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A Companion to GenethicsA Companion to GenethicsA Cooperative SpeciesA Mind So RareA Natural History of RapeAcquiring GenomesAdapting MindsAgeing, Health and CareAlas, Poor DarwinAn Introduction to Evolutionary EthicsAncient Bodies, Modern LivesAnimal ArchitectsAping MankindAre We Hardwired?Bang!BehavingBeyond EvolutionBeyond GeneticsBlood MattersBody BazaarBoneBrain Evolution and CognitionBrain StormBrave New BrainBrave New WorldsChoosing ChildrenCloneCloningConceptual Issues in Evolutionary BiologyConsciousness EvolvingContemporary Debates in Philosophy of BiologyControlling Our DestiniesCooperation and Its EvolutionCreatures of AccidentDarwin Loves YouDarwin's Brave New WorldDarwin's Gift to Science and ReligionDarwin's UniverseDarwin's WormsDarwinian ConservatismDarwinian PsychiatryDarwinism and its DiscontentsDarwinism as ReligionDebating DesignDecoding DarknessDefenders of the TruthDo We Still Need Doctors?Doubting Darwin?Early WarningEngineering the Human GermlineEnhancing EvolutionEnoughEntwined LivesEthical Issues in Human CloningEthical Issues in the New GeneticsEvil GenesEvolutionEvolutionEvolution and Human BehaviorEvolution and Human BehaviorEvolution and Human Sexual BehaviorEvolution and LearningEvolution and ReligionEvolution and the Human MindEvolution in MindEvolution, Gender, and RapeEvolution: The Modern SynthesisEvolutionary Ethics and Contemporary BiologyEvolutionary Origins of MoralityEvolutionary PsychiatryEvolutionary PsychologyEvolutionary Psychology and ViolenceEvolutionary Psychology as Maladapted PsychologyExploding the Gene MythFaces of Huntington'sFlesh of My FleshFrom Chance to ChoiceFrom Darwin to HitlerGenesGenes in ConflictGenes on the CouchGenes, Environment, and PsychopathologyGenes, Environment, and PsychopathologyGenes, Women, EqualityGenetic Nature/CultureGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetic SecretsGenetics of Criminal and Antisocial BehaviourGenetics of Mental DisordersGenetics of Original SinGenetics of Original SinGenomeGenomeGenome: Updated EditionGenomes and What to Make of ThemGlowing GenesHow Women Got Their Curves and Other Just-So StoriesHuman CloningHuman Evolution, Reproduction, and MoralityImproving Nature?In Our Own ImageIn Pursuit of the GeneIn the Name of GodIngenious GenesInheritanceInside the Human GenomeInside the O'BriensIntegrating Evolution and DevelopmentIntelligence, Race, and GeneticsIs Human Nature Obsolete?Language OriginsLess Than HumanLiberal EugenicsLiving with Our GenesMaking Genes, Making WavesMaking Sense of EvolutionMan As The PrayerMean GenesMenMood GenesMoral OriginsMothers and OthersNature Via NurtureNever Let Me GoNot By Genes AloneOf Flies, Mice, and MenOn the Origin of StoriesOrigin of MindOrigins of Human NatureOrigins of PsychopathologyOur Posthuman FuturePhilosophy of BiologyPlaying God?Playing God?Portraits of Huntington'sPrimates and PhilosophersPromiscuityPsychiatric Genetics and GenomicsPsychologyQuality of Life and Human DifferenceRe-creating MedicineRedesigning HumansResearch Advances in Genetics and GenomicsResponsible GeneticsResponsible GeneticsScience, Seeds and CyborgsSex and WarSociological Perspectives on the New GeneticsStrange BedfellowsStrange BehaviorSubjects of the WorldSubordination and DefeatThe Age of EmpathyThe Agile GeneThe Ape and the Sushi MasterThe Biotech CenturyThe Blank SlateThe Book of LifeThe Bridge to HumanityThe Case Against PerfectionThe Case for PerfectionThe Case of the Female OrgasmThe Century of the GeneThe Common ThreadThe Concept of the Gene in Development and EvolutionThe Debated MindThe Double-Edged HelixThe Epidemiology of SchizophreniaThe Ethics of Human CloningThe Evolution of CooperationThe Evolution of MindThe Evolution of MindThe Evolved ApprenticeThe Evolving WorldThe Fact of EvolutionThe Folly of FoolsThe Future of Human NatureThe God GeneThe Immortal Life of Henrietta LacksThe Impact of the GeneThe Innate MindThe Innate MindThe Innate Mind: Volume 3The Limits and Lies of Human Genetic ResearchThe Lives of the BrainThe Maladapted MindThe Meme MachineThe Misunderstood GeneThe Moral, Social, and Commercial Imperatives of Genetic Testing and ScreeningThe Most Dangerous AnimalThe New Genetic MedicineThe Nurture AssumptionThe Origin and Evolution of CulturesThe Origins of FairnessThe Paradoxical PrimateThe Perfect BabyThe Robot's RebellionThe Shape of ThoughtThe Shattered SelfThe Stem Cell ControversyThe Story WithinThe Stuff of LifeThe Talking ApeThe Temperamental ThreadThe Terrible GiftThe Theory of OptionsThe Top 10 Myths About EvolutionThe Triple HelixThe Triumph of SociobiologyThe Woman Who Walked into the SeaTwinsUnderstanding CloningUnderstanding the GenomeUnnatural SelectionUnto OthersUp From DragonsWar Against the WeakWhat Genes Can't DoWhat It Means to Be 98 Percent ChimpanzeeWho Owns YouWhose View of Life?Why Evolution Is TrueWhy Think? WondergenesWrestling with Behavioral GeneticsYour Genetic Destiny
