1
|
Dive L, Newson AJ. Reproductive carrier screening: responding to the eugenics critique. JOURNAL OF MEDICAL ETHICS 2022; 48:1060-1067. [PMID: 34244346 PMCID: PMC9726954 DOI: 10.1136/medethics-2021-107343] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 05/26/2023]
Abstract
Reproductive genetic carrier screening (RCS), when offered to anyone regardless of their family history or ancestry, has been subject to the critique that it is a form of eugenics. Eugenics describes a range of practices that seek to use the science of heredity to improve the genetic composition of a population group. The term is associated with a range of unethical programmes that were taken up in various countries during the 20th century. Contemporary practice in medical genetics has, understandably, distanced itself from such programmes. However, as RCS becomes more widespread, gains public funding and uses expanded gene panels, there are concerns that such programmes could be perceived as eugenic either in intent or outcome. The typical response to the eugenics critique of RCS is to emphasise the voluntary nature of both participating in screening and making subsequent reproductive choices. While safeguarding individuals' freedom to choose in relation to screening is essential, we consider this response inadequate. By examining the specific ethical wrongs committed by eugenics in the past, we argue that to avoid the perception of RCS being a form of eugenics it is essential to attend to the broader normative context in which reproductive decisions occur. Furthermore, ethical RCS programmes must recognise and respond to their potential to shift societal norms that shape individual reproductive choices.
Collapse
Affiliation(s)
- Lisa Dive
- Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
| | - Ainsley J Newson
- Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Meagher KM, Watson S, Suh GA, Virk A. The New Precision Stewards? J Pers Med 2022; 12:jpm12081308. [PMID: 36013256 PMCID: PMC9409858 DOI: 10.3390/jpm12081308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
The precision health era is likely to reduce and respond to antimicrobial resistance (AMR). Our stewardship and precision efforts share terminology, seeking to deliver the “right drug, at the right dose, at the right time.” Already, rapid diagnostic testing, phylogenetic surveillance, and real-time outbreak response provide just a few examples of molecular advances we dub “precision stewardship.” However, the AMR causal factors range from the molecular to that of global health policy. Mirroring the cross-sectoral nature of AMR science, the research addressing the ethical, legal and social implications (ELSI) of AMR ranges across academic scholarship. As the rise of AMR is accompanied by an escalating sense of its moral and social significance, what is needed is a parallel field of study. In this paper, we offer a gap analysis of this terrain, or an agenda for “the ELSI of precision stewardship.” In the first section, we discuss the accomplishments of a multi-decade U.S. national investment in ELSI research attending to the advances in human genetics. In the next section, we provide an overview of distinct ELSI topics pertinent to AMR. The distinctiveness of an ELSI agenda for precision stewardship suggests new opportunities for collaboration to build the stewardship teams of the future.
Collapse
Affiliation(s)
- Karen M. Meagher
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +1-507-293-9528
| | - Sara Watson
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55905, USA
| | - Gina A. Suh
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Abinash Virk
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
3
|
So D. From goodness to good looks: Changing images of human germline genetic modification. BIOETHICS 2022; 36:556-568. [PMID: 34218455 PMCID: PMC9292047 DOI: 10.1111/bioe.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/31/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
When writing about deliberate changes to the human germline, bioethicists tend not to discuss the modification of specific genes and instead refer to broader concepts like making people smarter, taller, or longer-lived. Only a limited number of these traits are mentioned regularly in the literature. Examples like health and intelligence appear frequently at all stages of the germline modification discourse, but the third most frequently mentioned trait has shifted over time. Prior to the early 1980s, publications discussed giving humans a kinder temperament significantly more often than cosmetic modifications, while more recent works reverse the frequency of these traits. Contributing factors likely include a greater focus on individual decision-making, combined with the increasing uptake of real-world reproductive technologies like IVF and gamete donation. This shifting imagery could have a profound influence on the way scholars develop arguments about gene editing since cosmetic modifications are generally viewed more negatively and considered less relevant to the identity of future people. In comparison with earlier images of germline modification, they also suggest a more contemporary, Western, and politically liberal social context for gene editing technology. Examining how authors move between writing about different traits can also help us to be aware of the traits that are arbitrarily omitted from the discourse and to consider our preparedness for unexpected kinds of modification.
