugenics time.
It is worth remembering in this instance a recent scientist
of such arrogant mentality. Professor Richard Seed, an
American physicist and researcher in embryology who intended
to open 10-20 cloning clinics in America and up to six
overseas. His proposal was greeted with horror around the
world and Clinton administration called for legislation to
ban professor Seed’s work. When he was confronted with a
question that his proposal was unethical in a radio
interview, he claimed that there was a “moral imperative” to
proceed; God made man in his own image. God intended for man
to become one with God, we are going to have almost as much
knowledge and almost as much power as God. This sort of
mentality is quite frightening if not controlled!
The new era of genetic with the completion of deciphering
Human Genome, may guide us into new form of eugenic. The
ability to select and grade Human embryo, brought about by
the alliance of medically assisted procreation (MAP) with
the diagnostic genetics, has created entirely new conditions
in the quality control of children. It enables parents and
doctors to refuse the low-grade handicaps that used to be
tolerated in conventional antenatal diagnosis (AND)
screening (which I will explain in further details later
on). The same diagnosis reached by (AND) requires more
circumspection than one made by preimplantation diagnosis (PID)
(which again will be discussed later) in a newly fertilised
embryo. AND involve a single foetus, which the parents
already think of as their baby, whereas PID is based on a
multiplicity of eggs carrying relatively low emotional
weight and as yet isolated from the mother’s body. Embryo
multiplicity is the cornerstone of a successful MAP
programme and the motor of the new eugenics : In AND the
worst was weeded out; in PID the best in planted in (Testart,
1995).
6.2. Privacy, Confidentiality and
Fairness in Dealing with Genetic Information :
The most critical issue of social implications of the Human
Genome is the privacy, confidentiality and the fairness in
the use of the genetic information.
Rothstein of the University of Houston, Law centre define
“Privacy” as the limited access to a person, the right to be
alone, and the right to keep certain information from
disclosure to other individuals.
Confidentiality, on the other hand, is the right of an
individual to prevent the redisclosure of certain sensitive
information that was originally disclosed in the confines of
a confidential relationship. Protecting confidentiality can
be difficult because others think they should have the right
to see an individual’s information (Rothstein, 1999). In
Hippocratic oath, first mentioned the “duty of
confidentiality”. The need to maintain the confidentiality
is considered as an ethical obligation in the relationship
between the patient and his doctor. This obligation
facilitates the openness and frank communication between the
two parties. This help immensely in the diagnosis and
treatment of the patient. The patient is reassured that his
dialogue with his doctor would remain confidential and any
documented information would remain secret. This is in legal
term, may be considered as an aspect of patient’s right to
privacy (Weiss, 1998). According to American Society of
Human Genetics, genetic information is medical information
and as such is entitled to confidentiality (NHGRI, 1998).
The growing number and use of genetic tests has many worried
about discrimination due to inappropriate access to, and use
of, private genetic information. A Gallup poll by the
institute for Health Freedom released in September 2000
revealed that 86% of US adults believe that physicians
should obtain permission before doing any genetic testing
beyond routine testing. Similarly, 93% of adults believe
that their permission should be granted before researchers
use their genetic information (Jefford and Daschle, 2001).
People who advocate that genetic information should not be
disclosed, point out to the historical abuses by Eugenic
movement, in particular the Nazi Germany, where
sterilisation were carried out in large scale as we
discussed earlier.
The National Human Genome Research Institute (NHGRI) made
the following observation in 1997 in one of its fact sheet:
Each of us probably has 5-50 genetic mutations that place us
at risk for some diseases. As genetic information accumulate
more and more of us will be classified as carriers of
genetic information that predispose us to disease. With the
help of the progress in genetic research and the completion
of Human Genome Project, diagnostic, preventive and
treatment of the diseases will be easier, and will be of
great benefit for the well being of humanity. But the fear
of the misuse of this information will be the big hurdle to
advancement of genetic research and a roadblock to reaping
the benefit. People may be unwilling to participate in
research and to share information about their genetic status
with their health providers or family members because of
concern about misuse of this information (Hudson, et al.,
1995). The misuse of genetic information to exclude
high-risk people from health care by denying coverage or
charging prohibitive rates will limit or nullify the
expected benefits of genetic research. Genetic screening may
create a class of people that labelled as unemployable and
/or uninsurable.
Unless safeguards are established, we all run the risk of
being victims of genetic discriminations on various levels,
employment, insurance, ethnicity, education, courts,
military and many others. American president Clinton
acknowledged the benefits of the Human Genome project, but
warns against the misuse of genetic information, in his
announcement in 1997 for the support of legislation to
provide comprehensive solution to the problem of genetic
discrimination. He said, “Genetic discrimination is more
than wrong. It is a life -threatening abuse of a potentially
life-saving discovery”.
