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From Chance to Choice: Genetics and Justice
  1. A J Newson

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    A Buchanan, D W Brock, N Daniels, et al. Cambridge University Press, 2000, £17.95, $US29.95, pp 398. ISBN 0521660017

    With over 10 000 bases of DNA being sequenced around the world per minute, it is vital that ethical discussion continues to keep pace with genetic research. This contribution by four top theorists in bioethics carefully considers the implications of the many ways genetic information will influence human health and reproduction, by considering “the most basic moral principles that would guide public policy and individual choice concerning the use of genetic interventions in a just and humane society” (45).

    Proceeding with the themes of rights, justice, and harm, problems addressed by the authors include: the significance of the moral difference between treating genetic disease and altering personality characteristics; whether the utilisation of prenatal interventions to avoid disability discriminates against the disabled, and who should have control over the utilisation of this technology.

    The main focus of the work is upon the future of genetics, however this is framed within an “ethical autopsy” of eugenics, in which the inappropriateness of past practices is considered. It is argued that the wrongs of eugenics (broadly, a denial of freedom) must be recognised when considering what an ethical practice should now constitute, but that wanting to provide future generations with genes that could contribute to their lives going better is not necessarily unpalatable. It is vital, however, that any such procedures are pursued justly.

    After moving through several topical themes in genetics (which are highlighted in the introduction by the presentation of several futuristic genetics scenarios, the final chapter of the book draws out the major principles that should be used in policy-making about genetic technology.

    Among the arguments advanced throughout are claims that a “normal functioning” perspective for the distribution of genetic technology is acceptable, and that this may also theoretically be applied to non-therapeutic interventions. Yet preferable to this is for social institutions to be designed which do not exclude people who are worse-off, and for plurality in views of personal assets and the good life to be protected (chapters three and seven). In chapters four and five it is argued that the boundary between treatment and enhancement does not always coincide with what is acceptable and unacceptable, however, it is a good starting point for what the obligations of the state should be in delivering health care. The authors found no “reason to object in general to using genetic influences any more than environmental ones” (202), however concerns about both fairness in the distribution of this technology and medical risk should still be recognised. Chapter six explores in more detail the idea of reproductive freedom in preventing or allowing harm to children, and discusses ways around the “non-identity” problem to illustrate a basis for obligations to prevent harm. Another effect of this obligation, however, is that parents should strive to benefit their children, and the limits of a requirement for these benefits are addressed in chapter seven, through an analysis of several disability-rights critiques of genetics.

    This is an excellent book that immediately engages the reader. Among the strengths of the analysis is the use of real-world examples, a recognition that there may be more than one ethical solution to each problem in genetics, and an articulation of the limits of ethical theory. Although each author has contributed different chapters, the book does not suffer from an inconsistency of style. It is worthwhile to read it from beginning to end, as subtle connections between many apparently unrelated issues begin to emerge. It will, however, also be useful as a tool for anyone interested in obtaining clear analysis of topical issues in genetics. An extremely comprehensive table of contents also makes the book easy to navigate.

    Overall, this book provides new insights on many important questions in genetics, but it also elegantly illustrates the inherent complexity in issues that have arisen and will continue to arise when genetics, reproductive technology and parenting practices coincide.

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