Collapse
Affiliation(s)
- Derek So
- Centre of Genomics and PolicyDepartment of Human GeneticsMcGill UniversityMontrealQuebecCanada
| |
Collapse
|
4
|
Raben TG, Lello L, Widen E, Hsu SDH. From Genotype to Phenotype: Polygenic Prediction of Complex Human Traits. Methods Mol Biol 2022; 2467:421-446. [PMID: 35451785 DOI: 10.1007/978-1-0716-2205-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Decoding the genome confers the capability to predict characteristics of the organism (phenotype) from DNA (genotype). We describe the present status and future prospects of genomic prediction of complex traits in humans. Some highly heritable complex phenotypes such as height and other quantitative traits can already be predicted with reasonable accuracy from DNA alone. For many diseases, including important common conditions such as coronary artery disease, breast cancer, type I and II diabetes, individuals with outlier polygenic scores (e.g., top few percent) have been shown to have 5 or even 10 times higher risk than average. Several psychiatric conditions such as schizophrenia and autism also fall into this category. We discuss related topics such as the genetic architecture of complex traits, sibling validation of polygenic scores, and applications to adult health, in vitro fertilization (embryo selection), and genetic engineering.
Collapse
Affiliation(s)
| | - Louis Lello
- Michigan State University, East Lansing, MI, USA
- Genomic Prediction, North Brunswick, NJ, USA
| | - Erik Widen
- Michigan State University, East Lansing, MI, USA
| | - Stephen D H Hsu
- Michigan State University, East Lansing, MI, USA.
- Genomic Prediction, North Brunswick, NJ, USA.
| |
Collapse
|
5
|
Dive L, Newson AJ. Ethics of Reproductive Genetic Carrier Screening: From the Clinic to the Population. Public Health Ethics 2021; 14:202-217. [PMID: 34650621 PMCID: PMC8510688 DOI: 10.1093/phe/phab017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive genetic carrier screening (RCS) is increasingly being offered more widely, including to people with no family history or otherwise elevated chance of having a baby with a genetic condition. There are valid reasons to reject a prevention-focused public health ethics approach to such screening programs. Rejecting the prevention paradigm in this context has led to an emphasis on more individually-focused values of freedom of choice and fostering reproductive autonomy in RCS. We argue, however, that population-wide RCS has sufficient features in common with other public health screening programs that it becomes important also to attend to its public health implications. Not doing so constitutes a failure to address the social conditions that significantly affect people's capacity to exercise their reproductive autonomy. We discuss how a public health ethics approach to RCS is broader in focus than prevention. We also show that additional values inherent to ethical public health-such as equity and solidarity-are essential to underpin and inform the aims and implementation of reproductive carrier screening programs.
