Epigenetics Changes Nothing: What a New Scientific Field Does and Does Not Mean for Ethics and Social Justice

Normative implications of postgenomic deterministic narratives: the case study of epigenetic harm

What do we mean when we talk about epigenetic harm? This paper presents a multidimensional view of epigenetic harm. It is a plea to take a step back from discussions of epigenetic responsibility distributions prevalent in ELSA literature on epigenetics. Instead, it urges researchers to take a closer look at the normative role played by the concept of epigenetic harm. It starts out by showing that the ways in which the object of epigenetic responsibility has already been conceptualized are all related to 'epigenetic harm': something negative that happens in which epigenetic mechanisms play a role, or rather something that needs to be avoided. Epigenetic harm is then characterized as a bridging concept between relatively neutral findings on epigenetics on the one side, and potential ethical and societal implications of those findings, primarily in terms of responsibility ascriptions and distributions, on the other. The paper proposes that a sufficiently nuanced account of epigenetic harm should include at least three dimensions. The dimension of causation alone leads to an overly narrow understanding of harm, and a wrong understanding of this dimension might prompt researchers to support an excessively simplistic epigenetic determinism. It is argued that a multidimensional analysis of epigenetic harm is less vulnerable to this threat and more reflective of the various kinds of harm that may be experienced by the subjects of epigenetic alterations. The paper applies insights from disability studies and feminist philosophy to draw attention to two other dimensions of epigenetic harm, namely lived experiences and relationality. The paper concludes by exploring what a shift towards a multidimensional approach to epigenetic harm might mean for epigenetic research and responsibility ascriptions by formulating some concrete implications.

Researcher perspectives on ethics considerations in epigenetics: an international survey

Over the past decade, bioethicists, legal scholars and social scientists have started to investigate the potential implications of epigenetic research and technologies on medicine and society. There is growing literature discussing the most promising opportunities, as well as arising ethical, legal and social issues (ELSI). This paper explores the views of epigenetic researchers about some of these discussions. From January to March 2020, we conducted an online survey of 189 epigenetic researchers working in 31 countries. We questioned them about the scope of their field, opportunities in different areas of specialization, and ELSI in the conduct of research and knowledge translation. We also assessed their level of concern regarding four emerging non-medical applications of epigenetic testing—i.e., in life insurance, forensics, immigration and direct-to-consumer testing. Although there was strong agreement on DNA methylation, histone modifications, 3D structure of chromatin and nucleosomes being integral elements of the field, there was considerable disagreement on transcription factors, RNA interference, RNA splicing and prions. The most prevalent ELSI experienced or witnessed by respondents were in obtaining timely access to epigenetic data in existing databases, and in the communication of epigenetic findings by the media. They expressed high levels of concern regarding non-medical applications of epigenetics, echoing cautionary appraisals in the social sciences and humanities literature.

Ethical implications of epigenetics in the era of personalized medicine

Given the increasing research activity on epigenetics to monitor human diseases and its connection with lifestyle and environmental expositions, the field of epigenetics has attracted a great deal of interest also at the ethical and societal level. In this review, we will identify and discuss current ethical, legal and social issues of epigenetics research in the context of personalized medicine. The review covers ethical aspects such as how epigenetic information should impact patient autonomy and the ability to generate an intentional and voluntary decision, the measures of data protection related to privacy and confidentiality derived from epigenome studies (e.g., risk of discrimination, patient re-identification and unexpected findings) or the debate in the distribution of responsibilities for health (i.e., personal versus public responsibilities). We pay special attention to the risk of social discrimination and stigmatization as a consequence of inferring information related to lifestyle and environmental exposures potentially contained in epigenetic data. Furthermore, as exposures to the environment and individual habits do not affect all populations equally, the violation of the principle of distributive justice in the access to the benefits of clinical epigenetics is discussed. In this regard, epigenetics represents a great opportunity for the integration of public policy measures aimed to create healthier living environments. Whether these public policies will coexist or, in contrast, compete with strategies reinforcing the personalized medicine interventions needs to be considered. The review ends with a reflection on the main challenges in epigenetic research, some of them in a technical dimension (e.g., assessing causality or establishing reference epigenomes) but also in the ethical and social sphere (e.g., risk to add an epigenetic determinism on top of the current genetic one). In sum, integration into life science investigation of social experiences such as exposure to risk, nutritional habits, prejudice and stigma, is imperative to understand epigenetic variation in disease. This pragmatic approach is required to locate clinical epigenetics out of the experimental laboratories and facilitate its implementation into society.

Exploring the evidence for epigenetic regulation of environmental influences on child health across generations

Environmental exposures, psychosocial stressors and nutrition are all potentially important influences that may impact health outcomes directly or via interactions with the genome or epigenome over generations. While there have been clear successes in large-scale human genetic studies in recent decades, there is still a substantial amount of missing heritability to be elucidated for complex childhood disorders. Mounting evidence, primarily in animals, suggests environmental exposures may generate or perpetuate altered health outcomes across one or more generations. One putative mechanism for these environmental health effects is via altered epigenetic regulation. This review highlights the current epidemiologic literature and supporting animal studies that describe intergenerational and transgenerational health effects of environmental exposures. Both maternal and paternal exposures and transmission patterns are considered, with attention paid to the attendant ethical, legal and social implications.

