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The Precautionary Principle and Genetics Michael Parker What is the precautionary Principle? • Many definitions in the literature- virtually every paper presents a different version • A generic ‘negative’ version might be something like the following: • Where a course of action presents a ‘possible’, ‘credible’, ‘plausible’, ‘likely’ or ‘foreseeable’ chance of a ‘substantial’, serious’ ‘harm’, ‘threat’ or ‘damage’, the action should be avoided, even where these is no conclusive evidence that the harm or damage would have resulted from the action • But there are many different versions The application of the precautionary principle (PP1) • The principle has often been called upon in situations concerning the introduction of a new technology: • New medical process e.g. gene therapy/PCR • Use of a new product e.g. GMOs, pesticides, dyes • Where there is a perception that these pose a threat/danger to: • the environment, human health, ecosystems etc. • And a belief that these harms should be avoided even where there is no conclusive evidence that they will/are likely to occur Some initial thoughts about PP (1) • Definitions of key terms: • What is to count as a ‘harm’, ‘damage’, ‘threat’? • What does it mean for a harm, damage or threat to be ‘serious’, ‘significant’? • What is a ‘high’, ‘plausible’, ‘credible’ risk? • What is to qualify as ‘certainty’, ‘conclusive evidence’, ‘justification’, ‘good reason’? Some initial thoughts (2) • How coherent are the moral principles upon which the precautionary principle depends? • On first sight it appears to be based on two such principles: • A strong form of ‘negative utilitarianism’ i.e. that in all cases the avoidance of harms ought to be the primary moral concern • The belief that there is a moral distinction between ‘acts’ and ‘omissions’. E.g. That stealing £5 from someone is worse (morally) than failing to give someone £5 (implications for 3rd world) • But, how coherent are these principles, either individually or in combination? The limitations of the PP • In my talk today I shall argue that these two sets of concerns must be taken seriously. That is: • Concerns about definitions • Concerns about moral principles • I shall conclude that, the PP must either be rejected or modified by other moral principles if it is to be coherent • I shall argue that it may be possible to arrive at a coherent conception of the PP but this is only possible within a framework of other obligations Precaution in genetics • Genetics is an ideal target for the application of the precautionary principle: • It involves the development and use of new technology • In many, most, cases the risks are uncertain i.e. a positive test result often identifies a risk without quantifying it e.g. SCD and ‘risk iceberg’ • In many cases, the potential harms are very serious and significant e.g. ‘sudden death’ • Here are some examples in clinical genetics Case One On the basis of her age and other risk factors, a woman who is 10 weeks pregnant is informed by her doctor, following a question from her, that she is at approximately 1:800 risk of having a child with Down Syndrome She is very concerned about this and asks for a prenatal test (CVS). She says that she will terminate the pregnancy if affected She is told that CVS brings with it a 1:50 risk of miscarriage. She understands this but insists that she wants to have the prenatal test. Should it be provided? Case Two Susan and Tim are informed about the diagnosis of a rare autosomal recessive condition in their new born baby. The condition is severe and there is a high chance that the baby will die in the first year. The genetic counsellor informs the couple that they have a 1 in 4 chance of any future baby being affected by the condition. Tests on the blood samples reveal that Tim is not the child’s biological father. Polly refuses permission for the clinic to inform him. Should Tim be informed? Case Three Rachel is an unaffected carrier of SED. This is an x-linked condition which only affects boys. At birth, they are of normal proportions but during childhood their growth is retarded and their adult height is usually around 1.5 metres. They tend to get some back and joint pain, osteoarthritis and restricted movement and in some cases, early hip replacement and pain management, is required. But, in most cases the care is ‘support’, and advice to avoid certain occupations. Affected boys have normal intelligence and life expectancy. Rachel requests prenatal testing. Should this be available? Precaution and Genetics • These cases show why genetics is an obvious target for the precautionary principle • I suggested earlier that PP is most commonly used in relation to introduction of new technology. Genetics is a good example (e.g. gene therapy, new tests). • In such cases, the precautionary principle is usually taken to suggest that we should not introduce a new technology, if it poses a ‘significant threat’, even if it cannot be conclusively shown that the threat will materialise The ‘threat’ of inaction • The origins of the PP in environmental ethics and emphasis on avoidance of harms, explain the emphasis on restraint in the use of technology • In the medical arena however, it becomes more obvious that failing to act can also present a serious threat • E.g. from failure to implement public health measures. Or, consider again the cases I described. • This suggests that being serious about the avoidance of harms requires one to consider the consequences of both action and of inaction • This is a point made by many commentators on the PP: Englehardt, Vineis, Vineis+Ghisleni, Harris+Holm, Häyry and others Precautionary principle (version 2) • This suggests the need for a revision of our first version of the PP to something like this: • Where there is a perceived serious threat we should choose the action or the omission that best minimises the likelihood of harm e.g. introduce a public health measure or decide not to use a potentially toxic pesticide • This rewording makes it clear that to be coherent, the PP must require an assessment of the potential harms of all available actions or omissions even where the risk of such harms is unclear The PP in practice • But, this rewording doesn’t reflect the way the PP is most often used in practice • Despite the conclusion that PP should treat both action and inaction with equal suspicion, the PP as currently practised tends to place greatest emphasis on the significance of actions i.e. people use PP1 • Origins in concern about environmental damage explain this, but this does not make it