Collapse
Affiliation(s)
- Lisa Dive
- Sydney Health Ethics, The University of Sydney
| | | |
Collapse
|
6
|
Munday S, Savulescu J. Three models for the regulation of polygenic scores in reproduction. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106588. [PMID: 33462079 PMCID: PMC8639919 DOI: 10.1136/medethics-2020-106588] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 05/06/2023]
Abstract
The past few years have brought significant breakthroughs in understanding human genetics. This knowledge has been used to develop 'polygenic scores' (or 'polygenic risk scores') which provide probabilistic information about the development of polygenic conditions such as diabetes or schizophrenia. They are already being used in reproduction to select for embryos at lower risk of developing disease. Currently, the use of polygenic scores for embryo selection is subject to existing regulations concerning embryo testing and selection. Existing regulatory approaches include 'disease-based' models which limit embryo selection to avoiding disease characteristics (employed in various formats in Australia, the UK, Italy, Switzerland and France, among others), and 'laissez-faire' or 'libertarian' models, under which embryo testing and selection remain unregulated (as in the USA). We introduce a novel 'Welfarist Model' which limits embryo selection according to the impact of the predicted trait on well-being. We compare the strengths and weaknesses of each model as a way of regulating polygenic scores. Polygenic scores create the potential for existing embryo selection technologies to be used to select for a wider range of predicted genetically influenced characteristics including continuous traits. Indeed, polygenic scores exist to predict future intelligence, and there have been suggestions that they will be used to make predictions within the normal range in the USA in embryo selection. We examine how these three models would apply to the prediction of non-disease traits such as intelligence. The genetics of intelligence remains controversial both scientifically and ethically. This paper does not attempt to resolve these issues. However, as with many biomedical advances, an effective regulatory regime must be in place as soon as the technology is available. If there is no regulation in place, then the market effectively decides ethical issues.
Collapse
Affiliation(s)
- Sarah Munday
- Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
- Biomedical Ethics Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne Law School, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Griesemer I, Staley BS, Lightfoot AF, Bain L, Byrd D, Conway C, Grant TL, Leach B, Milko L, Mollison L, Porter N, Reid S, Smith G, Waltz M, Berg JS, Rini C, O'Daniel JM. Engaging community stakeholders in research on best practices for clinical genomic sequencing. Per Med 2020; 17:435-444. [PMID: 33026293 PMCID: PMC7938705 DOI: 10.2217/pme-2020-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aim: Maximizing the utility and equity of genomic sequencing integration in clinical care requires engaging patients, their families, and communities. The NCGENES 2 study explores the impact of engagement between clinicians and caregivers of children with undiagnosed conditions in the context of a diagnostic genomic sequencing study. Methods: A Community Consult Team (CCT) of diverse parents and advocates for children with genetic and/or neurodevelopmental conditions was formed. Results: Early and consistent engagement with the CCT resulted in adaptations to study protocol and materials relevant to this unique study population. Discussion: This study demonstrates valuable contributions of community stakeholders to inform the implementation of translational genomics research for diverse participants.
Collapse
Affiliation(s)
- Ida Griesemer
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Cecil G. Sheps Center for Health Services Research, UNC Chapel Hill, Chapel Hill NC, USA
| | - Brooke S Staley
- Department of Epidemiology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Alexandra F Lightfoot
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, NC, USA.,Center for Health Promotion & Disease Prevention, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Derrick Byrd
- Parent/Advocate, Family Resource Center South Atlantic, Raleigh, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | - Tracey L Grant
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Laura Milko
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Lonna Mollison
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | | | - Sharron Reid
- Parent/Advocate, Wake County Sickle Cell Support Group, Raleigh, NC, USA
| | | | - Margaret Waltz
- Department of Social Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine & Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
8
|
Cavaliere G. The problem with reproductive freedom. Procreation beyond procreators' interests. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:131-140. [PMID: 31410737 PMCID: PMC7040050 DOI: 10.1007/s11019-019-09917-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reproductive freedom plays a pivotal role in debates on the ethics of procreation. This moral principle protects people's interests in procreative matters and allows them discretion over whether to have children, the number of children they have and, to a certain extent, the type of children they have. Reproductive freedom's theoretical and political emphasis on people's autonomy and well-being is grounded in an individual-centred framework for discussing the ethics of procreation. It protects procreators' interests and significantly reduces the permissible grounds for interference by third parties. In this article I show that procreative decisions have far-reaching effects on the composition and size of the population. The upshot of considering these effects allows for the appreciation of the inadequacy of a framework that solely considers individual (i.e. procreators') interests to discuss the ethics of procreation. To address such inadequacy, I assess costs and benefits of past and present proposals to reflect on procreation in such a way as to consider its far-reaching effects. I conclude by arguing that reproductive freedom should be defended as an imperfect but instrumentally necessary tool. This framing would enable those participating in debates on the ethics of procreative decisions to work towards an ethical framework that accounts for the cumulative effects of these decisions.
