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The Lives to Come

The Genetic Revolution and Human Possibilities. By Philip Kitcher.

Philip Kitcher: The Lives to Come. The Genetic Revolution and Human Possibilities, Simon & Schuster, New York 1996, ISBN 0-684-80055-1

12.08.1998 · Reviewed by Markus Vorbeck

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When basic facts are not in proper focus, imagination will run riot. This is the lesson to be drawn from the fuss that lamb number 6LL3, better known as Dolly, has caused since it gazed out from the pages of Nature. As a result, the speculation about the prospect of human cloning has taken away the public's attention from the broader implications of today's human molecular biology.

Fortunately, Philip Kitcher, an Englishman who is Presidential Professor of Philosophy at the University of California at San Diego, has come up with a clear and thorough guide to the immediate ethical and social consequences of the new molecular genetics. Based upon a year which he spent talking to the scientists associated with the Human Genome Project, Kitcher has written The Lives to Come, a well-argued piece of work which never panders to the reader's appetite for thrilling scenarios of hope and fear.

The forthcoming decades, Kitcher contends, will make possible thousands of genetic tests to determine whether people carry genes that predispose them to various diseases or disabilities. In the first part of the book he wrestles with the question what is going to happen with the information embedded in a genetic profile. Who gets to see what? Should it be public information, freely available to the police, your prospective employer or insurer? Kitcher points out that, for example, insurance companies may argue that they should have a right to inspect your genetic profile. They could demand higher premiums of those born with unlucky genes or deny coverage accordingly, since people who have private knowledge that potential major illness lurks in their genes would presumably want to load up on insurance.

To avoid what he describes as "a new breed of pariahs," Kitcher says, it is essential to make laws protecting genetic privacy and banning genetic discrimination. People who bear the burden of high risks of genetic disease should not be debarred from jobs, basic medical insurance and security. On the whole, though, we have to face the fact that the cost of genetic technology is high, to the extent that the poor might not be able to afford its potential benefits (genetic testing along with pharmaceuticals and different therapies). That is why he hopes that people who are born with "good" DNA will feel socially responsible for people who are not.

Kitcher is also particularly thoughtful on the issue of eugenic abortion. "Once we have left the garden of genetic innocence, some forms of eugenics is inescapable," he writes. There are a number of genetic disorders that result in physical agony, a curtailed life span and little or no sense of self. These are the sorts of cases in which the author's moral calculus would dictate that the fetal life be ended.

At the same time he puzzles over the question of what will happen to the notion of "letting nature take its course," if we no longer have to. He says that many parents of children born with disabilities speak of learning love and courage from their kids. But in a eugenic world, parents may feel more pressured to choose abortion, "even though they believe that a more caring or less prejudiced society might have enabled the child who would have been born to lead a happy and fulfilling life." In his view, it is most crucial that the responsibility for all reproductive decisions should remain in the hands of the parents themselves. Nonetheless, the state should play an active part by, first, creating an environment in which parents can make these choices without pressure, and, second, providing education and counselling to help make parents enlightened decisions about how to use the information they obtain about their unborn children.

Given the dynamic pace at which genetic technology is marching, Kitcher concedes that eugenic abortion might be just a passing phase. Stressing that gene replacement therapy is only one among many possible interventions, he foresees a patchwork of therapies, including dietary and environmental changes, to bring relief from hereditary disorders. If there is something to get excited about in the future, he concludes, then it is in this strictly medical context. Our most severe mistake would be to embrace genetic determinism and end up thinking that we can abolish crime by breeding people who do not have the crime gene. After all, the lives to come are not all in the genes.

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