In Your Genetic Destiny,
Aubrey Milunsky sets out some of the most recent information about genetic
medicine. The fundamental premise of
the book is simple: there are many genetic disorders, and prospective parents
should take whatever steps they can to avoid the terrible outcome of having a
baby with a genetic disorder. The book
sets out the scientific information about genetic abnormalities in clear
language, with explanation of cells, chromosomes, DNA and their role in genetic
disorders. In the 27 chapters, Milunsky
covers a wide range of disorders, including Down syndrome, Fragile X syndrome,
mental retardation, allergies, asthma, emphysema, heart disease, obesity, lipid
disorders, abnormalities of heart rhythm, high and low blood pressure,
diabetes, cancer, schizophrenia, depression, bipolar disorder, Alzheimer’s
Disease, aging, Huntington disease, and polycystic kidney disease. He explains both genetic and environmental
factors as causes of these disorders, and steps one can take to reduce one’s
chance of falling prey to them.

This is a relatively long book, at
over 400 pages, and it is somewhat repetitive. 
Readers who have some understanding of human biology will probably find
the explanations helpful, and it is possible that readers concerned about
genetic disorders will also find the information in the book helpful. For women and men wondering about the
possible health problems of their children, the book often recommends that they
consult with a genetic counseling and testing service. The real flaw is in the book’s uncritical and
somewhat old-fashioned attitude towards some disorders. Milunsky tells the reader that “you and your
partner owe it to yourselves and your future offspring to be as fully informed
as possible about your genetic risks and options when considering planned
child-bearing” (p. 19). He emphasizes
that “the presence of a child or adult with a serious birth defect or genetic
disorder in the home becomes a chronic emotional, physical and economic drain
on the parents (or family)” (p. 19). 
His language is often morally loaded: he often uses the phrases “genetic
defect” and “flawed genes” and he even uses the phrase “defective child” (p.
7). He discusses the “burden” of
families caring for children with Down syndrome, but makes no mention of the
rewards of doing so. Many people will
find his attitude toward genetic disorders problematic, because he pays so
little attention to the question of how we label these disorders and the
effects of our labeling. Some may
suspect that the shadow of eugenics falls over Milunsky’s approach, suggesting
that he takes an intolerant attitude towards people who are different. Disability activists may well find that his
language expresses the judgment that people with genetic disorders have less
valuable lives. It’s not certain that
Milunsky himself would explicitly embrace any sort of eugenic program, but
given the history of eugenics in the last century, anyone writing in this area
has to show awareness towards these issues. 
His book strikingly fails to show the appropriate sensitivity.

The book also gives very little
discussion of some difficult decisions people may face. For example, people with a family history of
Huntington’s Disease can get genetic testing to find out whether they will get
the disease which normally starts in mid-life and has a typical course of
twenty years. The book reproduces six
pages of guidelines about predictive testing from the World Federation of
Neurology Research Group on Huntington’s Chorea and the International
Huntington Association, which is in the form of a list of more than 80 main
points, but there is no discussion of these, nor any consideration of how
individuals work through such emotionally hard decisions. The chapter on genetic counseling is short
and somewhat perfunctory. The
penultimate chapter on ethical issues in the diagnosis and treatment of genetic
disorders and the use of genetic information covers a wide variety of issues,
but gives little discussion of any particular one. When women are facing questions about whether to have an abortion
because there is a strong likelihood their baby has a genetic disorder, or
whether to preventatively remove their breasts or ovaries because they are at a
high risk for cancer, their values are at the heart of the
decision-making. Milunsky’s neglect of
these central issues means that Your Genetic Destiny will be of only
limited use to people concerned about their genetic predispositions to medical
disorders.

© 2002 Christian Perring. All
rights reserved.

Christian Perring,
Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island.
He is editor of Metapsychology Online Review. His main research is on
philosophical issues in psychiatry. He is especially interested in exploring
how philosophers can play a greater role in public life, and he is keen to help
foster communication between philosophers, mental health professionals, and the
general public.

Categories: Genetics, Ethics