In order not to go in further details I will discuss the
issue of privacy, confidentiality and fairness form three
angles :
6.2.1. Doctor-patient relationship :
It is proved to be difficult for doctors to draw a clear
line between their patient’s privacy to their genetic
information and the disclosure of that information to third
parties who are at risk. Deftos in 1998 referred to the
American Medical Association (AMA) permit to breach the
confidence of the patients regarding his/her genetic
information, when there is a need to protect the welfare of
the relatives or the public interest. The American Society
of Human Genetics (ASHG) advocate that genetic information
relevant to health risk could be released by family doctor
to other family members or close relatives to make them
aware of a serious risk of harm and to take practical steps
to minimise or remove that risk. In extreme case, physician
may be privileged to violate a patient’s privacy if
justified by the likely reduction of imminent risk of harm
to an identifiable third party (Weiss, 1999). Though in less
critical situation the information should be kept
confidential. It appeared that there is a trend of support
from medical and legal point of views to disclose genetic
information to third parties whenever there is a likelihood
of risk. Since there is no Federal law currently in place to
prohibit release of genetic information, as such each state
has it’s own legal procedure to deal with dispute of this
nature. To clarify these, two examples will be explained :
In Olson v. Children’s Home Society of California (1988),
the appellate court found no duty to disclose a genetic
condition to relatives. The case involved a woman who had
agreed to have her infant son adopted. Thirteen years later,
she married, gave birth to another child who later died of a
genetic disease. When she contacted the adoption agency to
inquire about the health of the son she had put up for
adoption, she was informed that the child was still alive,
but also had a genetic condition. She and her husband sued
the agency for wrongful death of their son, intentional
infliction of emotional distress, and fraud, claiming that
the agency had a duty to warn them that her child had a
genetic disease. The trial court dismissed the complaint and
the appellate court affirmed, holding that there was no
special relationship between her and the agency that created
a duty to notify her of the risk of having another child.
Another example, In Schroeder V. Perkel and venin (1981), a
New Jersey couple who had two children born with Cystic
Fibrosis sued the paediatrician who had treated older
children and negligently failed to diagnose the condition in
sufficient time to prevent the second pregnancy or to abort
it. The New Jersey Supreme Court held that the physicians
had a duty to the child as well as an independent duty to
the parents to disclose that the child suffered from cystic
fibrosis. Failure to diagnose the disease and advise the
parents was a breach of the physician’s duty to the parents.
Each physician could be held liable for the medical costs of
a second child born with cystic fibrosis. The physician’s
defence was that they owed no duty to the parents because
the parents were not their patients. The court decided the
case on foreseeability ground, holding that “The
foressability of injury to members of a family other than
one immediately injured by wrongdoing of another must be
viewed in light of the legal relatioships among family
members. A family is woven of the fibres of life;
Although individually spun, create a web of interconnected
legal interest…. A physician duty thus may be extended
beyond the interest of a patient to members of the immediate
family of the patient who may be adversely affected by a
breach of that duty (Weiss, 1999).
6.2.2. Employment :
Many people are concerned about potential genetic
discrimination by their employers. In 1995 poll of general
public revealed that 85% indicated that genetic information
should not be disclosed to employers and insurers (Miller,
1998). The same finding was found in 1988 National Centre
for Genome Resources (NCGR) survey. Where 1000 American
adults were asked about genetic information, and the survey
found that the majority (85%) believed that employers should
not have access to a patient’s genetic information. 63%
indicated they “probably” or “definitely” would not undergo
genetic testing if they knew that insurers or employers
could discover the results information (Jefford and Daschle,
2001). Georgetown University survey also showed the same
trend.
Federal Laws in America such as “The American with
disabilities Act” and the “Rehabilitation Act” provide some
protections against genetic discrimination in the workplace.
The Society for Human Resource Management (SHRM) issued a
policy document in November 2000, that stated, “The SHRM
would oppose employment policies that permit employment
decisions to be made based on an individual’s genetic
information” (Jefford and Daschle, 2001).
Currently there are 24 states in America have enacted laws
regarding genetic discrimination and employment. These laws
stated that, no employers may required genetic testing or
may use the results of genetic testing or genetic
information to discriminate in employment.
In March 1995, the US Equal Employment Opportunity
Commission (EEOC) released official guidance on the
definition of the term “disability”. The EEOC’s guidance
clarifies that protection under the American with
disabilities Act (ADA) extends to individuals who are
discriminated against in employment decisions solely on the
basis of genetic information about an individual. For
example, an employer who makes an adverse employment
decision on the basis of an individual’s genetic
predisposition to disease, whether because of concerns about
insurance cost, productivity or attendance, is in violation
of the ADA because that employer is regarding the individual
as disabled. Issuance of the EEOC’s guidance is precedent
setting; it is the first broad federal protection against
the unfair use of genetic information (Hudson et al., 1995).
On other hand employers may have their own interests in
knowing the risks caused by certain genetic diseases of
their employees, in particular when the safety of other
employees or the general public is at risk. As an example,
if a person applied for a position that affects the public
safety such as train driver, physician or airline pilot, the
employer may ask for genetic screening of Alzheimer’s
disease. The gene that cause this disease may be present but
not expressed yet (in genetic term) which means “silent”, or
it’s effect may not become manifested until late in life,
which at the time of application may not pose any risk to
the public safety. In this situation, the person may be
denied employment far a head of posing any risk and this is
may be justifiable, in removing possible future risk to the
public! In other example, if a person applies for a
clerical job in a Bank and the employer ask for his genetic
profile. The Genetic screening reveals that this person is
predispose to diabetes in his fifties. Does the employer
have the right to deny him the job, and opt to offer the job
to a healthy applicant? In this case genetic discrimination
considered being unfair. Society then will be faced with the
conflict between an individual’s right to privacy in his or
her genetic information and the employer’s interest in
knowing about its worker’s health problems (Orentlicher,
1990).
