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Parts  3 and 4 have the same questions, however, you must answer with references and different writing always addressing them objectively, that is as if you were different students. Similar responses in wording or references will not be accepted.

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           Part 1: minimum  1 page

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Q 2. Health is XXXX

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__________________________________________________________________________________

Parts  1 and 2 have the same questions, however, you must answer with references and different writing always addressing them objectively, that is as if you were different students. Similar responses in wording or references will not be accepted.

Part 1: Transition to practice (Write in the first person)

 

Topic: Health Care Reform: Is it Beneficial to NPs?

1. Discuss your views on health care reform and how it will affect NPs. 

2. How will NPs be reimbursed under this plan?

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Part 2: Transition to practice (Write in the first person)

 

Topic: Health Care Reform: Is it Beneficial to NPs?

1. Discuss your views on health care reform and how it will affect NPs. 

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Part 3: Children and adolescents health (Write in the first person)

Toíc: Developmental Surveillance, Screening, and Anticipatory Guidance

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b. Screening

c. Anticipatory guidance in child well-visits and sick visits. 

1

Should gene-editing be abolished?

Analury Sanchez

Professor Ocxanne Jean, Ph.D.

Advance Writing and Research-DL-B

Apr 02, 2022

2

Should gene-editing be abolished?

I. Introduction: In the recent years, humans have witnessed technological developments

whereby tomatoes ripen slowly, cattle without horns, and even mosquitos that cannot transmit

malaria. This has been necessitated by gene editing. According to Ayanoğlu, Elçin & Elçin (2020),

gene editing is a technology that provides scientists with an opportunity of making changes to the

DNA of an organism. Thanks to gene editing, it is possible to edit a particular disease out of an

individual. The increase in ethical controversy of gene editing can be attributed to its potential of

asserting some significant control over the kind of future for humans. This topic emphasizes why

gene editing should be abolished due to the unprecedented health implications of genetically

modified humans.

II. Background: According to Abuhammad, Khabour and Alzoubi (2021), genetic

modifications can lead to the creation of super-humans and “designer babies” while also

perpetrating fundamental alteration of the human species. As a matter of fact, genomic research

may potentially be weaponized towards targeting as well as harming particular population groups.

The moral, ethical, and legal boundaries of utilizing genetic technologies are largely unclear, which

creates opportunities for their abuse and misuse. On the other hand, Howard et al. (2018) argued

that gene-editing technologies are associated with diverse ethical concerns, particularly when the

process is utilized towards addressing a given genetic diagnosis of an unborn child due to the

potential evolution of off-target edits.

Gene editing can result in unprecedented and unwanted heritable genetic alterations that

may contribute to long-term risks in clinical space (Conboy, 2018). Accessing gene therapies for

combating diseases, for instance, could be limited to those who can afford them, which increases

health inequality outcomes across and within countries. Ethically, there are safety concerns to the

Ocxanne Jean
this should be the first supporting paragraph on unethicalness
Ocxanne Jean
this section is not about this
Ocxanne Jean
this does not need to be in the introduction
this can be inserted in the supporting paragraphs
Ocxanne Jean
Ocxanne Jean

3

side effects of the technology, including lack of informed consent for germline as the affected

110

http://journals.tubitak.gov.tr/biology/

Turkish Journal of Biology Turk J Biol
(2020) 44: 110-120
© TÜBİTAK
doi:10.3906/biy-1912-52

Bioethical issues in genome editing by CRISPR-Cas9 technology

Fatma Betül AYANOĞLU1, Ayşe Eser ELÇİN1, Yaşar Murat ELÇİN1,2,*
1Tissue Engineering, Biomaterials and Nanobiotechnology Laboratory, Ankara University Faculty of Science,

Ankara University Biotechnology Institute, Ankara University Stem Cell Institute, Ankara, Turkey
2Biovalda Health Technologies, Inc., Ankara, Turkey

* Correspondence: [email protected]

1. Introduction
For many years, molecular biologists have sought ways
to use cellular repair mechanisms to manipulate DNA
through genome editing. In this way, they would have the
power to change the genome by correcting a mutation or
introducing a new function (Rodriguez, 2016). For this
purpose, genome editing technologies were developed
(Memi et al., 2018). In recent years, clustered regularly
interspaced short palindromic repeats technology
(CRISPR-Cas9) has become the most preferred method of
gene editing. This technology has advantages such as high
accuracy, easy handling, and relatively low cost compared to
previous technologies, such as zinc-finger nuclease (ZFN)
and transcription activator-like effector nuclease (TALEN).
Thanks to these benefits, CRISPR-Cas9 technology can be
easily applied in any molecular biology laboratory.