Collapse
Affiliation(s)
- Giulia Cavaliere
- Department of Global Health & Social Medicine, School of Global Affairs, King's College London, Room 3.12, Bush House NE Wing, 40 Aldwych, London, WC2B 4BG, UK.
| |
Collapse
|
9
|
Karavani E, Zuk O, Zeevi D, Barzilai N, Stefanis NC, Hatzimanolis A, Smyrnis N, Avramopoulos D, Kruglyak L, Atzmon G, Lam M, Lencz T, Carmi S. Screening Human Embryos for Polygenic Traits Has Limited Utility. Cell 2019; 179:1424-1435.e8. [PMID: 31761530 PMCID: PMC6957074 DOI: 10.1016/j.cell.2019.10.033] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/11/2019] [Accepted: 10/25/2019] [Indexed: 12/19/2022]
Abstract
The increasing proportion of variance in human complex traits explained by polygenic scores, along with progress in preimplantation genetic diagnosis, suggests the possibility of screening embryos for traits such as height or cognitive ability. However, the expected outcomes of embryo screening are unclear, which undermines discussion of associated ethical concerns. Here, we use theory, simulations, and real data to evaluate the potential gain of embryo screening, defined as the difference in trait value between the top-scoring embryo and the average embryo. The gain increases very slowly with the number of embryos but more rapidly with the variance explained by the score. Given current technology, the average gain due to screening would be ≈2.5 cm for height and ≈2.5 IQ points for cognitive ability. These mean values are accompanied by wide prediction intervals, and indeed, in large nuclear families, the majority of children top-scoring for height are not the tallest.
Collapse
Affiliation(s)
- Ehud Karavani
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Or Zuk
- Department of Statistics, The Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Danny Zeevi
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Genetics, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nikos C Stefanis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 115 28 Athens, Greece; University Mental Health Research Institute, 115 27 Athens, Greece; Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, 115 21 Athens, Greece
| | - Alex Hatzimanolis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 115 28 Athens, Greece; Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, 115 21 Athens, Greece
| | - Nikolaos Smyrnis
- Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 115 28 Athens, Greece; University Mental Health Research Institute, 115 27 Athens, Greece
| | - Dimitrios Avramopoulos
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Leonid Kruglyak
- Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Biological Chemistry, University of California, Los Angeles, Los Angeles, CA 90095, USA; Howard Hughes Medical Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Gil Atzmon
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Genetics, Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Biology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel
| | - Max Lam
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, NY 11030, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Todd Lencz
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004, USA; Institute of Behavioral Science, Feinstein Institutes of Medical Research, Manhasset, NY 11030, USA; Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA.
| | - Shai Carmi
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel.
| |
Collapse
|
10
|
Abstract
Eugenics is often referred to in debates on the ethics of reproductive technologies and practices, in relation to the creation of moral boundaries between acceptable and unacceptable technologies, and acceptable and unacceptable uses of these technologies. Historians have argued that twentieth century eugenics cannot be reduced to a uniform set of practices, and that no simple lessons can be drawn from this complex history. Some authors stress the similarities between past eugenics and present reproductive technologies and practices (what I define throughout the paper as 'the continuity view') in order to condemn the latter. Others focus on the differences between past and present practices (what I define throughout the paper as 'the discontinuity view') in order to defend contemporary reproductive technologies. In this paper, I explore the meanings of the word 'eugenics' and the relationship between its past and present uses in terms of contemporary debates on reproductive technologies and practices. I argue that moral disagreement about present technologies originate in divergent views of condemnable and justifiable features of the past.
