REVIEWED BY FR. THOMAS KOPFENSTEINER, STD
John F. Kilner, C. Christopher Hook, and Diann B. Uustal, eds.
William B. Eerdmans Publishing, Grand Rapids, MI, 2002, 201 pp., $22 (paperback)
"Cutting-edge" reflection on the Human Genome Project (HGP) has come
to mean one of two things. On the one hand, there are clinical implications
to the knowledge gained from the mapping of the human genome. Genetic advances
will provide medicine powerfully new diagnostic tools, preventive interventions,
and new therapies for disease. On the other hand, there are the social implications
of new genetic medicine. Genetic knowledge and medicine challenges theologians
and philosophers to go beyond traditional concerns such as privacy, informed
consent, and confidentiality to include justice as an explicitly moral concern.
The various articles in this collection treat both aspects of the new genetic
medicine. As for the emerging clinical implications, Cardinal Francis George
offers an appropriate apologia for a Catholic stance on the dignity of each
human person at every stage and condition. This is the cornerstone of his bioethical
vision rooted in a Christian anthropology. It guides the use of technology towards
therapeutic interventions that have the potential to enhance life. Against a
bioethical vision based on the dignity of the person, Cardinal George sees a
hostile cultural environment favoring the elimination of the "genetically
challenged" through abortion and euthanasia. Though there is no need to
doubt the core of his vision, it does not solve all of the dilemmas that will
emerge from the practice of genetic medicine.
The most dramatic challenge that genetic medicine will pose to a Catholic moral
thought is in the area of reproductive technologies. If and when, for example,
biomedical technology becomes capable of producing embryos free of such life
debilitating genetic defects as Tay-Sachs, will that good be urgent enough to
force us to rethink the traditional relationship of the goods of marriage?
Another clinical issue emerges in light of Daryl Sas's "Reliance
on Technology: Stem Cell Research and Beyond." What is the proper response
to a couple who, having undergone reproductive technologies, are faced with
embryos that are incompatible with human life? Some authors see the use of embryonic
stem cells in this case analogous to organ donation after a tragic accident
later in life. Sas, however, finds the use of embryonic stem cell contrary to
biblical law, making the destruction of the embryo equivalent to murder. This
view, of course, entails a debated normative assumption concerning the status
of the embryo in its earliest stages. Because, moreover, the use of embryonic
stem cells would be for selfish gain, Sas writes, it is also against biblical
love, which requires selfless care for the afflicted. Finally, the use of embryonic
stem cells is unjust because biblical justice demands that the embryo's
need for life outweighs the patient's need for comfort or freedom from
disease.
Nevertheess, Sas's critique of technology provides an important insight
that needs further development. In one way, the HGP's accomplishments have
set the stage for a revolutionary approach in our understanding of disease.
We rightly marvel at the possibility of detecting and correcting genetically
linked diseases before their effects are manifested in our bodies. Yet, since
we all carry genetic errors, we will have to reexamine how we define disease
or a defect that is in need of genetic intervention.
In another way, however, the HGP is no revolution at all. It reflects our continued
commitment to the belief that technology is the answer to social and personal
problems. We lose sight of a more holistic and realistic response to sickness,
suffering, and disease. In the era of genomic possibilities, we channel our
financial and intellectual resources into high-tech medical interventions — and
we lose the link between disease and social conditions; we forget that our most
effective intervention can often be a change in lifestyle.
The issue of justice is treated most explicitly by Francis Collins in "Human
Genetics" and Scott Rae in "Money Matters in Health Care." Both
authors emphasize how the prospects of genetic medicine are complicated by the
fact that access to health care is not universal. Who will benefit from the
new research in genetics? The short answer is — those who can afford to pay
for it or those who have insurance coverage for it. Further, in our present
economic system, future research will be carried out in a way that enables the
biotechnology industry to make a profit. Not only does the logic of the market
insure that future genetic interventions will be costly and limited to the few,
but it also guarantees that available resources will be channeled only to the
most profitable research.
Is it just, though, for the high-tech benefits of genetics to be limited to
the few when so many in the world suffer and die from easily preventable causes
like malaria, anemia, and tuberculosis? Should sophisticated technology be used
for the service of the few when the many suffer from lack of basic health care
services? In an age in which issues of justice have taken global significance,
the need to be fair in the research, distribution, and application of genetic
technologies is urgent.
Fr. Thomas Kopfensteiner, STD
Chair, Department of Theology
Fordham University
Bronx, NY