In 1996, 35% of the Fortune 500 companies acknowledged using
personnel health information in employment decision. In the
same year another study conducted by a team of medical
researchers documented more than 200 cases of individuals
with a genetic predisposition who were asymptomatic
reporting a number of discriminatory actions by insurance
companies and employers (Weiss, 1999).
A
report by the British government’s Human Genetics Advisory
Commission (HGAC) says that employers should be allowed to
genetically test employees under certain conditions. The
HGAC argues that employers should not use genetic test
simply to exclude employees who may become ill in the
future. In order to uphold their right not to know their
genes, individuals should not be required to take genetic
tests, except in what the report calls “exceptional
circumstances” for example for susceptibility to conditions
that might put the employees or others at risk in the
workplace. In jobs where issues of public safety arise, the
employer should be able to refuse to employ someone who
refuses to take a genetic test. The other circumstances in
which employers should offer genetic test is when a test can
detect sensitivity to specific features of the working
environment that do not normally present any hazard to other
workers. In these circumstances, say the report, genetic
testing would protect workers. The HGAC said its aim was to
provide appropriate protection for the public in a manner
least burdensome to employers. A recent analysis of
employment genetic screening in the Journal of Occupational
and Environmental Medicine found that in some circumstances
it would be a cost effective way of reducing workplace
induced health problems (GenEthics, 30/31 2000). The HGAC
also conducted a survey of genetic testing and found that
only employer currently using genetic testing is the
Ministry of Defence, which screens pilots to see if they are
carriers of the gene for sickle cell disease. It is though
that carriers, who have single copy of the sickle cell gene,
and are normally healthy, may be at risk of oxygen
deprivation. The report admits that the evidence for this is
uncertain. Because carriers of the sickle cell gene are
mainly black, the practice of excluding them sparked a major
controversy in the USA in the 1970s. The trade Union
congress said the MoD (Ministry of Defence) policy was
discriminatory. A spokesperson for the Campaign against
Human Genetic Engineering (CAHGE) describes the HGAC’s
report as an open invitation for employers to discriminate (GenEthics,
30/31 2000).
6.2.3. Insurance Companies :
Confidentiality is difficult to maintain in health
insurance, because of the financial incentives involved. The
knowledge of genetic information and possible predisposition
to certain debilitating diseases will stigmatise the
affected person and his family and may led to his/her lost
of jobs and possible denial of insurance cover (Andrew and
Jaeger, 1991).
Currently there are no federal laws in place in America to
prohibit genetic discrimination in health insurance. Only 16
states have enacted laws to prohibit insurance companies
from using genetic information to deny coverage or raise
health insurance rates. Similar legislation is pending in
other states (Rothstein, 1999). The Health Insurance
Probability and Accountability Act of 1996 in America
guarantee that insurers will cover all employees regardless
of pre-existing conditions, health status or genetic
background. This does not, however, prevent insurers from
charging higher premiums to groups that include individuals
with genetic illness.
Insurance companies on the other hand do argue that genetic
information, as any other predictive medical condition
should be used in deciding insurance cover. They also
justified their act by claiming that not considering genetic
information would be irrational, because it led to unfairly
high cost premiums for those who lack the genetic diseases.
The insurance companies case is not justifiable compared to
recent trends to protect against in health insurance
coverage and employment. Genetic discrimination play crucial
part in hindering medical research by preventing scientists
from studying families in order to understand gene
mutations. People may be reluctant to volunteer for those
studies, fearing that the result can be used against them
(Weiss, 1999). This fear is more justifiable, if we consider
that action of denying people employment or insurance cover
may be based on data, which are inconclusive and indicate a
predisposition or increased risk that may never materialise.
Other additional factors, such as stress, diet, and
environment contribute to the final outcome.
6.3. Reproductive Implications :
The implications of Human Genome Project on reproduction
arise from the highly probable alliance of Medically
Assisted Reproduction (MAR) with Diagnostic Genetics (DG).
This alliance was referred to nicely by new term used by
(Sliver, 1997) as Reprogenetics. This term comes from the
merging of remarkable scientific and technological advances
in two fields- Reproductive Biology and Genetics. This new
field will turn science fiction into reality from cloning to
embryo selection to genetic engineering and beyond (Sliver,
1997). It also raises serious ethical and legal questions
(Ahmed, 1998) and (Serour, 2001).
Currently the medically assisted reproduction aims to help
infertile couples through different techniques to have
children.
6.3.1. Reproductive Technology :
Reproductive Technology expands widely after the birth of
the first test-tube baby in July 25 1978 in Britain. Louise
Brown, the name of the extraordinary baby that was conceived
outside her mother’s womb and since then the name IVF (In
vitro fertilisation) and the dawn of new age of reproduction
started.
Currently there are several approaches available in IVF
clinics across the world that help infertile parents to have
a baby and more importantly a healthy one. The desire to
have children is an instinctive behaviour beneficial to
reproduction as explained by Silver. This desire is such a
powerful instinctive force that many people who experience
it have had a hard time explaining where it come from.
