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Do genomic tests enhance autonomy?
  1. Eline M Bunnik
  1. Correspondence to Eline M Bunnik, Medical Ethics and Philosophy of Medicine, Erasmus MC, dr. Molewaterplein 50, Rotterdam 3015 GE, The Netherlands; e.bunnik{at}erasmusmc.nl

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It is not a bad idea to assess whether direct-to-consumer (DTC) genomic tests are a threat to or instead an enhancement of autonomy, as is done in the article ‘Direct to consumer genomics on the scales of autonomy’ by Effy Vayena.1 Autonomy has played a starring role in ethical discussions surrounding DTC genomic testing, but has taken many different shapes. Vayena deploys Joseph Raz’ conception of autonomy, which entails that genomic tests enhance autonomy if they present the consumer with an adequate—that is, varied and morally worthwhile—range of options to choose from, which should promote the consumer's interests. She states that genomic tests generate ‘plural utilities’ that are taken to expand the range of valuable options and therewith to satisfy Raz’ thick conception of autonomy. Thus, Vayena makes an autonomy-based case in favour of legal permissibility of commercially offered genomic tests. The analysis however overlooks three crucial considerations.

First, there is no such thing as ‘genomic testing’. Plenitudes of genomic tests have been put to market, with different underlying techniques and test characteristics, different diseases and other phenotypical traits included in the testing offer, and …

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