The
book’s organization is tripartite:  seven papers on the genetic modification
and "invention" of people, five papers on genetics, determinism and
personal identity, and four papers on genes and the non-human world — genetic
modification of crops and non-human animals.  Michael Parker ends the book with
a paper on public deliberation and private choice in human genetics.

The foreword
is provocatively titled, "Are genes us?", and Appleyard provides a
resounding "no":  "Are genes us?  No, they are not.  Or,
perhaps, there is a more precise answer.  No, they are not, but they will be if
we let them."  Brenda Almond adds an introduction to the ethical
background related to recent advances in genetics:  a great deal has been
written, and she focuses on some of the major issues.

In
the first section of the book, Chadwick contributes a fine chapter on "genetic
possibilities", which begins with a well-reasoned critique of the old
concept of distributive justice.  She poses a very reasonable challenge to
clinical trials in genetics, a challenge which can certainly be incorporated
into genetic research.  Newson next asks whether there is a cost in the choice
of genetic enhancement, with an emphasis on parental views and values.  Takala
contributes a paper on the child’s right to an open future, with an emphasis on
Feinberg’s philosophical views on a child’s right to an "open" future
— it is unethical, in this view, to foreclose possibilities, when this is not
necessary.  This argument centers on the protection of the child’s autonomy —
it would not be ethical, in this view, to provide children with a wonderful
childhood experience but foreclose any teaching of reading and writing, for
example.  The author extends this argument to fetuses; she notes that,
depending on the nature of the argument, one could conclude that no genetic
alterations should occur or that all children should be entitled to them. 
Richter provides a very interesting paper on the fear of playing God.  He
discusses the fact that moral psychology moves more slowly than new
technologies and genetic science, and argues well that the fear of change
wrought by the new genetics is understandable and even useful.  Hayry adds a
paper on the objection to cloning people, with an emphasis on Devlin’s judicial
argument about the need for society to preserve and protect moral principles. 
This chapter is of interest and is certainly subject to varying interpretations
and critiques.  Glannon follows with a paper on the relationship of genetic
intervention to personal identity.  He considers genetic modification of
embryos for medical reasons and asks, "Should we regard it as a matter of
helping a continuing person, or does it in fact amount to substituting for one
person or possible person another quite different one?"  Some of the logic
in this paper is quite medieval, in relation to the concept of a person and in
relation to what constitutes "therapy", but the author’s conclusion
that "the coherence and justification of cognitive gene therapy hinges
crucially on the preservation of personal identity and whether the purpose of
therapy is restoring or raising people to a baseline of adequate mental
functioning" seems central to any argument about genetics, genomics and
psychiatry.

In
the first of the papers devoted to genetics, determinism, and personal
identity, Buller considers genetic reductionism and the concepts of health and
disease.  Buller dismisses (on good grounds) the concept that disease is totally
genetically determined and considers in a thoughtful way whether we shall
replace our model of health and disease with one which is more genetic — which
seems very likely.  Bluhm then considers the central dogma in mnolecular
biology — Crick’s assertion that information flows from DNA to RNA to protein,
asserting with good evidence that "the work of Watson and Crick began as a
narrowly defined and proper theory and paradigm of the gene, (but) has
mistakenly evolved into a theory and paradigm of life."  The author cites Lewontin
in terms of development as a dialectical process and suggests that the concept
of genetic determinism is more an ideology than scientific fact.  This is a
thought-provoking paper, as is the next one, by Schouten, on gene manipulation,
psychology, and molecular biology.  He begins by discussing the frequent
assertions that a behavioral trait has a genetic link, and urges wisely that
these assertions be interpreted with caution, especially in view of the
attempts to provide a unitary theory of cognitive science.  In this regard he
provides a thoughtful critique of the work of Eric Kandel’s group on memory:  "An
exclusive focus on the level of molecules is not likely to take us very far in
explaining what learning and memory is.  There is more to these phenomena than
what one finds at the lowest levels of investigation.  Deterministic
single-plot stories are not likely to suffice.  In that sense, there are no
learning or memory genes.  Research in behavioral genetics does not offer complete
molecular explanations, but rather local bridges between different domains of
investigation."  The next paper, by Miah, examines whether patenting human
DNA is ethical.  He examines possible scenarios, some extraordinarily
distasteful, but concludes that patenting aspects of human DNA need not be
unethical nor compromise personal identity.  This, too, is a very thoughtful
paper.  Kantardjian follows with a paper on genetics and legal philosophy,
predicting a new legal status for the human body.

The
next section deals with genetic modification of non-human animals and plants. 
Almond begins with a thoughtful paper on genetic engineering and patenting of
results in animals, examining several possible ethical approaches and ending
with a thoughtful plea to treat animals with care and respect during these
ventures.  Hughes discusses the use of a "precautionary principle" in
addressing genetically modified crops and the possibility of a moratorium on
some ventures, arguing for "a careful and balanced appraisal of the
empirical evidence concerning … environmental effects, and for an open mind
about the benefits … that future developments … may bring."  Ali provides
a paper on risk assessment in plant modification, and the discussion in this
paper is applicable to many of the issues throughout the book.

In
the last paper of the book, Michael Parker writes on public deliberation and
private choice in human genetics.  He points out the number and intensity of
ethical issues which rapid changes in genetic knowledge are posing, beautifully
summed up by a quote from the British Medical Association (page 167):  (Human
genetics is) "a science characterised by rapid and spectacular advances in
knowledge.  The advances affect not only individual patients but potentially
society at large.  Genetics opens possibilities to influence the composition of
future generations and the sort of people brought into the world.  It raises
questions about human identity and free will.  Speculation and research about
how genes might predispose an individual to develop certain characteristics
have long gone beyond the medical preoccupation with health and disease.  The
intriguing prospect of the heredity of character and behaviour such as criminality
is increasingly debated…"  The author wisely points out that many of the
ethical issues posed by advances in genetics are far from new, but have become
more urgent given the enormous and rapid development of this field.

I
liked aspects of this book very much.  Sadly, much that is written at the
interface of ethics and genetics is polemical:  this is not the case with any
of the contributions to this book.  Many of the papers go out of the way to
avoid this, and this is especially true with the contributions to the last
section, on plants and animals.  There are some formidable papers.  The
exegeses of research approaches and what genetics is and is not, in research,
by Bluhm and by Schouten in their papers, are simply outstanding and should be
read by all students of genetics and especially genetics-and-psychiatry.  Hayley’s
paper on the child and an "open future" is thought- provoking long
after one finishes the paper.  The introduction and the final paper are both
well written.  The scope and arguments of the book are almost uniformly excellent.

There
are problems with the book and with specific papers.  Hayry’s dwelling on
Devlin’s concepts seems anachronistic — ethical discourse has advanced well
beyond this early response to the Wolfenden Report in Great Britain. 
Glannon’s paper is irritatingly based on definitions which have passed their
prime.  Most of all, in this most rapidly developing of sciences, almost all
the papers are already, in some ways, out of date.  

In
summary, this is an excellent book.  I recommend it to philosophers and
ethicists as well as to genetics researchers and medical residents in many
fields.

© 2003 Lloyd A.
Wells

Lloyd A. Wells, Ph.D., M.D., Mayo Clinic, Rochester, MN

Categories: Genetics, Ethics