There are many diverse factors that contribute to
infertility of both women and men. The natural process of
conception takes place when enough healthy sperms make its
way to fallopian tubes and fertilise the egg. The fertilised
egg move into the uterus where implantation takes place. The
fertilised egg will then grow into a foetus. Any faults in
any of these steps will result in inability to conceive.
There are many factors that contribute to male infertility,
among them :
*
Sperm count less than required
*
Sperm mobility is slow
*
The tubes (vas deference) through which the sperm swim from
the testes to the penis may be blocked
*
Hormonal imbalance which affect the ability to produce the
optimum quality and quantity of sperms
*
The immune system may produce antibodies that attack the
sperms
*
Undescended testicles
*
Chronic condition such as depression and asthma
Whereas female infertility may arise from the following
factors :
*
Hormonal imbalance affect the ovulation
*
Damage or block of fallopian tubes
*
Tumours and fibroids can cause cervical problems and poor
mucus production
*
The immune system may produce antibodies that kill the sperm
of the partner or the fertilised egg
*
Irregular period
*
Uterus rejection of the growing foetus
Most of the previously mentioned infertility problems are
currently treated in different ways through the following
approaches :
*
Infertility medication
*
Reproductive surgery
*
Reproductive technologies
I
will focus on Reproductive Technologies for its relevance to
this book.
Currently there are many reproductive technologies available
to assist infertile couple to have babies, among these
technologies which are expanding yearly are :
6.3.1.1. Artificial Insemination (AI) :
This technique involves taking a sample of sperms from
infertile male with slow sperm motility. The sperms are
cleaned in special way and then injected into female uterus
with the hope to fertilise the ovum.
6.3.1.2. In Vitro Fertilisation (IVF) :
This technique refers to fertilisation of an egg by a sperm
outside the womb in a laboratory in culture dish. The
fertilised egg or zygote then transferred into the uterus
after few days. Currently there are more than 500 IVF
clinics across the world, in United States alone more than
300 clinics and the number increase yearly.
6.3.1.3. Gamete Intra Fallopian Transfer
(GIFT) :
This technique involves combination of an egg with sperms
and then places them directly into the fallopian tube where
conception will occur naturally.
6.3.1.4. Zygote Intra Fallopian Transfer
(ZIFT) :
This procedure ensures that fertilisation takes place first
in the laboratory and within 24 hours, the zygote is
transferred to the fallopian tube by laproscopy. ZIFT has an
advantage over GIFT approach in particular if the
infertility problem is with male rather than female.
6.3.1.5. Intravaginal Culture (IVC) :
This technique takes the advantage of the body’s own
environment, where the sperm and egg mixture are placed in a
culture medium inside a sterile hermetically sealed
container carried inside the vagina. After 1-2 days the
fertilised egg transferred into the uterus.
6.3.1.6. Ultra Sound GIFT :
The purpose of this technique is to avoid surgery involved
in GIFT. The entire procedure from egg retrieval to tubule
transfer of the egg and sperm are performed by ultrasound
guidance.
6.3.1.7. Intra Cytoplasmic Sperm
Injection (ICSI) :
This technique revolutionises the infertility treatment
utilising micromanipulation technology that specifically
targets male factor infertility issues. It involves the
injection of a single sperm directly into the egg avoiding
the infertility problem of poor sperm motility and low
count. Current fertilisation rate of ICSI is 65%, which is
much higher than any procedure so far.
6.3.1.8. Round Spermatid Nucleous
Injection (ROSNI) :
This technique is an exciting breakthrough in treatment of
the infertile man who has zero sperm count. In this
technique, immature cells (round spermtids) are removed from
the testis before the final stage of spermatogensis and the
formation of sperms. The nucleus of these cells is taken
which contain half the number of the chromosomes and
injected directly into the female egg, which is removed
during IVF.
This technique which still needs to be perfected will
provide a hope for hopeless couple to father a biological
child.
Most of the above-mentioned techniques are currently used
across the world to treat infertility, and the IVF services
continue to expand at a comparable rate. By 1994, more than
38 countries had established IVF programms. It is estimated
that by the year 2005 more than 500.000 IVF babies will born
annually in US alone, and millions more in other countries
(Sliver, 1997). The annual test tube babies count in France
is 150.000 (Testart, 1995). Though the cost for this sort of
treatment is very expensive and the parents can expect to
pay about $25.000 for one child conceived in this way,
nevertheless the strong desire for having a child will push
the number of IVF clinics to increase dramatically in the
future. In a move recalling Aldous Huxley’s (1960) famous
production lines for making babies in Brave New world,
researchers in the US are building a “chip” that can
automatically carry out all steps involved in IVF, from
fertilised egg to preparing embryos for implantation.
Ultimately, such devices –which amount to artificial
reproductive tracts-may even be able to sort and test
embryos for genetic flaws (Ananthaswamy, 2001). This work
could be the first step towards a future in which IVF
becomes the norm, says Geroge Seidel, a reproductive
physiologist at Colorado State University in Fort Collins.
