Table 1. Summary table of articles used for the review.

GGE: germline genetic engineering; MENA: Middle East and North Africa; HGE: Human Genome Editing

Study	Study description/purpose	Sample	Major findings and limitations
Philosophy
Morar (2015) [9]	To assess the validity of Habermas’ argument against genetic enhancement.	N/A	The author argued against Habermas’ argument, claiming that it was a series of assumptions that mischaracterized evolution and that the facts presented did not have data to support them.
Segers and Mertes (2020) [22]	To explore how human dignity is invoked normatively in relation to heritable genome editing.	N/A	Human germline gene editing has the potential to reinforce and violate human dignity. This means that considerations about human dignity should be included in the calls for debate over the ethics of genome editing, but there is no need to come to a complete standstill.
Chan (2015) [23]	To discuss how international guidelines of ethics utilize the concept of human dignity and its application to restricting genetic engineering.	N/A	The issue with utilizing human dignity as a point of debating the use of genetic engineering is that different people interpret the concept differently resulting in different opinions as to the acceptability of engineering. Thus, clarifying that dignity has different meanings may help to create a better understanding of the debate. He states that there is a hidden assumption in debates about the role of dignity in guidelines on bioethics, which may help to recognize what is at issue between people who disagree about the forms of genetic research and technology that are morally acceptable.
Raposo (2019) [24]	To address and rebuke the argument that gene editing violates human dignity and is not compatible with human nature.	N/A	Human dignity won’t be an obstacle to gene editing once an understanding of human dignity is achieved. Then, justice will be done to its rich philosophical background and simultaneously will be able to meet current needs. Such understanding of human dignity must be one that expresses a characteristic that inherently differentiates the human person from other creatures: the power to decide destiny and to develop in order to become the best version of oneself. Thus, human dignity is respect for human autonomy.
Alonso and Savulescu (2021) [25]	Analyze He Jiankui’s case in relation to one of the most difficult problems in procreative ethics: the non-identity problem. The analysis will help to understand the ethics involved in gene editing and hopefully allow for better, more philosophically grounded legislation on CRISPR and other gene-editing technologies.	N/A	It is a slippery slope to decry the birth of these twins because it seems incorrect to say they should not have been born, but to accept what was done is a slippery slope to further irresponsible genetic modifications.
Li and Zhang (2019) [26]	To analyze all the ethical arguments against genomic editing and point out their merits and flaws. It then juxtaposes a Confucianism approach to find a new perspective to determine whether designing babies with CRISPR is ethical.	N/A	As of now, both sides to the argument have been unable to completely disprove the other. A very specific argument by Sandel vehemently goes against embryo gene designing (EGD). On the one hand, Confucianism is able to address many questions unanswered by Sandel’s argument, such as who gives children to parents as gifts. On the other hand, unlike Sandel’s total denial of EGD, Confucianism holds a context-sensitive attitude towards EGD. That is, Confucianism would allow EGD if it benefits a family’s prosperity and integrity. The main points against EGD are future generations deciding, playing God/nature, commodifying, and prejudice. The main points for EGD are liberty, well-being, and risk.
Gyngell et al. (2017) [27]	To analyze the ethical arguments for and against pursuing germline genetic engineering and the effectiveness of these arguments.	N/A	Calls for bans on GGE should be resisted as there are more medical benefits than possible risks for the use of it. While issues like future consent, enhancement, and safety are at the forefront of the argument against GGE, the medical benefit of disease eradication and the act of being cautious mitigate these risks.
Theology
Alsomali and Hussein (2021) [28]	To argue that from an Islamic standpoint, the therapeutic application of CRISPR-Cas9 for germline editing may be permissible if the safety and efficacy concerns are resolved and if the principles of Maqasid al-Shari'a are fulfilled.	N/A	(1) Decisions from an Islamic perspective rely on the application of Maqasid al-Shari'a and Qawaid Fiqhiyyah as the sources of ethical guidelines for the evaluation of novel technologies, including CRISPR-Cas9 from the Islamic bioethics' perspective. (2) Multi-disciplinary experts, including geneticists, Shari'a law specialists, bioethicists, and social scientists, will need to work together to generate appropriate ethical, religious, and moral conclusions regarding the use of CRISPR-Cas9 in the Muslim world. (3) CRISPR-Cas9 may be permissible for therapeutic applications, including germline editing, based on necessity, once concerns regarding safety and efficiency have been resolved.
