Expert answer:Bioethics: watch movie and write two pages
Solved by verified expert:Please watch the file and answer the questions below:A) Identify 2 arguments in favor and 2 opposed to using the genetic engineering concepts/methods depicted in the movie Gattaca. B) Summarize your personal position and base your position on one of the ethical theories we have discussed in class. Link of Film : Gattaca.1997 https://ok.ru/video/334216760046
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genetic_discrimination.pdf
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Bioethics for Public Health
Webster’s New World 3rd College Edition Definitions –
Opinion – a belief not based on absolute certainty or positive knowledge but on
what seems true, valid, or probable to one’s own mind.
Perspective – a specific point of view in understanding or judging things or
events, especially one that shows them in their true relationship
to one another.
Preference – to place before something or someone in one’s liking, opinion, or
priority appreciation for.
Prejudice – a judgment or opinion formed before all of the facts are known.
Usually an unfavorable opinion marked by suspicion, fear, bias
or hatred.
Bioethics
Bioethics Defined – The areas of medicine, the life sciences,
psychology, biotechnology, and genetics concerned with the issues
of the biological revolution happening all around us and how the
development in these fields has a profound impact on our lives and
the society in which we live.
Bioethics – the problems and issues that challenge our personal
and cultural value systems, not to just dismiss or reduce these
issues as a matter of opinion or preference.
Ethical Theories
Deontologism – Duty Bound/Obligations
Consequentialism – Outcomes/Consequences
Intuitionism – How one Feels/Intuits(Emotion)
Right Ethics – Hierarchy of Rights
Bioethics
DEONTOLOGICAL THEORY- (Kant)
Deontologism – is based on the Greek word
“Deon” meaning duty or obligation, has a
principle based ethics association which
promotes we are duty-bound and have a
moral obligation to act or behave in a certain
manner, regardless of the outcome or
consequences.
Bioethics
Consequential Theory Consequentialism – is sometimes referred to as
Utilitarianism in general ethics theory. It approaches
a problem from the perspective of taking the best
course of action to achieve the most desirable
outcome or result. Therefore, Consequentialism
argues that it is not good enough to simply do good;
One must develop the ability to decide and choose
the best course of all possible choices and then act
accordingly.
HBioethics
Intuition Theory- (Virtue Ethics)
Intuitionism – resolves moral dilemmas by
appealing to one’s intuition. A persons
moral faculty, sense of right and wrong and
it is this moral sense which directs and
influences the decision making process.
Inevitably we make decisions based on the
“feeling” that something is just right or that
it is wrong and either one of these prevails.
Bioethics
Right Ethics – This theory resolves ethical
dilemmas by first determining what rights or
moral claims are involved. Then issues are
resolved in terms of the hierarchy of rights. The
main advantage of this approach is it considers
the moral centrality of the individual and their
claim relative to their rights.On the other hand
this theory does not promote how to resolve
conflicts of rights.
Bioethics
Deontological – based on the Greek word “Deon” meaning duty or obligation, has a
principle based ethics association which promotes we are duty-bound and have a moral
obligation to act or behave in a certain manner, regardless of the outcome/consequences.
Consequentialism – sometimes referred to as Utilitarianism in general ethics theory,
approaches a problem from the perspective of taking the best course of action to achieve
the most desirable outcome or result. Thus Consequentialism argues that it is not good
enough to simply do good. One must develop the ability to decide and choose the best
course of all possible choices and then act accordingly.
Intuitionism – resolves moral dilemmas by appealing to one’s intuition. A persons
moral faculty, sense of right and wrong and it is this moral sense which directs and
influences the decision making process. Inevitably we make decisions based on the
“feeling” that something is just right or that it is wrong and either one of these prevails.
Right Ethics – This theory resolves ethical dilemmas by first determining what rights or
moral claims are involved. Then issues are resolved in terms of the hierarchy of rights.
The main advantage of this approach is it considers the moral centrality of the individual
and their claim relative to their rights. On the other hand this theory does not promote
how to resolve conflicts of rights.