Negotiating Novelty: Constructing the Novel within Scientific Accounts of Epigenetics

Epigenetics is regarded by many as a compelling domain of biomedicine. The purported novelty of epigenetics has begun to have various societal ramifications, particularly in relation to processes of responsibilisation. Within sociology, it has stimulated hopeful debate about conceptual rapprochements between the biomedical and social sciences. This article is concerned with how novelty is socially produced and negotiated. The article engages directly with scientists' talk and writings about epigenetics (as process and field of study). I aim to advance an explicitly sociological analysis about the novelty of epigenetics that underscores its social production rather than an account which participates in its reification. I attend to definitional skirmishes, comparisons with genetics, excitement and intrigue, and considerations of the ethical dimensions of epigenetics. Any assertions that epigenetics is exciting or important should not inadvertently elide reflexive consideration of how such characterisations might be part of the machinery by which they become real.

The end of the 'Bad seed' Era? Epigenetics' contribution to violence prevention initiatives in public health

Despite numerous initiatives and significant resource investment, violence remains a pervasive threat to public health. The burgeoning field of epigenetics may offer an exciting new possibility for violence prevention efforts by illuminating the mechanisms of gene-environment interactions. In particular, it may improve our ability to design more effective primary interventions, facilitate improved intervention tailoring, and better position communities to be active agents in their well-being. However, without attention to the distinction between awareness, self-efficacy, and agency, it risks encouraging a false sense of individual accountability for violence, a perception that may perpetuate or increase existing inequities. Thus, embracing epigenetic insights in public health raises new opportunities but also new concerns. Ultimately, I argue public health should embrace epigenetics' potential, but only with an equal commitment to state responsibility and systemic justice.

Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study

Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk of cancer. Moreover, epigenetic markers might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions.

Advancing Indigenous Mental Health Research: Ethical, conceptual and methodological challenges

The articles in this issue of Transcultural Psychiatry point the way toward meaningful advances in mental health research pertaining to Indigenous peoples, illuminating the distinctive problems and predicaments that confront these communities as well as unrecognized or neglected sources of well-being and resilience. As we observe in this introductory essay, future research will benefit from ethical awareness, conceptual clarity, and methodological refinement. Such efforts will enable additional insight into that which is common to Indigenous mental health across settler societies, and that which is specific to local histories, cultures and contexts. Research of this kind can contribute to nuanced understandings of developmental pathways, intergenerational effects, and community resilience, and inform policy and practice to better meet the needs of Indigenous individuals, communities and populations.

Epigenetics, ethics, law and society: A multidisciplinary review of descriptive, instrumental, dialectical and reflexive analyses

Epigenetics, defined as 'the study of mitotically and/or meiotically heritable changes in gene function that cannot be explained by changes in DNA sequence', has emerged as a promissory yet controversial field of scientific inquiry over the past decade. Scholars from many disciplines have formulated both optimistic and cautionary claims regarding its potential normative implications. This article provides a comprehensive review of the nascent literature at the crossroads of epigenetics, ethics, law and society. It describes nine emerging areas of discussion, relating to (1) the impact of epigenetics on the nature versus nurture dualism, (2) the potential resulting biologization of the social, (3) the meaning of epigenetics for public health, its potential influence on (4) reproduction and parenting, (5) political theory and (6) legal proceedings, and concerns regarding (7) stigmatization and discrimination, (8) privacy protection and (9) knowledge translation. While there is some degree of similarity between the nature and content of these areas and the abundant literature on ethical, legal and social issues in genetics, the potential implications of epigenetics ought not be conflated with the latter. Critical studies on epigenetics are emerging within a separate space of bioethical and biopolitical investigations and claims, with scholars from various epistemological standpoints utilizing distinct yet complementary analytical approaches.

Epigenetics: ethics, politics, biosociality

BACKGROUND

Epigenetics is a burgeoning field of contemporary biosciences, which has attracted a lot of interest both in biomedical and in social sciences.

SOURCES OF DATA

Unsystematic literature analysis and retrospective mapping of highly cited work (source: Web of Science core collection) in the social sciences and humanities engaging with epigenetics.

AREAS OF AGREEMENT

Epigenetics poses no new ethical issue over and above those discussed in relation to genetics.

AREAS OF CONTROVERSY

However, it encourages a different framing and reflexivity on some of the commonly held categories in the moral uptake of scientific discoveries.

GROWING POINTS

Epigenetics presents us with normative questions that touch upon privacy, responsibility for individual health and for the well-being of future generations, as well as matters of health justice and equality of opportunities.

AREAS TIMELY FOR DEVELOPING RESEARCH

Epigenetic thinking could help us adjust and refine the problem frames and categories that inform our ethical and political questions with a complex biosocial description of situations, of persons or actions.