Genome editing technologies are used in the formation
of human disease models in experimental animals and for
the understanding of basic gene functions. They also have
great therapeutic potential for future treatment of untreated
diseases such as certain cancers, genetic disorders, and

HIV/AIDS. Today, genome editing in somatic cells is one
of the promising areas of therapeutic development (Otieno,
2015). However, various bioethical issues have arisen due
to the potential impact of these technologies on the safety
of food stocks and clinical applications (Hundleby and
Harwood, 2018; Hirch et al., 2019). This review discusses
the challenges, possible consequences, and bioethical
issues of CRISPR-Cas9 in detail.

2. Biology and function of CRISPR-Cas9 technology
Genome editing technologies often work by creating
fractures in chromosomal DNA. ZFN, TALEN, and
CRISPR-Cas9 are all based solely on nucleases (Kim
and Kim, 2014; Roh et al., 2018). The strength of these
technologies stems from the ability to create fractures in the
desired region of a specific target sequence as determined
by the researcher. This allows researchers to modify the
genome in practice in any region (Memi et al., 2018).

The creation of changes in the genome depends mainly
on the DNA repair capacity of the cells (Lau et al

Heliyon 7 (2021) e06860

Contents lists available at ScienceDirect

Heliyon

journal homepage: www.cell.com/heliyon

Research article

Researchers views about perceived harms and benefits of gene editing:
A study from the MENA region

Sawsan Abuhammad a,*, Omar F. Khabour b, Karem H. Alzoubi c

a Dept. of Maternal and Child Health, Jordan University of Science and Technology, Irbid 22110, Jordan
b Dept. of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
c Dept. of Clinical Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan

A R T I C L E I N F O

Keywords:
Gene editing
MENA
Ethics
Gene therapy
Enhancement

* Corresponding author.
E-mail address: [email protected] (S. A

https://doi.org/10.1016/j.heliyon.2021.e06860
Received 7 November 2020; Received in revised fo
2405-8440/© 2021 The Author(s). Published by Els
nc-nd/4.0/).

A B S T R A C T

Background: The development of gene editing technologies is very promising for the treatment of genetic diseases.
However, gene editing can be also used to enhance the characteristics of healthy individuals. This study aims to
determine ethical challenges that may face the constitution of gene editing in the Middle East and North Africa
(MENA) region.
Methods: An online discussion forum about the ethical challenges of applying gene editing technologies was held.
The participants were a group of researchers (n ¼ 28) from the MENA region.
Results: Most of the participants agreed on the importance of gene editing for the treatment of genetic diseases.
However, participants had concerns regarding the use of gene editing to enhance the characteristics of healthy
individuals such as athletic abilities and intelligence. Among ethical issues that were raised are justice, harm,
beneficence, discrimination, conflict with religion and culture, and lack of regulations.
Conclusion: Several ethical issues were raised for using gene editing technologies based on the perception of
biomedical researchers from the MENA region. Therefore, the scientific community and other interested
bioethical, social, legal, and governmental parties should be provided with a detailed guide from the scientists in
this area for future uses of this technology.

1. Introduction

The evolution of genetic technologies has made it possible to modify
somatic and germ cells (Sung et al., 2012; Kimbrel and Lanza 2020; van
Haasteren et al., 2020). Scientists have recently used gene editing tools to
efficiently edit the human embryonic genome (Huang et al., 2020; Kar-
imian et al., 2020). Gene editing focuses on a specific region in the
genome leading to the altering of harmful loci that cause diseases
(Mehravar et al., 20

European Journal of Human Genetics (2018) 26:1–11
https://doi.org/10.1038/s41431-017-0024-z

POLICY

One small edit for humans, one giant edit for humankind? Points
and questions to consider for a responsible way forward for gene
editing in humans

Heidi C. Howard1 ● Carla G. van El2 ● Francesca Forzano3 ● Dragica Radojkovic4 ● Emmanuelle Rial-Sebbag5 ●

Guido de Wert7 ● Pascal Borry6 ● Martina C. Cornel 2 on behalf of the Public and Professional Policy
Committee of the European Society of Human Genetics

Received: 2 February 2017 / Revised: 24 September 2017 / Accepted: 29 September 2017 / Published online: 30 November 2017
© The Author(s) 2018. This article is published with open access