Isa et al. (2020) [29]	To discuss the principles of preservation of human life, lineage, and dignity and the fact that preventing harm takes precedence over securing benefit are among the guiding principles in assessing the permissibility of CRISPR-Cas9-mediated human germline editing, within an Islamic perspective.	N/A	Based on this study, it can be concluded that CRISPR-Cas9-mediated human germline gene editing would be considered lawful in Islam if it met the following conditions: (a) it is only used for medical purposes particularly to prevent or treat diseases. Such a modification is not considered tampering with God’s creation. (b) It is allowed only after safety and efficacy issues are resolved. The technology used should not bring more harm to the parents, the resulting child, society, and the future generation. (c) Strict regulation is established to ensure respect for the persons involved, prevent premature use, and abuse of the technology as well as strictly prevent human genetic enhancement.
Loike and Kadish (2018) [30]	To analyze, from a Jewish legal perspective, some of the ethical conundrums that society faces in pushing the outer limits in researching these new biotechnologies.	N/A	The general rule in Judaism is that gene editing for non-medical applications is ethically wrong and should not be routinely acceptable. The Torah states that its laws are created for people to live by, and so medical and technological advances that promote the saving of lives should be supported. In the realm of new biotechnology, the goal of partnering with God to save lives should be paramount.
Peters (2017) [31]	To assess how CRISPR-Cas9, like so many other new biotechnologies, is forcing a moral choice on a large scale. Gene editing for purposes of medical therapy, human enhancement, engineering future children, and even creating a posthuman species, confronts our society with the inescapable necessity of making moral choices.	N/A	Human creativity belongs to God and should be morally guided even in self-transformation, and not suppressed. Human’s relationship to self, God, and the world should be taken into consideration. Using CRISPR-Cas9 to improve human health by advancing medical technology would not violate the image of God. Therefore, therapeutic somatic gene editing is ethically acceptable. However, although gene editing for enhancement purposes brings up ethical questions, it does not threaten human nature, and therefore requires further discussion. Since human germline editing has further consequences for generations to come, further discussion and research are required to determine future practical applications without violating ethical and moral standards.
Peters (2019) [32]	To explain the split between scientists with regards to the extent of genetic engineering and how much of a backlash from nature could be expected from using this technology and provide an opinion as to the validity of this perspective.	N/A	First, encourage the scientific community to remain in the conversation regarding bioethics without separating the professions. Second, bioethical research projects should be funded to examine the long-range impact of germline modification via CRISPR or other genome modification methods. Overall, a more cautionary approach should be taken towards eugenics, a balance between flying forward towards a posthuman future and stopping all advancements for a boogeyman that may not exist.
Public perspectives
Rubeis and Steger (2018) [33]	To analyze the ethical implications, risks, and benefits of genome editing.	N/A	The trajectory of the genome editing techniques suggests that it could one day be safe. Society’s perspective of its risk could be appeased by the presence of regulation.
Vasquez-Loarte et al. (2020) [34]	To identify patients’ beliefs and values of gene editing as a therapy for hemophilia in themselves and their relatives.	Contacted 21 individuals in the United States who either had hemophilia A/B or were a parent of someone with it.	Gene editing was not immediately accepted due to an insufficient amount of research and clinical data along with hesitancy to manipulate the genetics of the unborn baby. Data were inclined to favor such therapy if more research was done.
Howell et al. (2022) [35]	To assess perceptions of the risks and benefits of types of gene editing in the United States.	An online survey was completed by 1,600 adults from the United States that addressed perspectives on heritable edits for enhancement, heritable edits for therapy, non-heritable edits for enhancement, and non-heritable edits for therapy.	Revealing therapeutic benefits information yielded more positive views and support for human gene editing. Revealing heritable edits information yielded more negative views about and less support for human gene editing. No difference between risk and benefit perspectives of heritable and non-heritable edits.
Shozi (2021) [36]	To analyze how one African perspective may justify the application of human germline genome editing.	N/A	According to a particular African perspective called “Ubuntu,” the grounds for using human genome editing applications are contingent on whether the autonomy of the child is maintained or not. Therefore, there is no justification for an entire inhibition of germline genome editing.
Ebeling and Gebhard (2022) [37]	To assess the perspective of German young adults on genome editing and its impact on society and nature.	Forty 20-24-year-old students and 57 16-18 years old students	Based on the audio recordings obtained in the group discussions, only negative fantasies and myths were articulated regarding gene editing.