CRG
GENETIC DISCRIMINATION:
Position Paper
INTRODUCTION
Cases of genetic discrimination documented
by researchers include:
The Council for Responsible Genetics (CRG) is
a national bioethics advocacy organization
based in Cambridge, Massachusetts. The
mission of the CRG is to educate the public
about the ethical implications of new genetic
technologies and to advocate for the socially
responsible use of these technologies. One of
the main goals of the CRG is to document
cases of discrimination that occur as a result
of predictive genetic information.
* Seven-year-old Danny is in perfect health,
but a genetic tests reveals that he has a gene
predisposing him to a heart disorder. Even
though he takes medication that lowers his
risk of a heart attack, he is denied health
insurance. His insurance company argues that
since his gene has been present since birth,
this qualifies as a pre-existing medical
condition.
The science of genetics has been transformed
into a major new industry, with public and
private investment continuing to skyrocket.
Much of this research is funded by the federal
government, through the Human Genome
Project. The goal of this multi-billion dollar
project is to identify and sequence all of the
genes that make up the human genome. Much
of this research focuses on genetic
diagnostics: tests designed to identify genes
thought to be associated with various medical
conditions. Scores of new genetic tests have
been developed in recent years.
* Lisa’s young son has been having difficulty
in school. Suspecting a learning disability, she
consults her doctor. Her doctor performs some
genetic tests, and tells her that Jonathan has
Fragile X Syndrome, an inherited form of
mental retardation. Her insurance company
eliminates Jonathan’s health coverage,
claiming that his disability represents a preexisting condition. Lisa searches
unsuccessfully for another company that will
be willing to insure her son. She ultimately
quits her job so that she can qualify for
Medicaid.
GENETIC TESTS CAN BE USED TO HELP . . .
AND TO HARM
Genetic tests are rapidly becoming a routine
tool for medical diagnosis. The information
produced by these tests, while potentially
valuable for medical treatment, is
increasingly used out of context in ways that
are contrary to the interests of the patient.
CRG has found that an increasing number of
healthy individuals have suffered
discrimination on the basis of predictive
genetic information, a practice known as
genetic discrimination.
Council for Responsible Genetics
* Kim is a social worker with a large human
services agency. During a staff workshop on
caring for people with chronic illnesses, Kim
mentions that she was the primary caretaker
for her mother who died of Huntington’s
disease. Kim herself has a 50% chance of
developing this fatal genetic condition. One
week after she reveals her risk status, Kim is
fired from her job — even though she has
received outstanding performance reviews in
the months prior to the firing.
* Mary has a family history of breast cancer:
both her mother and her aunt have been
diagnosed with it. She worries about her
future and is considering getting tested for
5 Upland Road, Suite 3 Cambridge, MA 02140 USA
Tel 617.868.0870 Fax 617.491.5344 Web www.gene-watch.org Email crg@gene-watch.org
BRCA-1, a gene associated with some forms of
hereditary breast cancer. Ultimately, she
decides not to take advantage of the test,
because she fears a positive result will
jeopardize her chances for promotion at her
law firm.
These cases begin to tell the story of genetic
discrimination. They are but a few of the
hundreds of cases of genetic discrimination
that have been documented. As genetic tests
become simpler to administer and their use
expands, a growing number of individuals are
being stigmatized on the basis of their genetic
makeup. Employers and insurers are using the
results of genetic tests to discriminate based
on perceptions of long-term health risks and
possible future disabilities.
Not only is this discrimination unjust, it is
scientifically inaccurate. Genes can tell us
only part of the story about why some people
get sick and others do not. Even if we were
able to know exactly what genes a person has,
we still would be unable to predict their future
health needs. This is because many genetic
tests predict—with limited accuracy—that a
disease may become manifest at an
undetermined time in the future. Because the
severity of many diseases—such as sickle cell
anemia and spina bifida—varies widely among
individuals, a genetic prediction cannot
foretell how disabling the disease will be for a
specific person.
THE EXPANSION OF GENETIC TESTS
MEANS THAT THE DISCRIMINATION WILL
LIKELY INCREASE.
During the past ten years, there has been an
explosion in the number of available tests for
genetic conditions. Ten years ago we had only
a handful of genetic tests; today we have
hundreds. Doctors can screen for cystic
fibrosis, Duchenne muscular dystrophy,
fragile X syndrome, Gaucher’s disease,
Huntington’s disease, Lou Gerig’s disease,
Marfan syndrome, Tay Sachs and many
others.