Abstract
Gene editing, which allows for specific location(s) in the genome to be targeted and altered by deleting, adding or
substituting nucleotides, is currently the subject of important academic and policy discussions. With the advent of efficient
tools, such as CRISPR-Cas9, the plausibility of using gene editing safely in humans for either somatic or germ line gene
editing is being considered seriously. Beyond safety issues, somatic gene editing in humans does raise ethical, legal and
social issues (ELSI), however, it is suggested to be less challenging to existing ethical and legal frameworks; indeed somatic
gene editing is already applied in (pre-) clinical trials. In contrast, the notion of altering the germ line or embryo such that
alterations could be heritable in humans raises a large number of ELSI; it is currently debated whether it should even be
allowed in the context of basic research. Even greater ELSI debates address the potential use of germ line or embryo gene
editing for clinical purposes, which, at the moment is not being conducted and is prohibited in several jurisdictions. In the
context of these ongoing debates surrounding gene editing, we present herein guidance to further discussion and
investigation by highlighting three crucial areas that merit the most attention, time and resources at this stage in the
responsible development and use of gene editing technologies: (1) conducting careful scientific research and disseminating
results to build a solid evidence base; (2) conducting ethical, legal and social issues research; and (3) conducting meaningful
stakeholder engagement, education and dialogue.

Introduction

Gene editing, which allows for specific location(s) in the
genome to be targeted and changed by deleting, adding or
substituting nucleotides, is currently the subject of much
academic, industry and policy discussions. While not new
per se, gene editing has become a particularly salient topic

primarily due to a relatively novel tool called CRISPR-
Cas9. This specific tool distinguishes itself from its coun-
terparts, (e.g., zinc-finger nucleases and TAL effector
nucleases (TALENs)) due to a mixture of increased effi-
cienc

Cambridge Quarterly of Healthcare Ethics (2019), 28, 100–111.
© Cambridge University Press 2018.
doi:10.1017/S0963180118000439100

Articles

Let Us Assume That Gene Editing is Safe—
The Role of Safety Arguments in the
Gene Editing Debate

SØREN HOLM

Abstract: This paper provides an analysis of the statement, made in many papers and
reports on the use of gene editing in humans, that we should only use the technology
when it is safe. It provides an analysis of what the statement means in the context of
nonreproductive and reproductive gene editing and argues that the statement is inconsist-
ent with the philosophical commitments of some of the authors, who put it forward in
relation to reproductive uses of gene editing, specifically their commitment to Parfitian
nonidentity considerations and to a legal principle of reproductive liberty.

But, if that is true it raises a question about why the statement is made. What is its discur-
sive and rhetorical function? Five functions are suggested, some of which are more conten-
tious and problematic than others. It is argued that it is possible, perhaps even likely, that
the “only when it is safe” rider is part of a deliberate obfuscation aimed at hiding the full
implications of the arguments made about the ethics of gene editing and their underlying
philosophical justifications.

Keywords: gene editing; gene modification; gene therapy; harm; nonidentity problem;
principle of procreative beneficence; reproductive liberty; safety; wrong

As noted above, we do not believe that sufficient knowledge is available
to consider the use of genome editing for clinical reproductive purposes
at this time. However, we acknowledge that when all safety, efficacy, and
governance needs are met, there may be morally acceptable uses of this
technology in human reproduction, though further substantial discus-
sion and debate will be required as detailed below.1

Various groups, including ours, agree that numerous technical and safety
issues need to be addressed before genome-editing technologies could
feasibly be used in reproductive clinical applications.2

The clearest ethical concerns regarding current gene editing techniques is
that they are unsafe. The study by Huang and coauthors showed that
current gene editing techniques can lead to a large number of off-target
mutations. This could cause significant defects and disabilities in any
individuals born as the result of the research. While some research sug-
gests there are ways to edit genes that greatly reduce the number of
off-target mutations, . . . it would be highly unethical to bring modified
human embryos to term unless we were very confident that the tech-
nique could be used safely. The risk would simply not be justified by
any potential benefits.3

Translating germline modification into clinical trials and society requires

Cambridge Quarterly of Healthcare Ethics (2019), 28, 62–75.
© Cambridge University Press 2018.
doi:10.1017/S096318011800039762

Articles

Can the Thought of Teilhard de Chardin Carry
Us Past Current Contentious Discussions of
Gene Editing Technologies?

MÁRIA ŠULEKOVÁ and KEVIN T. FITZGERALD

Abstract: The advent of CRISPR-Cas9 technology has increased attention, and contention,
regarding the use and regulation of genome editing technologies. Public discussions continue
to give evidence of this debate falling back into the previous polarized positions of techno-
logical enthusiasts versus those who are more cautious in their approach. One response to
this contentious relapse could be to view this promising and problematic new technology
from a radically different perspective that embraces both the excitement of this technologi-
cal advance and the prudence necessary to use it well. The thought of Teilhard de Chardin
provides this desired perspective, and some insights that may help carry forward public
discussions to achieve widely accepted uses and regulations.