Collapse
Affiliation(s)
- Giulia Cavaliere
- Department of Global Health and Social Medicine, School of Global Affairs, King's College London, Room 3.12, Bush House (NE), 30, Aldwych, London, WC2B 4BG, UK.
| |
Collapse
|
11
|
Kapoor P. Between fact and fiction: Can there be a postcolonial feminist ethnography? WOMENS STUDIES INTERNATIONAL FORUM 2017. [DOI: 10.1016/j.wsif.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Toldson IL, Toldson IA. Biomedical Ethics: An African-Centered Psychological Perspective. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798401027004002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Biomedical ethics examine questions of right and good action that arise in biological and medical settings. In the biomedical, ethical universe, continental Africans and the diasporic descendants tend to react differently than the ordinary Westerner. African American psychology is particularly concerned with the ethical dimensions and cultural competence of systems of health care. The quantity and quality of psychological health care delivered to African Americans raise deeply pervasive and troubling ethical questions. The significance of African consciousness, skin color, religion, education, racism, and the sociopolitical and economic posture of African people cannot be ignored. In a world culture where the rationing of resources is determined along a color line, the medical and mental health status of continental and diasporic Africans is adversely affected. A psychological perspective on the biomedical ethics of the African communities, particularly in America, is urgently needed. This exposition is intended to stimulate scholarship toward that end.
Collapse
|
13
|
Iltis AS. Prenatal screening and prenatal diagnosis: contemporary practices in light of the past. JOURNAL OF MEDICAL ETHICS 2016; 42:334-339. [PMID: 27161556 DOI: 10.1136/medethics-2016-103623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/18/2016] [Indexed: 06/05/2023]
Abstract
The 20th century eugenics movement in the USA and contemporary practices involving prenatal screening (PNS), prenatal diagnosis (PND), abortion and preimplantation genetic diagnosis (PGD) share important morally relevant similarities. I summarise some features of the 20th century eugenics movement; describe the contemporary standard of care in the USA regarding PNS, PND, abortion and PGD; and demonstrate that the 'old eugenics' the contemporary standard of care share the underlying view that social resources should be invested to prevent the birth of people with certain characteristics. This comparison makes evident the difficulty of crafting moral arguments that treat some uses of PNS, PND, abortion and PGD as licit and others as illicit.
Collapse
|
14
|
Lee LM, Royo-Bordonada MÁ. Continuing the conversation about public health ethics: education for public health professionals in Europe. Public Health Rev 2015; 36:5. [PMID: 29450033 PMCID: PMC5804496 DOI: 10.1186/s40985-015-0001-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/02/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lisa M Lee
- Executive Director, U.S. Presidential Commission for the Study of Bioethical Issues, Washington, DC USA
| | | |
Collapse
|
15
|
Affiliation(s)
| | - Hanan Hamamy
- Department of Genetic Medicine and Development, 1211 Geneva, Switzerland
| | | | - Alex Mauron
- Institute for Biomedical Ethics University of Geneva Medical School, 1211 Geneva, Switzerland
| | - Samia A Hurst
- Institute for Biomedical Ethics University of Geneva Medical School, 1211 Geneva, Switzerland.
| |
Collapse
|
16
|
Sparrow R. Queerin' the PGD clinic : human enhancement and the future of bodily diversity. THE JOURNAL OF MEDICAL HUMANITIES 2013; 34:177-196. [PMID: 23468396 DOI: 10.1007/s10912-013-9223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Disability activists influenced by queer theory and advocates of "human enhancement" have each disputed the idea that what is "normal" is normatively significant, which currently plays a key role in the regulation of pre-implantation genetic diagnosis (PGD). Previously, I have argued that the only way to avoid the implication that parents have strong reasons to select children of one sex (most plausibly, female) over the other is to affirm the moral significance of sexually dimorphic human biological norms. After outlining the logic that generates this conclusion, I investigate the extent to which it might also facilitate an alternative, progressive, opening up of the notion of the normal and of the criteria against which we should evaluate the relative merits of different forms of embodiment. This paper therefore investigates the implications of ideas derived from queer theory for the future of PGD and of PGD for the future of queerness.