“Fifty or 100 years from now, our in vitro procedures for
parts or even all pregnancy may end up being safer than
dealing with the various things that occur in the body- in
terms of viruses that the mother come across, toxins and so
on” (Ananthaswamy, 2001).
6.3.2. Screening in early pregnancy :
Currently there are two approaches to deal with genetic
diseases in early pregnancy. One is called prenatal
(antenatal) genetic testing which is less controversial and
currently performed on a limited scale. The second is called
Preimplantation genetic testing which is more controversial
and open the door wide for future baby designers with the
help of huge information provided by Human Genome Project.
6.3.2.1. Prenatal Testing :
This test is offered where there is a family history of
having a genetic disease caused by a single gene or
inherited chromosomal abnormality. The tests provide results
to the parents in order to make an informed decision whether
to terminate the pregnancy or not. There are different
techniques to perform the prenatal genetic test :
*
Amniocentesis
:
In this technique a needle inserted through amniotic cavity,
which contains cells of the foetus, samples a small quantity
of amniotic fluid. It is usually carried out during the 16th
through the 20th weeks of gestation. The cells are cultured
and subject to examination (eg. Chromosome number is
examined to confirm the right number or otherwise Down’s
syndrome!)
* Chorionic Villus Sampling (CVS) :
Samples are taken from the developing placenta at 9-12 weeks
of gestation. The cells are subject to test as in
amniocentesis, though both procedures increase the rate of
miscarriage slightly.
*
Coelocentesis :
This technique promise to perform test before 10 weeks and
samples are taken from coelomic cavity, which surrounds the
amniotic sac. This technique is less risky to the safety of
the foetus compared to previous techniques.
All the previous techniques can be used to determine the sex
of the foetus, which provide very useful information to
avoid sex-linked diseases. Though the parents could exploit
the results to choose the sex of the child for non-medical
reasons. It also helps the parents to check for debilitating
diseases which might be shown up in early childhood, such as
Down’s syndrome, Spina bifida, Cystic fibrosis, Tay-Sachs,
Huntingdon’s disease and many others and take the
responsible informed decision. The test can also provide
biochemical abnormalities at the genetic level, detecting up
to 180 genetic diseases (Kevles and Hood, 2000). Sir Robert
Winston from Hammersmith Hospital in London was able to take
single cell from very early embryo (6-10 cell) and then to
sex them by examining specific DNA markers on the Y
chromosome. Their aim was to help couple with a history of
x-linked conditions. Removal of the individual cell did not
damage the rest of the embryo. Although this technique could
not guarantee the birth of a healthy boy, it could ensure,
though that the mother receive a female embryo (Garvin, et
al, 1995). It could also prevent unnecessary abortion for
certain x-linked conditions, all male pregnancies would be
terminated after sex determination by aminocentesis or CVS
sampling, although half of these would be unaffected. Same
approach was adopted for screening for Cystic fibrosis,
Duchenne muscular dystrophy and others.
6.3.2.2. Preimplantation Genetic Diagnosis (PGD) :
This technique involves a removal of a sample (biopsy) from
an early IVF embryo at the stage of 8 cells. While the
sampled cell is tested, the remainder of the embryo is
stored to be implanted should the tests show that it is free
of serious genetic disease. Since the cells of the early
embryo are undifferentiated, the removal of one cell does
not harm and subsequent development proceeds as normal.
This is the most controversial area where the test could be
misused and instead of being used for medical purposes to
help infertile parents to have healthy children, PGD could
be used in a way that implies acceptance of an open-ended
eugenics.
To discuss the implications of PGD we need to distinguish
between two approaches :
*
Embryo Selection : In IVF clinics, the high risk parents of
some genetic diseases such as Huntington’s disease, Tay
Sachs and Cystic fibrosis, are offered an option to ensure
that they will not pass on the defective genes to their
children. They were also offered to be ignorant if they wish
to, which many parents do. Embryo selection provides an
effective and safe way of preventing the appearance of these
devastating genetic diseases in growing children. The idea
behind this technique is, as long as parents are capable of
producing non defected genotype in their offspring according
to Mendelian ratio, there is always a possibility to select
an embryo with a healthy genotype. This possibility is
available as long as there is one parent who is disease free
or both parents who are carrier of recessive genotypes. The
technique involves the test of growing embryos resulting
from IVF. The test looks for gene mutations associated with
certain genetic diseases among the embryos, and those free
from such mutations are selected and transferred into the
uterus for implantation. Over 100 normal babies’ worldwide
have been born following PGD for sex or for a specific
disease (Mange and mange 1999). The genetic diseases that
have been diagnosed in this way are listed in table (3)
*
Preimplantation genetic manipulation :
This is the
most critical and debatable area in reproductive technology
and could be open widely to misuse. But also we need to make
two distinctions: genetic manipulation to treat rare genetic
diseases or to enhance or nullify other social attributes
and ultimately to change the Human nature. In very rare
case, if two cystic fibrosis couple or sickle cell anaemia
couples decided to marry and have children. All their
children will have the same diseases present in their
parents, in this case only genetic manipulation could help
them to get healthy children through combination of IVF-PGD
techniques.