coherent • This implicit belief that harm caused by inaction is less morally blameworthy than action needs to be analysed Three possible justifications for this • The status quo is of intrinsic moral value and should only be changed where there is very good reason to do so • But, change is inevitable • Belief in the value of the ‘natural’ as good or as stable is untenable • Ecological arguments about the dangers of rapid change- genetic stress • True that rapid change can cause harms, but sometime inaction can also lead to rapid change • Or, that there is an intrinsic moral distinction between acts and omission What is wrong with Acts-Omissions? • As negative utilitarians it is difficult to see why PP advocates should care how a harm results, the concern is to avoid it • Some might be tempted to argue that even if harm is the same, it is less bad if we didn’t actively cause it • They have ceased to be utilitarians • James Rachels’ thought experiment • So, if advocates of PP are negative utilitarians they should simply avoid harms, whether by action or omission. They should be neutral about technology (Englehardt) • This is the only coherent form of negative utilitarianism But, should we be negative utilitarians? • Overriding principle of negative utilitarianism is the avoidance of harm/misery • Hence the appeal for advocates of environmental caution • But, the only certain way to avoid all harms would be the painless extermination of all life (Glover) • So, the avoidance of harms cannot be the only moral concern when thinking about genetics or other new technologies • Must also be at least some role in the consideration of decisions about technology for the production of benefits Precautionary principle (version 3) • Calls for another revision: PP3 • In addition to being concerned with the effects of both acts and omissions, a coherent version of the principle requires a consideration of both harms and benefits • To be ‘precautionary’ however the principle would have to be such that, where there was uncertainty, the avoidance of harm should trump the promotion of benefits • But, what are the implications of this third version of PP when applied in the arena of genetics and reproduction? A Case • A woman wishes to use sex selection to avoid having a girl child. She considers girls to be of intrinsically much less value than boys and wants a son, who she will love. • Knowing the woman well, the doctor considers it very likely that if she has a girl she will treat her extremely badly and neglect her. • Should the doctor provide sex selection (sperm sorting) to avoid the possible harms to a girl child conceived ‘naturally’? • One could imagine a similar case involving ‘disability’ A need for other moral principles • It ‘might’ be possible for the advocate of PP3 to argue that overall, the consequences of providing sex selection in such cases are worse than those of not doing so and hence it would be wrong • But even if so, this is not a good enough reason • it suggests that discrimination is only contingently wrong • This is not the case. Discrimination against women and disabled people would be wrong even if it did avoid more overall ‘harms’ or promote more overall ‘benefits’ • Implies a role for deontological concepts such as justice, equality, fairness and autonomy (in addition to thinking about harms and benefits) Precautionary principle (version 4) • These arguments imply that moral decisionmaking, even if it takes the precautionary principle seriously, also takes place against a background of other, non-consequentialist, principles, obligations and duties • A coherent PP4 must consider: actions, omissions, benefits, harms and do so in the light of other obligations, duties etc. • Confronting the moral challenges of decisionmaking in an empirically and morally complex world requires moral ‘judgement’ concerning competing moral demands Justice and precaution • This suggests that it might, theoretically at least, be morally right under certain circumstances to choose to risk a serious harm where the avoidance of that harm would conflict (badly) with another important moral principle e.g. ‘justice’ • If, for example, failing to introduce a risky new technology would be likely to lead to a vastly more unjust world, it might under extreme conditions be right to take the risk • Use of GMOs in sub-saharan Africa might be an example (possibly) A final problem • The complex moral challenges we face in an increasingly uncertain world cannot be addressed through the use of the PP alone (PP1, PP2, PP3)) • Decision-making in the face of serious threats and uncertain risks requires the use of moral judgement in the light of competing moral principles (PP4) • But this raises the other concern I introduced at the beginning of this talk: the ‘definition’ of key terms • Consider again, my first case: Case One On the basis of her age and other risk factors, a woman who is 10 weeks pregnant is informed by her doctor, following a question from her, that she is at approximately 1:800 risk of having a child with Down Syndrome. She is very concerned about this. She asks for a prenatal test (CVS) and says that she will terminate an affected foetus. She is told that CVS brings with it a 1:50 risk of miscarriage. She understands this but insists that she wants to have the prenatal test. Should it be provided? Who is to decide? • The use of key terms such as: serious harm, significant threat, credible risk, convincing evidence and so on, raises the question of ‘who should decide what is to count as ‘serious’, ‘harmful’ and so on? Are there any objective measures? • Who should be involved in the moral judgement? • This is not a question I can answer here, but it does highlight the need for decision-making, even precautionary decision-making, to be made in the context of a genuinely democratic, transparent, inclusive and reasonable process • But, what role in decision-making about GMOs should be given to sub-saharan countries, for example? How do we consider future generations? Conclusion • We are confronted by an ever-increasing array of difficult moral decisions with a technological aspect • The potential harms and threats of (introducing or not introducing) technology should play an important role in decision-making • But, this takes place against a background of other important moral considerations e.g. justice • And requires complex and sensitive moral judgment • Concerns about democracy and about definitions imply the need to also take seriously the importance of the nature of the decision-making process • Such decision-making should be inclusive, open and fair