As these tests become simpler to administer
and their use expands, the CRG strongly
believes that employers and insurers will
continue to use genetic information in a
discriminatory manner and that a growing
number of people will be stigmatized on the
basis of their genetic makeup.
This potential for discrimination increased
dramatically last year. Up until now, genetic
tests were only available for relatively rare
single-gene disorders. In the last year,
however, scientists discovered genes
associated with two forms of cancer, a disease
that strikes millions of Americans every year.
Individuals who carry these genes are at
increased risk for developing certain forms of
colon and breast cancer. Many in the medical
community advocate population-wide
screening for these so-called “cancer genes,”
so that people who carry these genes can be
closely monitored for early signs of cancer.
While this may save lives through early
diagnosis and intervention, it may also lead to
stigmatization and discrimination. Insurance
lobbyists from the American Council of Life
Insurance (ACLI) have already stated that
insurance companies should be allowed to use
information about cancer predisposition to
assign risk categories in medical
underwriting and possibly refuse to insure
those individuals who carry these genes.
THE SOCIAL COSTS OF GENETIC
DISCRIMINATION
While the new diagnostics will provide
identification of genetic factors that may be
responsible for evoking certain diseases or
disabilities, it is not at all obvious how rapidly
and to what extent this information will lead
to treatments or cures for the diseases in
question. Diagnoses unaccompanied by cures
are of questionable value. This is especially
true when the diagnosis can be made long
before the person in question begins to notice
any symptoms of disability or disease, as is
often the case.
This kind of “predictive medicine” raises
novel problems for affected individuals and
they, together with their physicians and
counselors, will have to learn how to approach
them. Meanwhile the exaggerated emphasis
on genetic diagnoses is not without its
dangers because it draws attention away from
the social measures that are needed in order
to ameliorate most diseases, including
equitable access to health care. Once socially
stigmatized behaviors, such as alcoholism or
other forms of addiction or mental illness,
become included under the umbrella of
“genetic diseases,” economic and social
resources are likely to be diverted into finding
biomedical “cures” while social measures will
be short-changed.
EMPLOYMENT DISCRIMINATION
The tragedies of race and sex discrimination
illustrate the dangers of basing employment
decisions on inborn characteristics. Like
these, discrimination on the basis of genetics
ignores the present abilities and health status
of workers and substitutes questionable
stereotypes about future performance.
Basing employment decisions on genetic
status opens the door to unfounded
generalizations about employee performance
and increases acceptance of the notion that
employers need to exercise such
discrimination in order to lower labor costs.
Indeed, without countervailing equitable
forces, employers face economic pressures to
identify workers who are likely to remain
healthy. Less absenteeism, reduced life and
health insurance costs, and longer returns on
investments in employee training all reduce
the costs of labor. To the extent that
employers believe that genetic information
can help identify workers who have a “healthy
constitution,” they have strong economic
incentives to screen applicants and workers.
Such policies victimize all workers.
Discrimination against individuals with
particular genetic characteristics harms all
workers by diverting attention from the need
to improve and, if possible, eliminate
workplace and environmental conditions that
contribute to ill health for everyone.
Moreover, such genetic discrimination masks
the fundamental need for adequate leave
policies and insurance coverage as well as for
reasonable workplace accommodation for all
workers who experience temporary or
permanent disabilities, for whatever reasons.
Currently, most Americans who have health
insurance receive it through their place of
employment. As the costs of health care
continue to rise, employers may perceive an
economic incentive to hire employees who
they believe are least likely to have future
health problems. A 1989 survey commissioned
by the Congressional Office of Technology
Assessment (OTA) documented at least five
Fortune 500 companies that were conducting
genetic screening on their employees. As the
technology improves and genetic tests become
less expensive, we can expect that more
employers will begin using them. Unless
prevented by law, some employers will use
these tests to avoid people they fear will be
“bad risks.”
