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© 2004 European Society for Medical Oncology

Genetic medicine: the balance between science and morality

A. Surbone*

Department of Medicine, New York University School of Medicine, New York, NY, USA

* Correspondence to: Dr A. Surbone, 330 East 38th Street, Suite 5B, New York, NY 10016, USA. Tel: +1-917-4391051; Fax: +1-212-2636958; Email: surbonea{at}aol.com

Abstract

This article explores the relationship between science and morality with respect to the major changes that genetic knowledge has induced in medicine, as well as in many other spheres of our lives. The following themes are treated: (i) the influence of genetic knowledge on the concepts of normalcy and diversity with respect to health; (ii) the influence of genetic knowledge on the concept of responsibility; (iii) the reciprocal influence of pre-existing biases and genetic knowledge; (iv) the influence of genetic knowledge on the concept of community; and (v) the influence of genetic knowledge on autonomy and trust in the patient–doctor relationship. The article does not wish to be prescriptive, but rather to raise open questions. The key philosophical question is to what extent human beings benefit from predictions about the future. The role attributed to genetics is largely overestimated. Genetic knowledge can be perceived as enhancing the control that individuals have on their lives, or as paralyzing the decision process of an individual who may feel predestined to a serious disease. In the case of breast and ovarian cancer, the probabilistic nature of genetics is especially relevant, given the relatively low penetrance of BRCA mutations. "Future things: not our domain. But in this today which unravels in front of us, what shall we do?" (Sophocles, Antigones).

Key words: breast cancer, familiarity, moral aspects


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