Watanabe et al. (2020) [38]	To assess how the media in Japan covered genome editing affected the public opinion of genome editing.	Japanese people ranging from the age 20-60 years.	Respondents to the surveys were overall approving of genome editing when exposed to medical applications of the technology. Respondents to the surveys were overall opposed to genome editing when exposed to the news about its use with human fertilized eggs.
Hudson et al. (2019) [39]	To explore the spectrum of Māori perspectives on the risks and benefits of gene editing.	Eight key Māori informants.	Māori informants were not overall against new gene editing technologies; however, desired a dynamic approach based on the specific case of use.
Hendriks et al. (2018) [40]	To assess the general Dutch opinions on gene modification.	1,013 Dutch individuals ranging from 11 to 90 years old.	Subjects who were younger, male, or had seen the documentary on gene editing implications were more likely to accept its use in more cases.
Abuhammad et al. (2021) [41]	To identify any ethical challenges that the MENA region would encounter with the introduction of gene editing	28 researchers from the Middle East and North Africa region	The researchers shared the belief that gene editing for treating genetic conditions was important; however, suggested the presence of regulation to ensure no misuse of the technology.
Hollister et al. (2019) [42]	This study investigates the views of the sickle cell disease (SCD) community. We utilized a mixed-methods approach to examine SCD stakeholders' views in the United States.	N/A	SCD holders, while equally worried, are more enthusiastic about and more likely to use HGE than the public if it provides a much-reduced risk of serious diseases for their child. Significantly more SCD stakeholders indicated that they probably or definitely would use HGE to give their baby a much-reduced risk of serious diseases or conditions over his/her lifetime when compared to the general population from Pew (v2=13.92, p=0.0002) and African Americans from Pew (v2=21.33, p<0.0001). This pattern was consistent when participants were asked about how enthusiastic they were about the possibility of HGE for society as a whole. SCD stakeholders were more enthusiastic than the general Pew population (v2=27.21, p<0.0001) and Pew African Americans (v2‡38.67, p<0.0001). However, SCD stakeholders were equally as worried about the possibility of HGE for society when compared to both the general Pew population (v2=0.05, p=0.82) and Pew African Americans (v2=0.11, p=0.73). As the large majority of SCD stakeholders in our sample identified as African American, we felt it was appropriate to compare their opinions to both groups.
Petre (2017) [10]	To investigate the morality of human germline editing from the perspective of future generations.	N/A	From the future generation’s perspective, editing could lead to the reduction of heterozygosity, which is correlated with a health or performance advantage and the uniformization of the genes involved in reproductive recombination, which may lead to health risks when it comes to asexual reproduction. As such, germline interventions aimed at modifying the genomes of future people cannot be ethically justifiable if there is no possibility of controlling the intervention either by reversing or altering it.
Research ethics
Getz and Dellaire (2020) [43]	The study examines Dr. He’s principles under the perspective of Beauchamp and Childress’ Principles of Biomedical Ethics, as well as that the “clinical future” of heritable genome editing was made clear on the basis of Dr. He’s proposal.	N/A	Five principles are examined in regard to gene editing: mercy for families in need, only for serious disease-never vanity, respect a child’s autonomy, genes do not define you, and everyone deserves freedom from genetic disease. Each of these five principles presents limitations which leads to the conclusion that human gene editing performed for medical purposes presents no basic moral dilemmas, while human gene editing performed with the goal of enhancing an individual defies ethical principles.
Malmqvist (2021) [44]	This study examines the event of two twin girls born in China after being genetically edited.	Participants in potential experimentation could be individuals who do not desire a healthy genetic child at all costs or that can fulfill their desire for offspring by other methods, adoption for example.	It has been concluded that an acceptable methodology for gene editing is hardly uncovered; this represents an obstacle to human germline editing. This paper argues that allowing this procedure to be the norm would conflict with the research ethic principle of non-exploitation.
Zang and Yueqin (2021) [45]	This study takes into account both benefits and risks of human gene editing. It shows that different applications depending on their purposes may be justifiable or not.	N/A	Thanks to progress in science, alteration of human characteristics is now possible; however, gene-editing technology is confronted by limits of ethical principles. For this reason, several experiments were banned in previous years.
Farrell et al. (2019) [46]	This article ought to explore the perspective of women as patients in gene editing, along with its repercussions on women's health and well-being.	Volunteering women free from any type of coercion.	This article explains why excluding women from the discussion of germline editing is unjust as well as the importance of informed consent. Women must have priority in the decision to use gene editing. Limitations however are represented by the fact that innovation needs researchers, ethicists, policymakers, and other key stakeholders to dynamically cooperate with women.