REVIEWED BY REV. KEVIN D. O'ROURKE, OP, JCD, STM
Jan Christian Heller
Creighton University Press, Omaha, NE, 1996, 182 pp., $24.95
If you are concerned about the ethical issues arising from the type of person who will be generated in the future, this is the book for you. Heller clearly foretells the effect of the Human Genome Project (HGP) on future human beings and explains the ethical theories that might serve as future signposts regarding the basic treatment of "future contingent people."
Why is the effect of the HGP on future people important? The author explains that "some far-reaching actions are judged to have morally significant effects upon future persons . . . ." For example, as a result of the HGP, it may be possible to eliminate Tay-Sachs disease. Is this a benefit for a person who might exist in the future? As Heller notes, "Of course, the more we project the effect of our actions into the future, the more difficult it is to predict them. But insofar as our actions can be judged to hold significant benefits, costs, or risks for future people, we are rightly concerned with the effects of the actions on them" (p. 9).
The book "attempts to address a two-pronged problem relative to human genome research and future generations." It investigates how the HGP is likely to affect future generations, and it asks what implications these effects hold for evaluating HGP and other research efforts like it, particularly from a theological perspective. Most of the study of the HGP's effects is provided in Chapter 3, "Diagnostic and Therapeutic Applications of the HGP." The concern that most of the expense of HGP will be borne by generations that do not realize its benefits is also pointed out. However, the U.S. Congress, which finances the greater part of the HGP, hopes that applied technologies will spin off from the project and that biomedical technologies will lead to the detection, prevention, and treatment of thousands of genetic diseases and disorders. In a sense, then, altruism is essential for appreciating the HGP.
This work is replete with predictions concerning the results, burdens, and benefits of the HGP. Predictions are seldom accurate as far as major and minor details are concerned. Thus, while the concern of the study is valid as an ethical issue, the various details set forth as the result of the HGP may prove in the future to be ambiguous or even erroneous.
One predicted outcome of the HGP that seems to be valid and worth repeating is the lapse that will occur between detection and diagnosis of genetic anomalies and the ability to provide improved treatment, prevention, and ultimate care (p. 51). What the author admits in regard to analyzing the approach to values, which will serve as a basis for ethical evaluation, is true of the rest of the book as well: "We are working on very high levels of abstraction." Thus the book will be an excellent challenge for the professional theologian, but for the healthcare professional interested in ethical issues, it seems that a further simplification of the entire matter is needed in the form of articles summarizing the main considerations.
Although the theological answers to the questions giving rise to the study are not set forth definitively, it is clear that the author relies on James Gustafson and Rev. Richard McCormick for a basis of his thought. In commenting on the Roman Catholic Church's evaluation of the preembryo, it is simply erroneous to state that it "results from a physicalist interpretation of the natural law." Moreover, the theologian who does not agree with Fr. McCormick when he states there is such a thing as a preembryo is not necessarily "more conservative" (p. 124), nor does the rejection of proportionalism by Catholic theologians follow from a conservative stance in regard to moral theology. Rather, it follows from the scriptural teaching that no one may do evil to achieve good.
This is an original and probing study of a significant issue, stimulating questions most of us have never considered. It aptly fulfills the goal the author had in mind: to explain how the HGP is likely to affect future generations both positively and negatively and to consider ways to evaluate its far-reaching effects (p. 3).
Reviewed by Rev. Kevin D. O'Rourke, OP, Director, Center for Health Care Ethics, Saint Louis University, Health Sciences Center, St. Louis
Copyright © 1998 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.