Altered Inheritance: CRISPR and the Ethics of Human Genome Editing by Françoise Baylis (review)

Altered Inheritance is essential reading for anyone interested in genome editing and its ethical and social implications. Current genome editing technologies are rapidly making science fiction a reality. Indeed, it is a marvelous time for genetics, largely due to CRISPR-Cas tools being adopted in research and commercial sectors. While scientists were able to alter DNA for over thirty years, CRISPR offers faster, cheaper, and more accurate methods to remove, add, or alter genes. Applications abound, with researchers working to develop therapies to treat a wide range of genetic disorders. However, as Françoise Baylis so aptly states, although “CRISPR shows great promise for therapeutic use, it raises thorny ethical, legal, political, and societal concerns because it can be used to make permanent changes to future generations” (cover copy). Changes to the blueprint of life could usher in a new age where genetic disorders are a thing of the past and where parents can design their children. However, modifications could also have a wide range of unforeseen negative consequences for individuals, families, and societies. Françoise Baylis expertly grapples with the sticky normative impacts of genome editing in Altered Inheritance: CRISPR and the Ethics of Human Genome Editing. The publication provides an excellent overview of the current state of the technology and the ethical, social, and policy implications of genomics. It also provides the foundation for a “new bioethics” that scholars dedicated to socially just science, policy, and normative analysis may find illuminating.

Although the science of genome editing may be complex, the purpose of this volume is simple: to ensure all people have a role in determining the future of humankind. Decisions concerning how these technologies are applied must come from social consensus, including members of the public, as we all have a stake in the consequences of gene altering. In the first three chapters, Baylis provides a highly accessible introduction to somatic cell genome editing, heritable germline genome editing, and reproductive applications, with the latter focusing on designer babies. Specifically, the first chapter uses Huntington’s disease as an example of when targeting a single gene is important, while chapter two is careful to differentiate somatic cell editing from germline modifications, as these can be passed on to offspring. The third chapter on designer babies offers key historical context, as it provides a succinct overview of the history of this term. Each of the chapters seamlessly combine historical context, definitional information, and scientific explanation into a highly enjoyable read. The author is quite adept at drawing readers in, as she uses specific case studies to ground her explanations. This improves the accessibility of the information and helps to highlight how genome editing could impact people’s daily lives. For example, I found myself caring about one of Baylis’s case studies: Joe, as well as his four children, who might inherit Huntington’s disease. From this perspective, one can easily grasp the emotions behind the view that CRISPR is “a dream come true” for some families. The first three chapters would make excellent readings for students taking bioethics classes or a primer for scholars interested in joining in current discussions.

Chapters four, five, and six grapple with ethical concerns that arise when applying genome editing technologies. I particularly like how Baylis complicates the often taken-for-granted demarcation of therapeutic applications from other types of editing (such as enhancement) in chapter four. This is an important contribution to the wider social discussion because many debates are fixated on this distinction, as the author notes. In fact, attempting to pin down definitions of these terms plays an essential role in current bioethical and policy debates, especially after He Jiankui used CRISPR to alter the genomes of twin girls (Greely 2019). The author shifts the ethical focus, arguing that the important analytic work does not involve drawing definitional lines in the sand, so to speak. If that is even possible. Rather, we should be exploring whether genomics technologies...