The Human Genome Project and the clinician

The Florida Supreme Court's decision in Pate v Threlkel is an early warning sing of the massive impact human genome research will have on medical practice. Genetic screening is a scientific tool whose widespread use in clinical medicine will expand due to the combined influences of the federally funded Human Genome Project, biotechnology market forces, and corporate and societal pressures to both use and further develop the technique. Once testing becomes cost-effective, clinicians, by virtue of their position as "knowledgeable professionals" and as the primary source of health information for patients with genetic disorders, will be required to act as gatekeepers to the genetic heritage of their patients. This will seriously impact the legal definitions of reasonable care, a physician's duty to warn, the concept of informed consent, and the confidentiality of medical records.

Ethics, genomics, and information retrieval

The union of genomics and computational information retrieval raises a number of ethical issues, including data sharing, database accuracy, group and subgroup stigma, and privacy and confidentiality. These issues are introduced and assigned a preliminary analysis which, it is hoped, may be of use in more sustained efforts to identify issues, solutions and potential guidelines, to stimulate education, and to strike the most appropriate balance between the rights of individuals and the needs of researchers and society.

The Human Genome Project: research tactics and economic strategies

In the Museum of Science and Technology in San Jose, California, there is a display dedicated to advances in biotechnology. Most prominent in the display is a double helix of telephone books stacked in two staggered spirals from the floor to the ceiling twenty-five feet above. The books are said to represent the current state of our knowledge of the eukaryotic genome: the primary sequences of DNA polynucleotides for the gene products which have been discovered so far in the twenty years since cloning and sequencing the genome became possible.

Genome research: implications for children

New discoveries from genetic research may benefit children through increased knowledge of genetic causes of diseases, and new methods of diagnosis and treatment including presymptomatic diagnoses, carrier diagnoses, and gene therapy. However, these discoveries are also creating ethical, legal, and social dilemmas regarding children's health. Inaccurate interpretation of carrier test results, a limited understanding of implications of genetic information, emotional implications of testing, and potential insurance denials are examples. Ways in which pediatric nurses will apply knowledge of genome research in their practice include: education, counseling, advocacy, clarification of values and feelings, and referral for information, support, and assistance.

Self-critical federal science? The ethics experiment within the U.S. Human Genome Project

On October 1, 1988, thirty-five years after co-discovering the structure of the DNA molecule, Dr. James Watson launched an unprecedented experiment in American science policy. In response to a reporter's question at a press conference, he unilaterally set aside 3 to 5 percent of the budget of the newly launched Human Genome Project to support studies of the ethical, legal, and social implications of new advances in human genetics. The Human Genome Project (HGP), by providing geneticists with the molecular maps of the human chromosomes that they use to identify specific human genes, will speed the proliferation of a class of DNA-based diagnostic and risk-assessment tests that already create professional ethical and health-policy challenges for clinicians. “The problems are with us now, independent of the genome program, but they will be associated with it,” Watson said. “We should devote real money to discussing these issues.” By 1994, the “ELSI program” (short for “Ethical, Legal, and Social Implications”) had spent almost $20 million in pursuit of its mission, and gained both praise and criticism for its accomplishments.

Choosing who will be disabled: genetic intervention and the morality of inclusion

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge.

The case for genomic patenting

Opposition to the patenting of genomic inventions threatens to erode the foundation of intellectual property rights needed to convert innovative research into new drugs, vaccines and diagnostic tests.