Collapse
Affiliation(s)
- Robert Sparrow
- Philosophy Program, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
17
|
Valles SA. Lionel Penrose and the concept of normal variation in human intelligence. STUDIES IN HISTORY AND PHILOSOPHY OF BIOLOGICAL AND BIOMEDICAL SCIENCES 2012; 43:281-289. [PMID: 22326097 DOI: 10.1016/j.shpsc.2011.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 08/25/2011] [Indexed: 05/31/2023]
Abstract
Lionel Penrose (1898-1972) was an important leader during the mid-20th century decline of eugenics and the development of modern medical genetics. However, historians have paid little attention to his radical theoretical challenges to mainline eugenic concepts of mental disease. Working from a classification system developed with his colleague, E. O. Lewis, Penrose developed a statistically sophisticated and clinically grounded refutation of the popular position that low intelligence is inherently a disease state. In the early 1930s, Penrose advocated dividing "mental defect" (low intelligence) into two categories: "pathological mental defect," which is a disease state that can be traced to a distinct genetic or environmental cause, and "subcultural mental defect," which is not an inherent disease state, but rather a statistically necessary manifestation of human variation in intelligence. I explore the historical context and theoretical import of this contribution, discussing its rejection of typological thinking and noting that it preceded Theodosius Dobzhansky's better-known defense of human diversity. I illustrate the importance of Penrose's contribution with a discussion of an analogous situation in contemporary medicine, the controversial practice of using human growth hormone injections to treat "idiopathic short stature" (mere diminutive height, with no distinct cause). I show how Penrose's contributions to understanding human variation make such treatments appear quite misguided.
Collapse
Affiliation(s)
- Sean A Valles
- Lyman Briggs College and Department of Philosophy, Michigan State University, 25C West Holmes Hall, East Lansing, MI 48825, USA.
| |
Collapse
|
18
|
Extending the reach of public health genomics: What should be the agenda for public health in an era of genome-based and “personalized” medicine? Genet Med 2010; 12:785-91. [DOI: 10.1097/gim.0b013e3182011222] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
19
|
Abstract
Non-invasive prenatal diagnosis (NIPD) could significantly change the framework for testing and screening in pregnancy. This chapter reviews the ethical implications of this technology, including current issues in prenatal diagnosis, implications for informed consent, possible non-medical uses and options for regulation. The prospect of NIPD normalising screening and termination in pregnancy is raised as a concern. NIPD will also require monitoring to ensure women are making well-informed decisions, given that a risk to the pregnancy is absent. The question of whether NIPD will reduce anxiety needs to be established and the prospect that it will increase terminations on the grounds of disability should be recognised. The offer of NIPD external to any clinical oversight might give rise to wider social sex selection, paternity testing or testing 'for information'. The value assumptions of these uses of NIPD need to be addressed.
Collapse
Affiliation(s)
- Ainsley J Newson
- Centre for Ethics in Medicine, University of Bristol, 3rd Floor, Hampton House, Cotham Hill, Bristol BS6 6AU, UK.
| |
Collapse
|
20
|
Abstract
We will analyse the representations and conceptualisation of genetics and genetic information in bioethical discourse. Genetics and genetic information is widely believed to be revolutionizing medicine and is sometimes misconceived as having a high predictive value compared to traditional diagnostics. We will attempt to present the inherent limitations of genetic information within its health care context. We will also argue against the exceptional treatment of genetic information that seems to govern bioethical reflection and regulatory approaches. And finally, we will make the claim that geneticization should be seen as a more serious threat to our privacy, autonomy and freedom, than genetic discrimination.