Keywords: CRISPR-Cas9; gene editing; genetic engineering; ethics; Pierre Teilhard de
Chardin; evolution; responsibility; biosphere stability; genetic diversity; common good;
transhumanism

CRISPR has greatly increased interest in applying genome editing to plants,
animals, and humans. In addition, it has also increased tensions surrounding
the public debates about how to use this rapidly improving technology. Current
tension between bioenthusiasts and bioconservatives results in significant
gridlock in public discussions. Deliberations about genome editing are falling
into old patterns of polarization and conflict. There is a lack of real, substantive
discussion about the issue. “We can’t get sufficient dialog going,” stated Arthur
Caplan in the June issue of Nature this year, calling for a greater variety of forums
for this discussion.1 There is an increasing need to review the situation and
look at it from a different perspective, one more amenable to substantive dialogue
and a better interchange of ideas and values. It is necessary to gather “informa-
tion from dispersed sources, bringing to the fore perspectives that are often
overlooked and promoting exchange across disciplinary and cultural divides,”2
claim the proposers of a global observatory for gene editing, Sheila Jasanoff
and J. Benjamin Hurlbut. This new institution is being created to foster differ-
ent perspectives and bring them into the larger discussion, where “approaches
currently taken for granted can be tested and recalibrated in the light of alter-
native . . . perspectives.”3

Historically, we have examples of how alternative perspectives to dominant
ethical theories have benefited the overall philosophical discussion of difficult
issues. It is indisputable that one such effort was the “ethics of ca

Xu Cell Biosci (2020) 10:48
https://doi.org/10.1186/s13578-020-00410-6

R E S E A R C H H I G H L I G H T

CCR5-Δ32 biology, gene editing,
and warnings for the future of CRISPR-Cas9
as a human and humane gene editing tool
MengMeng Xu*

Abstract
Background: Biomedical technologies have not just improved human health but also assisted in the creation of
human life. Since the first birth of a healthy baby by in vitro fertilization (IVF) 40 years ago, IVF has been the mainstay
treatment for couples struggling with infertility. This technology, in addition to increasingly accessible genetic testing,
has made it possible for countless couples to have children. Since CRISPR-Cas9 gene editing was described in 2015,
its potential for targeting genetic diseases has been much anticipated. However, the potential of using CRISPR-Cas9
for human germline modification has led to many fears of “designer babies” and widespread concerns for the impact
of this technology on human evolution and its implications in Social Darwinism. In addition to these ethical/moral
concerns, there remain many unknowns about CRISPR-Cas9 technology and endless unanticipated consequence to
gene editing.

Methods: In this paper, we analyze the current progresses of CRISPR-Cas9 technology and discuss the theoretical
advantages of certain allelic variances in the C-C chemokine receptor 5 gene (CCR5) in the setting of recent ethical/
moral concerns regarding gene editing using the CRISPR-Cas9 system.

Results: These uncertainties have been highlighted recently by the birth of Chinese twins whose C-C chemokine
receptor 5 (CCR5) gene had been inactivated via CRISPR-Cas9 to be theoretically protective against HIV infection. CCR5
signaling is critical for the successful infection of human immunodeficiency virus (HIV ) and people with homozy-
gous inactivating CCR5-Δ32 mutations have been shown to be protected against HIV infection. Those with the
CCR5-Δ32/Δ32 mutation also have greater neuroplasticity, allowing for improved recovery from neurological trauma,
and decreased Chagas cardiomyopathy. However, the CCR5-Δ32/Δ32 mutation has also been associated with earlier
clinical manifestations for West Nile infection, ambiguous effects on osteoclast function, and a four-fold increased
mortality from influenza infection. These detrimental health impacts, in addition to the confounding factor that these
CRISPR babies do not carry this exact CCR5-Δ32/Δ32 mutation, lead to many questions regarding the children’s future
health and the moral conundrum of their birth. The creation and birth of these babies was not completed with any
scientific, ethical, or governmental oversight, which has spurned the acceleration of talks regarding global regulations
for human genetic editing.