The other application of genetic manipulation is the most
frightening venture. Where to add a new gene in growing
embryo which is not naturally present in his parents or
delete one which is naturally present. In the first instance
we refer to enhancement and in the later we refer to
purification. Luckily both are not attempted yet in Human,
but are routine procedure on mice and other animals. But
Genetic manipulation will eventually be used by
reprogeneticists as explained by (Sliver, 1997). “Genetic
engineering will begin in away that is most ethically
acceptable to the largest portion of society, with the
treatment of only those childhood diseases-like sickle cell
anaemia or cystic fibrosis-that have a sever impact on
quality of life. The number of parents who will desire this
service will be tiny, but their experience will help to ease
society’s trepidation. As the fear begins to subside,
reprogeneticists will expand their services to nullify
mutations that have less sever impact on a child, or an
impact delayed until adulthood. Predisposition to obesity,
diabetes, heart diseases, asthma and various forms of cancer
all fall into this category. And the technology spreads, its
range will be extended to the addition of new genes that
serve as genetic inoculations against various infectious
agents, including the HIV virus. The same time, other genes
will be added to improve various health characteristics and
disease resistance in children who would not otherwise have
been born with any particular problem. The final frontier
will be the mind and the sense. Alcohol addiction will be
eliminated, along with tendencies toward mental disease and
antisocial behaviour like extreme aggression”.
There will be no limits to what can be achieved through
genetic manipulation after we seize control over our Human
Genome and subsequent availability of huge genetic
information.
The position of various European religions with regards to
Bioethical question regarding reproductive technologies are
presented in Table (4)
6.4. Psychological Implications :
The genetic information will be accumulated as a result of
Human Genome project and consequently result in expansion of
genetic testing. The genetic testing will expand beyond
single gene disorders, to testing for genes associated with
common disorders, thus it is very crucial to take into
consideration what impacts this will have on the psychology
of the individuals, their families and the society as a
whole. The psychological implications of genetic screening
for genes associated with increased risk of certain diseases
have been well studied and researched (Croyle, 1995).
Currently most of the genetic screening is carried out in
prenatal or preimplantation stage to ensure the safety of
the future children, but predictive tests, which allow
people to know their possible predisposition to certain
diseases, are increasing frequently as genetic information
accumulated. The following table (5) show some currently
available DNA-Based gene tests :
The completion of Human Genome sequence will facilitate the
identification of all the genes that contribute to diseases.
The functional classification of disease gene and their
products will reveal general principles of Human diseases.
Sancheze and his team (2001) determined functional
categories for nearly 1000 documented disease genes, and
they found striking correlation between the function of the
gene product and features of the disease, such as age of
onset and mode of inheritance. Online resources documenting
Human diseases and their associated genes are available on (WWW.ncbi.nlm.nih.gov).
Geneticists now can identify predisposition to a growing
number of hereditary diseases. Test now exist for about
thirty disorders, and as more genes and markers are
identified, it is anticipated that test will be available to
indicate predisposition not only for purely genetic diseases
but also to very complex disorders suspected of having
genetic components. These include mental illness, hyper
activity, early-onset of Alzheimer’s, certain form of
cancers and alcoholism and addiction. In other words, test
will predict behaviour as well as diseases (Kevles and Hood,
2000).
Over 4 million genetic tests are now conducted every year in
US alone.
The factors that influence the decision to take genetic
tests are:
*
Availability of effective cure for treatment or assured
preventative measure. Studies showed that 10% of people take
predictive genetic test for Huntington’s disease for which
there is no current treatment compared with 50% taking
predictive genetic test for breast cancer disease for which
there is some possibility of prevention and treatment (Marteau
and Croyle, 1998).
*
Culture and Societal factors
*
How the test is offered
*
Reducing uncertainties regarding future risk
*
Gender factor, women are more likely than men to undergo
carrier tests (Evans, et al. 1997).
*
Religious aspect
The ultimate value of genetic screening must be assessed in
social and psychological terms. Elizabeth Anionwu, a senior
genetics counsellor at the institute of Child Health in
London argue, through a list of questions to the benefit of
genetic screening; Do the people being tested feel that
genetic screening improves their lives, or does it, on the
whole, make things worse ? What do those on the receiving
end of a “genetic service” actually experience ? And on what
information do people base their decisions when given the
option of having a genetic test, or a termination, and what
knowledge do they take away with them after counselling
sessions ? Answering such questions is the goal of a new
academic discipline known as “psychosocial genetics”, which
is fast attracting the interest of Britain’s major
grant-giving bodies such as the Medical Research Council and
the Wellcome Trust (Vines, 1994).
To assess the psychological impact on personnel level, a
study carried by Marteau, head of the wellcome-funded
psychology and genetics research group at Guy’s Hospital in
London and her colleagues would help to throw some light. In
two studies, one on the impact of screening programme for
Tay-Sachs disease, a neurological disorder that leads to the
early death of babies born with two copies of the faulty
gene (mostly common in Jewish community). The second study
was on screening for Cystic fibrosis disease. In both
studies the authors revealed that, hearing a piece of bad
news- learning that you are a carrier for the genetic risk
reduces a person’s tendency to be optimistic about the
future, with heightened anxiety and with the possibly
harmful consequences in the long run (Marteau and Bekker,
1994). Informing a woman that she carries an allele at BRCA1
that is associated with a high risk of developing breast
cancer is a serious issue, particularly if treatment options
are difficult, painful, debilitating, or oftentimes less
than successful. In a study conducted by (Leman, 1996) on
families with Hereditary Breast-Ovarian cancer indicated
that many women from high-risk families simply prefer not to
know to avoid the trauma associated with knowing.