Collapse
Affiliation(s)
- Péter Kakuk
- Department of Behavioral Sciences, Medical and Health Sciences Centre, University of Debrecen, 4032 Nagyerdei krt. 98, P.O. Box 45, Debrecen, Hungary.
| |
Collapse
|
21
|
Savulescu J, Hemsley M, Newson A, Foddy B. Behavioural genetics: why eugenic selection is preferable to enhancement. JOURNAL OF APPLIED PHILOSOPHY 2006; 23:157-71. [PMID: 17036429 DOI: 10.1111/j.1468-5930.2006.00336.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Criminal behaviour is but one behavioural tendency for which a genetic influence has been suggested. Whilst this research certainly raises difficult ethical questions and is subject to scientific criticism, one recent research project suggests that for some families, criminal tendency might be predicted by genetics. In this paper, supposing this research is valid, we consider whether intervening in the criminal tendency of future children is ethically justifiable. We argue that, if avoidance of harm is a paramount consideration, such an intervention is acceptable when genetic selection is employed instead of genetic enhancement. Moreover, other moral problems in avoiding having children with a tendency to criminal behaviour, such as the prospect of social discrimination, can also be overcome.
Collapse
Affiliation(s)
- Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, St Ebbe's Street, University of Oxford, Oxford OX1 1PT, UK.
| | | | | | | |
Collapse
|
22
|
Jordaan DW. Preimplantation Genetic Screening and Selection: An Ethical Analysis. Biotechnol Law Rep 2003. [DOI: 10.1089/073003103322616742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Parker MH, Forbes KL, Findlay I. Eugenics or empowered choice? Community issues arising from prenatal testing. Aust N Z J Obstet Gynaecol 2002; 42:10-4. [PMID: 11926633 DOI: 10.1111/j.0004-8666.2002.00010.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The prevention of inherited disabilities is viewed in two contrasting ways--either as enhancing reproductive choice and improving population health, or as discriminating against disabled community members. We argue that modern clinical genetics, including preimplantation genetic diagnosis (PGD), reflects a persistent and defensible desire by the community to prevent disability, rather than as increasing discrimination or threatening to produce a 'new eugenic' society Screening should be presented as a distinct issue for decision-making about the prevention or acceptance of disability, rather than as a routinely accepted component of antenatal care. The community must improve its understanding of the experiences of those who manage disability, and continue to debate the issues of discrimination, selective genetic prevention and enhancement, reproductive freedom, and eugenics.
Collapse
Affiliation(s)
- Malcolm H Parker
- School of Medicine, University of Queensland, Brisbane, Australia
| | | | | |
Collapse
|
24
|
Modell SM, Citrin T. Ethics instruction in an issues-oriented course on public health genetics. HEALTH EDUCATION & BEHAVIOR 2002; 29:43-60. [PMID: 11822552 DOI: 10.1177/109019810202900106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Public health ethics and genetics in public health have in the last decade emerged as fields in their own right. This article describes the ethics component of an "Issues in Public Health Genetics" course uniting the fields of genetics, ethics, and public health. As the third member of the University of Michigan Interdepartmental Concentration in Genetics, the course emphasizes the translation of ethical-social issues into substantive policies. A central tension repeated throughout the course exists between respect for individuals' libertarian interests and the welfare of the entire population. Students become familiar with the process of resolving conflicting values through interactive exercises addressing the health needs of diverse communities. Key lessons in course design are described.