Conclusions: Although we can try to regulate for ethical, health-related only use of this technology, moral a

Review

Genome-Editing Technologies: Concept, Pros, and
Cons of Various Genome-Editing Techniques and
Bioethical Concerns for Clinical Application
Sikandar Hayat Khan1

1Department of Pathology, PNS HAFEEZ Hospital, Pathology E-8, Islamabad, Islamabad 44400, Pakistan

The traditional healthcare system is at the doorstep for entering
into the arena of molecular medicine. The enormous knowl-
edge and ongoing research have now been able to demonstrate
methodologies that can alter DNA coding. The techniques used
to edit or change the genome evolved from the earlier attempts
like nuclease technologies, homing endonucleases, and certain
chemical methods. Molecular techniques like meganuclease,
transcription activator-like effector nucleases (TALENs), and
zinc-finger nucleases (ZFNs) initially emerged as genome-edit-
ing technologies. These initial technologies suffer from lower
specificity due to their off-targets side effects. Moreover, from
biotechnology’s perspective, the main obstacle was to develop
simple but effective delivery methods for host cell entry. Later,
small RNAs, including microRNA (miRNA) and small inter-
fering RNA (siRNA), have been widely adopted in the research
laboratories to replace lab animals and cell lines. The latest dis-
covery of CRISPR/Cas9 technology seems more encouraging by
providing better efficiency, feasibility, and multi-role clinical
application. This later biotechnology seem to take genome-
engineering techniques to the next level of molecular engineer-
ing. This review generally discusses the various gene-editing
technologies in terms of the mechanisms of action, advantages,
and side effects.

https://doi.org/10.1016/j.omtn.2019.02.027.

Correspondence: Sikandar Hayat Khan, Department of Pathology, PNS HAFEEZ
Hospital, Pathology E-8, Islamabad, Islamabad 44400, Pakistan.
E-mail: [email protected]

Over the last half century after post-DNA helical structure discovery,
the world has seen a continuous staircase outburst of various molec-
ular technologies, which are now heading forward toward transla-
tion into clinical and laboratory practice.1 Given the availability of
sequencing platforms, acquired wisdom about the micro-mechanics
at work within the genetic apparatus, and the introduction of user-
friendly nanotechnologies, it was possible for next-generation scien-
tists to manipulate the genetic codes at various levels.2 Over the last
two decades we saw a plethora of molecular techniques, which al-
lowed us to edit genes or their alter pathways, allowing humans for
the first time to micro-edit the DNA codes and further to alter the
mRNA fate through post-transcriptional modifications.3

Principally, genome-wide editing techniques can be interpreted as
methods where DNA sequences are changed by deletions, mRNA

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
For permissions, please e-mail: [email protected]

Human Reproduction, Vol.34, No.11, pp. 2104–2111, 2019
Advance Access Publication on November 14, 2019 doi:10.1093/humrep/dez162

INVITED COMMENTARY

The technical risks of human gene
editing
Benjamin Davies*
Welcome Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.

*Correspondence. Email: [email protected]

Submitted on May 29, 2019; resubmitted on July 2, 2019; editorial decision on July 15, 2019

ABSTRACT: A recent report from Dr He Jiankui concerning the birth of twin girls harbouring mutations engineered by CRISPR/Cas nucleases
has been met with international condemnation. Beside the serious ethical concerns, there are known technical risks associated with CRISPR/Cas
gene editing which further raise questions about how these events could have been allowed to occur. Numerous studies have reported
unexpected genomic mutation and mosaicism following the use of CRISPR/Cas nucleases, and it is currently unclear how prevalent these
disadvantageous events are and how robust and sensitive the strategies to detect these unwanted events may be. Although Dr Jiankui’s study
appears to have involved certain checks to ascertain these risks, the decision to implant the manipulated embryos, given these unknowns, must
nonetheless be considered reckless. Here I review the technical concerns surrounding genome editing and consider the available data from Dr
Jiankui in this context. Although the data remains unpublished, preventing a thorough assessment of what was performed, it seems clear that
the rationale behind the undertaking was seriously flawed; the procedures involved substantial technical risks which, when added to the serious
ethical concerns, fully justify the widespread criticism that the events have received.

Key words: gene editing / CRISPR / nuclease / mutagenesis / Cas9

Introduction
The development of site-specific nucleases over the last decade now
makes it possible to introduce precise changes into the DNA sequence
of our cells (Carroll, 2017). In particular, RNA-guided CRISPR/Cas
nucleases are very easy to design against specific genomic target
sequences and high efficiencies of mutagenesis can be achieved (Sander
and Joung, 2014). These qualities are making the therapeutic applica-
tion of CRISPR/Cas nucleases to tackle genetic disease feasible, and
there has been a diverse range of success stories published in pre-
clinical models (Porteus, 2019). For example,