On society level, Genetic screening also has huge impacts.
The screening of black Americans during 1970’s for
sickle-cell anaemia resulted in wide spread discrimination
against people who are carriers. They were discriminated
against in arm forces and by employers. The same situation
happened in Greece, when screening started for thalassaemia,
a blood disorder equivalent to sickle cell anaemia among
Mediterranean inhabitants. Healthy carriers were stigmatised
by the community and devalued as marriage partners (Vines,
1994). In another study a group of Dutch doctors have found
“unexpected long term emotional numbing” and “survivor
guilt” among people who thought they were at risk of
Huntington’s disease but were then found not to have
inherited the gene. In some cases their relatives reacted to
their privileged position by banning them from the family
because the HD tie had been severed, the Dutch researchers
report. Others couldn’t relax and enjoy feelings of relief
because they felt obliged to be continuously available to
support affected or at risk relatives (Vines, 1994). Women
taking the gene test run the unusual psychological and
social risks and these risks will very likely reach their
daughter as well (Casey, 1997).
Many in the medical establishment believe that uncertainties
surrounding test interpretation, the current lack of
available medical options for these diseases, the tests’
potential for provoking anxiety and the risks for
discrimination and social stigmatisation could outweigh the
benefit of testing.
6.5. Philosophical and Conceptual Implications :
Since the dawn of history, the argument of Human
responsibility, free will Vs genetic determinism has been an
important part of Human thinking. If the theologians and
philosophers discuss this issue logically, the Geneticists
and in particular behaviour geneticists are tackling this
vital issue experimentally. They are trying to prove whether
people’s genes make them behave in a particular way ? Or can
people always control their behaviour ? And what is
considered acceptable diversity ? In answering these
questions the scientist do differ, some proof it this way
and others believe it the other way. Some believe that the
gene makes us Human and the notion of “genes are us”
provides a sensational media items these days. We heard on a
daily basis that they found a gene for aggressiveness,
homosexuality, alcoholism and even promiscuity (Ahmed, 1995
a)! We heard that the genes make some musicians, Olympic
athletes, or genius and make others schizophrenics,
manic-depressives, even drug addicts. Moving in this
slippery road will inevitably lead us to the memory of
Eugenic movements in first half of 20th century as I
discussed earlier in section 6.1.1. Where the reliance on a
distorted scientific data and then promoted these results as
an ideology caused tremendous misery among wide spectrum of
people across the civilised world!. Single genes do not
determine most Human behaviour. Only certain rare disorders
such as Huntington’s disease have a simple mode of
transmission in which a specific mutation confers the
certainty of developing the disorder. Most behavioural
traits have a more complex aetiology, known as complex
traits. Such traits have no such clear-cut inheritance and
most likely result from the interaction of multiple genes
with various environmental factors, and possibly many genes
interacting with one another as well as environmental
factors. With the recent completion of the of the Human
Genome sequencing project and with the aid of a greatly
improved map based on hundreds of thousands of
single-nucleotide polymorphism (SNPs), association studies
should be able to identify genes involved in complex traits.
In addition, computers are increasingly becoming more
efficient at doing much of the hard work of positional
cloning. Thus, gene sequence and even polymorphism can be
identified by searching appropriate computer database (McGuffin,
et al., 2001). A number of genes have been implicated in
playing a large part in the susceptibility of certain
behaviours. as shown in table (6). However, many of these
studies have not been successfully replicated mainly due to
the enormous underlying complexity of such traits and the
inefficiency of experimental designs.
Some of the recent researchers who advocate the biological
basis for certain behaviours rely on certain studies on mice
and rats (recent research on enhancement of memory by
American scientists, GenEthics, 30/31 2000). In other
instance, studies on the worm C.elegans in three specific
area of research: Genetic basis of Chemoreception, which is
analogues to taste and smell in Human, Social feeding and
classical conditioning and associated learning. All these
studies show genes in the worm C.elegans control these
behaviours. It is worth mentioning one example relating to
social feeding in C. elegans. A recently described gene
controls an interesting aspect of social behaviour in C.
elegans. When various strains of the worm kept in
laboratories around the world are examined for feeding
behaviour, two phenotypes are observed. Some worms when
plated onto a petri dish containing bacteria, spread out
evenly across the plate, and feed essentially as loners.
They tend to move a way from one another if they collide. In
other strains, the worms always group together in visible
clumps, where they feed as “socializer”. They actively brush
up against one another, squirming and winding around one
another as they feed. This behaviour is induced by the
presence of food; when food is absent, the socializers also
spread more or less evenly across the plate (Clark and
Grunstein, 2000). It turns out that this difference in
feeding behaviour is determined by which of the two alleles
of a single gene is present in a given strain. The npr-1
allele is found in social strain whereas npr-1.215 allele
defines loner strain. When the npr-1.215 gene of the loner
strain was used to replace the npr-1 gene in social feeders,
they became solitary feeders. This clearly demonstrates the
genetic basis for feeding behaviour. The other experiments
with chemoreception and classical conditioning and
associated learning revealed the same results whereby the
genetic basis is clearly responsible for certain behaviour
in the worm C. elegans.