Collapse
Affiliation(s)
- Stephen M Modell
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
| | | |
Collapse
|
25
|
Robertson J. Blood talks: eugenic modernity and the creation of new Japanese. HISTORY AND ANTHROPOLOGY 2002; 13:191-216. [PMID: 19499628 DOI: 10.1080/0275720022000025547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
26
|
Savulescu J. Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion. JOURNAL OF MEDICAL ETHICS 2001; 27:165-171. [PMID: 11417023 PMCID: PMC1733410 DOI: 10.1136/jme.27.3.165] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The attitudes of Australian practitioners working in clinical genetics and obstetrical ultrasound were surveyed on whether termination of pregnancy (TOP) should be available for conditions ranging from mild to severe fetal abnormality and for non-medical reasons. These were compared for terminations at 13 weeks and 24 weeks. It was found that some practitioners would not facilitate TOP at 24 weeks even for lethal or major abnormalities, fewer practitioners support TOP at 24 weeks compared with 13 weeks for any condition, and the difference in attitudes to TOP between 13 weeks and 24 weeks is most marked for pregnancies which are normal or involve a mild disorder. It is argued that a fetal abnormality criterion for late TOP is inconsistently applied, discriminatory and eugenic. Four possible moral justifications for current practice are examined, each of which would require significant changes to current practice. I argue in favour of a maternal interests criterion for any TOP.
Collapse
|
27
|
Henn W. Consumerism in prenatal diagnosis: a challenge for ethical guidelines. JOURNAL OF MEDICAL ETHICS 2000; 26:444-6. [PMID: 11129845 PMCID: PMC1733311 DOI: 10.1136/jme.26.6.444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The ethical guidelines for prenatal diagnosis proposed by the World Health Organisation (WHO), as well as by national regulations, only refer to paternity and gender of the fetus as unacceptable, disease-unrelated criteria for prenatal selection, as no other such parameters are at hand so far. This perspective is too narrow because research on complex genetic systems such as cognition and ageing is about to provide clinically applicable tests for genetic constituents of potentially desirable properties such as intelligence or longevity which could be misused as parameters for prenatal diagnosis. Moreover, there is an increasing number of prenatally testable genetic traits, such as heritable deafness, which are generally regarded as pathological but desired by some prospective parents and taken into account as parameters for pro-disability selection. To protect prenatal diagnosis from ethically unacceptable genetic consumerism, guidelines must be clarified as soon as possible and updated towards a worldwide restriction of prenatal genetic testing to immediately disease-determining traits.
Collapse
Affiliation(s)
- W Henn
- Institute of Human Genetics, Saarland University, Homburg/Saar, Germany
| |
Collapse
|
28
|
Abstract
Recently there has been a revival of interest in the theory and practice of eugenics by both academics and lay people. The ongoing revolution in biology and the increasing ability to acquire genetic information has led to concerns about genetics being used again for sinister eugenic ends. Although the goals behind traditional eugenics--the minimization of disease and the improvement of human health--remain unchanged, the means by which these goals should be achieved have altered significantly. However, in debates about the impact of human genetic research, eugenics is sometimes viewed as a purely historical phenomenon and its relevance to the current situation is minimized. This article outlines the history of the eugenics movement, describes some eugenic practices, and explores why an appreciation of these historical debates is important for nurses.
Collapse
Affiliation(s)
- R Iredale
- Nursing and Midwifery Research Unit, School of Care Sciences, University of Glamorgan, Pontypridd, UK
| |
Collapse
|
29
|
Abstract
The papers of Burley and Harris, and Draper and Chadwick, in this issue, raise a problem: what should doctors do when patients request an option which is not the best available? This commentary argues that doctors have a duty to offer that option which will result in the individual affected by that choice enjoying the highest level of wellbeing. Doctors can deviate from this duty and submaximise--bring about an outcome that is less than the best--only if there are good reasons to do so. The desire to have a child which is genetically related provides little, if any, reason to submaximise. The implication for cloning, preimplantation diagnosis and embryo transfer is that doctors should only produce a clone or transfer embryos expected to enjoy a level of wellbeing which is less than that enjoyed by other children the couple could have, if there is a good reason to employ that technology. This paper sketches what might constitute a good reason to submaximise.
Collapse
Affiliation(s)
- J Savulescu
- Murdoch Institute, Royal Children's Hospital, Melbourne, Australia
| |
Collapse
|