Narrative and medical genetics: on ethics and therapeutics

Narrative, as a hermeneutic social science with its key concepts borrowed from literary theory, guides interpretation of lived-experience and has found expression in qualitative research in the health sciences. Narrative, as it will be advocated here, is an appropriate method for phenomenological investigations relating to genetic counseling. The benefits to the practice of medical genetics from qualitative-that is, narrative-studies will be explored and sources of resistance to phenomenological investigations will be identified. Narrative studies in medical genetics will be shown to have the potential clinical significance of fundamentally altering the stance of genetic counselors toward those who seek their services. By understanding the client's "illness experience," counseling practice, including the ethics of practice, is altered. Finally, the Human Genome Project, by compounding the social and ethical demands on genetic counseling, makes this advocacy especially timely.

Research on the human genome and patentability--the ethical consequences

The genome is one of the primordial elements of the human being and is responsible for human identity and its transmission to descendants. The gene as such ought not be appropriated or owned by man. However, any sufficiently complete description of a gene should be capable of being protected as intellectual property. Furthermore, all utilisations of a gene or its elements that permit development of processes or new products should be patentable. Ethics, in the sense of moral action, should come into play from the very first stages of research into the human genome. Protection of intellectual and industrial property is of purely legal concern and need not provoke ethical consideration. By contrast, the use of the results of, and in particular the commercialisation of products deriving from, research into the human genome, ought to be subjected to ethical consideration and control. Considering the economic and societal stakes of such research, ethical analysis ought to be at an international level if mistakes and unforeseen risks of conflict are to be avoided.

Genetic privacy

Human genomic information is invested with enormous power in a scientifically motivated society. Genomic information has the capacity to produce a great deal of good for society. It can help identify and understand the etiology and pathophysiology of disease. In so doing, medicine and science can expand the ability to prevent and ameliorate human malady through genetic testing, treatment, and reproductive counseling.

Genomic information can just as powerfully serve less beneficent ends. Information can be used to discover deeply personal attributes of an individual's life. That information can be used to invade a person's private sphere, to alter a person's sense of self- and family identity, and to affect adversely opportunities in education, employment, and insurance. Genomic information can also affect families and ethnic groups that share genetic similarities.

Designing babies: morally permissible ways to modify the human genome

My focus in this paper is the question of the moral acceptability of attempts to modify the human genome. Much of the debate in this area has revolved around the distinction between supposedly therapeutic modification on the one hand, and eugenic modification on the other. In the first part of the paper I reject some recent arguments against genetic engineering. In the second part I seek to distinguish between permissible and impermissible forms of intervention in such a way that does not appeal to the therapeutic/eugenic distinction. If I am right much of what we would intuitively call eugenic intervention will be morally acceptable. Central to my argument is an asymmetry in the way genetic engineers can influence a person's capacities on the one hand and life-goals on the other. Forms of genetic intervention that have a high probability of producing a mismatch of life-goals and capacities will be ruled out.

Telling stories: metaphors of the Human Genome Project

Scientists of the Human Genome Project tend to rely on three metaphors to describe their work, each of which implicitly tells much the same story. Whether they claim to interpret the ultimate “book,” to fix a flawed “machine,” or to map a mysterious “wilderness,” they invariably cast the researcher as one who dominates and exploits the Other. This essay, which explores the ways such a story conflicts with feminist values, proposes an alternative.

Conflicts of interest

Academic institutions must be more zealous in policing arrangements between employees and industry.