A
fairly complete “library” of genes expressed in the Human
brain has already been established, but the function of very
few of them is actually known. The C. elegans genes can be
used to screen this library for their Human homologs, and
the function for these genes we find in C. elegans will
likely be the function they serve in the Human nervous
system as well, for more detail, refer to section 2.3.2
functional genomic. We can then ask whether variants of
these genes among Human correlate with variations we see in
a range of Human behaviours, particularly learning and
memory. Thus, research on a lowly roundworm has the
potential for providing important insights into Human
behaviour, and the functioning of the Human brain (Clark and
Grunstein, 2000).
However, there is strong evidence to suggest there is a
greater level of complexity in the role that genes play in
Human when compared to organisms with a lower level of
molecular complexity (Ewing and Green, 2000).
Behaviour is a sophisticated aspect of Human attributes
because it is the product of the most complicated organ in
the Human body, the brain. The genetic basis of many aspects
of Human behaviour is very difficult to assess due to the
fact that a human’s behaviour is not a constant physical
entity, but rather extremely dynamic and continually
changing all the time. This changing potential gives the
Human being an immense capability to adapt to divers
environment and increased his survival opportunities. Thus,
no wonder the genetic basis of Human behaviour is still
poorly understood. But, for the plan fact is that, if our
mind and rational thinking and conduct are connected to our
brains, then the characteristics of our brains like any
other organs of our body will be influenced by our genes.
That dose not necessary means that there are genes for IQ or
Schizophrenia, but there are bound to be genes that
influence IQ and Schizophrenia. Though Schizophrenia is a
fuzzy and socially constructed disease, there is now clear
evidence of the role of genes in provoking this condition
(Baron, 2001).
The role of genes in Human behaviour has been largely
established from family studies and in particular from the
quantitative genetic research on twins and adopted people.
The findings show a significant correlation between the
genetic components and certain behavioural traits, such as,
psychopathology, personality, and cognitive abilities and
disabilities. These studies compare certain behavioural
traits between two kind of Human twins, monozygotic (one egg
fertilised by a single sperm), which split into two at a
very early stage of development resulting into two
individuals who are genetically identical. The second is
dizygotic twin which result from two eggs being fertilised
by two different sperms, thus the resulting twins is the
same as brothers and sisters in term of genetic make up. One
of the best studies on Human behaviour that rely on the
interaction of many genes and a multitude of environmental
factors is Schizophrenia. Large number of Geneticists
believe that genetic contribute largely to certain types of
this disorder and they derived their conclusion from studies
on twins as shown in table (7) :
These studies clearly show that genes play an important role
in the susceptibility to schizophrenia. Some researchers
believe that such studies are not conclusive. Their
criticisms arise from the fact that these studies are done
on twins who are raised in the same household by the same
parents and almost share the same environmental factors
which are known to be the main factor in the development of
some kinds of schizophrenia (Singer, 1985).
Though some studies of the physical and behavioural
characteristics of identical twins raised apart revealed
very interesting similarities. Studies carried at University
of Minnesota on 39-year old female twins who were separated
shortly after birth. Each arrived at the study centre
wearing seven rings on the same finger; each also wore two
bracelets on one wrist, and a watch and a bracelet on the
other. One twin had a son named Richard Andrew; the other
had a son named Andrew Richard. Other similar finding were
reported (Singer, 1985). Each pair of twins in the study was
subjected to six days of physical and psychological testing.
Of all of the tests administered to the twins, the highest
concordance was in their scores on IQ tests.
Although these research showed how certain behaviour are
influenced to large extent by the genetic make up of an
individual, but still suffer serious criticism. The most
sound criticism is the very small number of cases studied
where identical twins raised apart are very rare. Other
criticisms that the environment in which separated twins
grow up are not very different (Singer, 1985).
It is a concern that the importance of environmental
influence will be lost in the fanfare about genetics, says
Professor Robert Plomin at the institute of Psychiatry in
London. The first message from genetic researches is that
genes play a surprisingly important role for almost all
complex traits, whether behavioural or medical. But the
second message is just as important: individual differences
in complex traits are due at least as much to environmental
influences as they are to genetic influences (Carringto,
2000).
In the same way professor Peter little, of Imperial College,
London says : “By understanding genetic changes, we can then
go on to identify the environmental changes that
contribute“. If we can identify the nature, which we will do
to a very significant extent, we can use this to identify
the nurture. This is the second goal of the Human Genome
Project.
Small numbers of diseases are caused by genetic defect
alone, but the majority has both a genetic and environmental
component. Why is concordance for complex disease in
identical twins often only in the 40%-70% range, even though
such twins share all of their genes and usually have the
same intrauterine and postnatal environment. Thus suggesting
stochastic or random factors may play a role. And
environmental influence may be at least as important as
genetic factors in determining intelligence and other
aspects of personality.
6.6. Bioethical Implications and Islamic view :
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