Early Warning contains 29
real cases involving ethical issues in presymptomatic testing for genetic disorders;
all but six of them concern Huntingtons Disease. Of course, identifying information is removed or altered to
preserve the anonymity of the patients.
The cases are put into four main groups:
cases where the testing of one person will result in
information a family member does not want to know
cases where people do not want to know about their own
risk for genetic disorders
cases where testing decisions concerning one individual
could have benefits or dangers for other people
cases of testing children and adults where the test may
be inappropriate or the subjects ability to consent is compromised.
The cases contain some technical discussion of genetic
diseases and testing information, but the book explains the relevant details
and should be accessible to a fairly general readership. There is a glossary of technical terms at
the end of the book. The authors do not
start out with any particular moral approach, but rather use a case-by-case
method, making no strong distinction between clear thinking and moral
theory. They certainly write in the
tradition of American medical ethics that respects the autonomy of competent
subjects, but they also write from the perspective of clinicians immersed in
the realities of everyday practice. The
authors do not always agree on how to proceed in each case, and their
disagreements are explained in the case discussions. The case studies vary in detail, from a short paragraph to two
pages, and the subsequent discussion varies in length from two to four
pages. The book ends with a length set
of guidelines extrapolated from the case analyses, and which include commentary
that refers to the cases in the main portion of the book.
Since the world of genetic medicine
is progressing so rapidly, it is inevitable that some of the medical
information in the book will be somewhat out-of-date, but the discussion of the
ethical issues should be useful to clinicians, patients, and students of
genetic ethics. The discussion of cases
is sensible and thoughtful, and normally covers most of the issues that need to
be included. Often the best way to
approach difficult cases is with an open mind and an ability to find creative
solutions. When faced with extremely
tough choices, one can also learn from such cases to create new policies for a
testing and counseling facility to avoid facing such difficult decisions in the
future. Its invaluable for ethicists
to work through the details of real cases, and even if readers do not always
agree with the recommendations of the authors, they will learn from the
Some readers may find that the fact
that the bulk of cases concern Huntingtons Disease makes the discussion
somewhat less useful if they are more concerned with other disorders such as
some forms of cancer, for example. The
book may also disappoint someone looking for simple answers to difficult
questions, because even with the list of guidelines at the end of the book, it
is still largely a matter of judgment when it comes to applying the guidelines
to real cases. Nevertheless, this
collection of cases probably provides the most thorough and thoughtful
available discussion of the ethical issues arising in presymptomatic genetic
testing. It will be very useful as a
resource to anyone teaching a course in genetic ethics.
© 2002 Christian Perring. All
Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island.
He is editor of Metapsychology Online Review. His main research is on
philosophical issues in psychiatry. He is especially interested in exploring
how philosophers can play a greater role in public life, and he is keen to help
foster communication between philosophers, mental health professionals, and the
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