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The Moral, Social, and Commercial Imperatives of Genetic Testing and ScreeningReview - The Moral, Social, and Commercial Imperatives of Genetic Testing and Screening
The Australian Case
by Michela Betta (Editor)
Springer, 2006
Review by Jeremy Green
Dec 18th 2007 (Volume 11, Issue 51)

Betta offers a collection of essays concerned with the "new genetics," that is, the "convergence of knowledge fields such as biology, computer science, chemistry, physics, and engineering" (4).  The first two essays set the stage for the remaining chapters by initiating the reader into the controversies surrounding the new genetics in social and commercial contexts.  Chapter 1 asks this important question:  given the control that genes have over an individual, does knowledge of the encoded genetic information mitigate the sense that one acts as a self-determining agent?  If a genetic test revealed to an otherwise healthy person that she was predisposed to acquiring some debilitating illness, one could feel that the disease was inevitable.  Betta is concerned that genetic screening and testing will give rise to a number of persons living as if the testing stripped control of their lives away from them.  Besides the case of disease, one can easily imagine a defense attorney claiming that his client had no choice but to commit the crime--his genes made him do it.  The concern is that an increased awareness of our own genetic material will lead to overloading our DNA with too much responsibility.  The challenge is to strike a balance between making responsible use of information gleaned from genetic screening and testing on the one hand and allowing that information to run our lives on the other.

Chapter 2 specifically treats the commercial relationship between biotech corporations and the medical science community.  Betta argues that a tendency exists to regard scientists and medical practitioners as wholly removed from the world of commercialism.  Joint ventures between corporations and scientists leads a community to be skeptical of the genuine objectivity of the scientists involved.  One interesting issue that Betta engages is the influence of market driven economies on patient care.  Betta sees a profit motive influencing contemporary healthcare coming from a "fundamental transformation of healthcare into a commodity that introduces market practices into the medical profession and its establishments" (34).  Betta cites the U. S.'s putative healthcare crisis as the paradigmatic case of market driven medicine.  The supposed problem is that through private health insurance patients become consumers.

However, such a claim is misguided.  Insurance companies are the primary consumers of healthcare goods, deciding what kinds of patient services are worth the financial risk.  In this context, the patient has relatively little say about the services that she will procure.  Of course, the patient may decide to purchase a medical service independently, but insurance companies have skewed the market such that healthcare costs have moved beyond the financial resources of the average middle class patient.

Medical savings accounts may provide a solution to the problem by giving patients the means to make their own healthcare decisions with their physicians.  Nevertheless, Betta sees these savings accounts as the primary factor responsible for turning healthcare into a commodity (35).  Her problem with such a move is that consumers are much more interested in new cars and vacations than medical care.  This seems patently false.  Despite my own lack of faith in the rationality of human beings, most of us seem to be interested in not dying.  Even if I am wrong on this point, if one decides to purchase a new sports car as opposed to electing to have heart surgery, it ought to be the person's decision.  The responsibility for making a bad decision rests on the one refusing care, and no one else (including the government).  In several places, Betta seems to imply that government ought to be the distributor healthcare.  Our intuitions part on this point.  I have no space to argue against this claim.

Moving on, chapters 3 through 12 discuss the way in which Australia has met the challenges of the new genetics, specifically considering the Australia Law Reform Commission's (ALRC) and the Australian Health Ethics Committee's (AHEC) joint study Essentially Yours:  The Protection of Human Genetic Information in Australia.  Three main issues are discussed:  (1) the need to protect the of privacy an individual's genetic material, (2) the need to protect individuals from discrimination (by insurance providers and in the workplace), and (3) the protection of persons vulnerable to harm such as children caught in paternity battles and innocents coerced to provide genetic material by police agencies.  Unfortunately, these chapters all take the same form:  the Study discovered the need for policies addressing the concerns mentioned above, and the Study recommended the development of policies addressing the concerns mentioned above.  The authors take no position and offer no arguments. Chapters 5 and 6 provide the most in-depth reporting of the facts of the Study.  Read these two chapters together as one long paper.  Once one has read them, there seems to be very little reason to read the rest of the second part.  Each of the other chapters either rehashes the results of the Study in total or picks one of the three on which to focus.

Chapter 13 closes the book with a discussion of "self-knowledge and self-care in the age of genetic manipulation" as the base for an ethical life (249).  Ending in a place not too far from where she started, Betta reminds us that who we are as humans and the kinds of persons we take ourselves to be will be challenged by the new genetics.  The information our genes give us threatens to destroy our sense of moral agency.  Yet, we can care for ourselves and make the best with what we have.  Such self-care reflects a moral life "that not only has its own rewards, but relieves others of any obligation to care" (255).

The opening and closing chapters of the book present the most interesting material for those interested in applied ethics.  Despite the fact that the remaining chapters fail to cover much philosophical ground, if one is looking for a list of the imperative looming on the genetic horizon, then this book makes an important contribution.

© 2007 Jeremy Green

Jeremy Green, Department of Philosophy, Western Michigan University

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