The Americans with Disability Act (ADA)
forbids employers from discriminating
against disabled individuals who are able to
perform their duties with reasonable
accommodation. In revised guidelines
released in March of 1995, the Equal
Employment Opportunities Commission
(EEOC) stated that healthy individuals who
have a genetic predisposition to a disease and
are thus perceived as disabled fall within the
scope of the ADA. There is no valid
justification for employers to perform
mandatory DNA testing on their employees,
since they are forbidden by the ADA from
using this information in employee
evaluations.
INSURANCE DISCRIMINATION
Insurers also face strong economic incentives
to identify individuals perceived to be at
increased risk for ill health in the future.
Insurance is a publicly regulated activity
designed to meet broad community goals. In
the case of health insurance, the goal is to
ensure access to health care by providing
adequate financing mechanisms. In the case
of life and disability insurance, the goal is to
provide families some measure of economic
security following a tragic death or disability.
Rating practices for all three types of
insurance are becoming increasing stringent,
violate individual privacy, and seem geared to
identify and insure only the healthy and longlived. The number of individuals stigmatized
as “substandard” risks or “uninsurable” has
increased. Currently nearly 100 million
Americans either lack health insurance or are
underinsured. More and more consumers are
now unable to obtain affordable life and
disability insurance products. Our current
insurance market system is not meeting its
primary publicly endorsed goal. This
stratification of our community into “haves”
and “have-nots” is neither morally or publicly
acceptable.
As publicly regulated entities, insurance
companies must adopt and enact practices
which the community views as
nondiscriminatory, fair and equitable both in
order to survive in a competitive market and
to retain their legal rights to operate. Because
of the important public impact of the
insurance business, the industry’s programs
and practices should always be open to
community scrutiny and specific control.
Thus, though from a business perspective
fairness may dictate “treating similar risks
alike,” it may be significantly in the public
interest to insist that different risks also be
treated as alike. The public’s view of fairness
requires that groups that differ by race,
ethnicity or religious affiliation, and who may
have differing actuarial morbidity or
mortality rates, be offered similar insurance
contracts. Genetic information is another
potentially discriminating factor that the
public has indicated cannot be fairly included
in insurance underwriting practices. Several
national polls demonstrate this view and
nearly 20% of Americans now live in states
that prohibit by differing means the use of
genetic information in rating insurance
contracts. In this manner, the community
through political and regulatory processes has
asserted its view of fairness as dominant over
the narrower insurance industry derived
conception.
There is a strong community sentiment
against using “pre-existing medical
condition” exclusions to deny people
insurance. The removal from insurance pools
of those who clearly need the benefits which
insurance based financing affords strikes a
blow to the social purpose of insurance. In
fact, the spreading of risk across a community
(community rating) is exactly what the public
intended when it first allowed private insurers
to provide such an important social product.
Unlike infectious diseases, genetic conditions
exist at a fairly stable incidence in our society.
There is no epidemic of genetic conditions.
Thus, they are already reflected in the
actuarial tables used by insurers to establish
rates. It is misleading for insurers to suggest
that their financial solvency will be
jeopardized if they are obligated to insure
people at risk for genetic conditions. In fact,
insurers have always insured people at risk
for genetic conditions. Previously, however, it
was not possible to identify those people at
risk for genetic conditions before they become
they became ill with the disorder.
The insurance industry has offered no
compelling reason to specifically exclude this
group from the insured pool now. Early
identification of risk status may actually lead
to insurer cost savings as a result of
preventative care and longer life spans during
which premiums can be collected.
Recent developments in human genetic
science and the technology of testing are not
identifying new costly diseases that were not
previously accounted for by the insurance
industry’s actuarial data. Rather, these
developments are only facilitating the
identification of those individuals who carry
disease-associated genes at earlier times;
many of these people will never have a related
illness, or will experience a lifetime of the
asymptomatic, presymptomatic or minimally
symptomatic phases of the condition. It is not,
therefore, the cost of financing the care of
genetic conditions which is driving the call for
access and inclusion of genetic information in
insurance practices. There is no reason for
insurers to begin to use this new predictive
information now, merely because it is
available.
GENETIC DISCRIMINATION SETS A
DANGEROUS PRECEDENT
Genetic testing is not only a medical
procedure. It is also a way of creating social
categories. As a basic principle, we believe
that people should be evaluated based on their
individual merits and abilities, and not based
on stereotypes and predi …
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