genomics & society

Trying on Ethical Frameworks

Posted by Myra I. Roche on March 21, 2012

At our last reading group meeting, Rebecca Walker, led a discussion about creating an “ethical analysis” of a topic, such as the one we posed a few weeks ago: “Should students use their own DNA for classroom activities?” Some background information about the controversy can be found here.  Rebecca described both prescriptive and descriptive aims of an ethical analysis.  While a prescriptive approach would argue for a particular “best practice”, a descriptive one would detail the moral claims of each side of the argument.  Please note that this post represents my relatively uneducated summary of our session so feel free to contribute a comment to correct me.

We discussed three ethical frameworks upon which we might build a prescriptive analysis for our topic: a casuistical approach, a feminist approach, and a principles-based approach.

The casuistical method, unlike the financial market, actually does rely on past performances to predict future actions.

This case-based approach is commonly used in medicine.  It is analogous to asking: “Let’s see, what did we do the last time we had a similar case?” If we look to the past to illuminate the present, we find numerous examples in which learners were routinely encouraged to use their own blood for laboratory experiences.  Many genetic counselors, for example, can remember their own cytogenetic laboratory rotation where they first learned how to construct a karyotype.  They were expected to use their own samples upon which to practice because it would be wrong to waste a real patient’s blood.  As with any genetic testing, this scenario resulted in a few instances where individuals were startled to learn of an abnormality (primarily a sex chromosome abnormality) that they had not previously suspected.  And, of course, the timing and setting of this discovery only added to the trauma. In fact, this history prompted the UNC Cytogenetics Laboratory to require rotating students to meet with a laboratory certified genetic counselor to discuss the potential risks of using their own sample and to offer the option of using an anonymous one.

A second ethical framework, a feminist framework, provides a way to discuss the unequal power relationships between a student and a professor that are inherent in the classroom setting.  The moral acceptability of encouraging students to “use their bodies” to learn was questioned and the tremendous power of the social group, especially among young adults, was viewed as potentially coercive.  Experiencing genetic testing in a classroom could make genetic testing in general come to be viewed as “normal” thus paving the way for greater acceptance solely because of its increasingly familiarity.  Children, even 20 year olds, who decide to have their genome sequenced, can learn results that have significant implications about their parent’s genetic status thus completely up-ending the traditional power relationship of a parent to their child.

Finally, a principles-based framework was considered.  This now familiar perspective includes the four principles of biomedical ethics, as first introduced by Beauchamp and Childress.  These principles are respect for autonomy, non-maleficence, beneficence and justice.  According to this approach, the moral implications of each principle must be specified to the context of the case and, may need to be “weighed” against the other relevant principles. Participants felt this approach was helpful in giving some language to frame the moral issues in the case, but required additional input from the other approaches, such as feminism or narrative approaches (which we did not consider in this session).  Critics have claimed that in the principles approach, it is respect for autonomy that often trumps the other three principles, particularly in the US, where individual rights are often regarded as sacrosanct.

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6 Responses to “Trying on Ethical Frameworks”

  1. Karey said

    I found this exercise to be very helpful. Though I was not placed in the exciting feminist group, I learned quite a bit by applying a principles based framework to an ethical analysis. After applying the principles-based framework to the case of using student’s DNA in classroom activities, we found that this particular framework can be used as the starting point for an ethical analysis. However, the exercise did allow us to tease apart this complex case and explore areas of which we believed ethical principles were not followed.

  2. marthaeking said

    Over in the feminist group we read “Why a Feminist Approach to Bioethics?” by Margaret Olivia Little (Kennedy Institute of Ethics Journal 6.1, 1-18). I really enjoyed this article; I found Little’s writing to be a clear discussion of feminist approaches that could be used in almost any context. Her article makes a feminist approach very accessible and I plan to use this piece with undergrads in the future– thanks to Rebecca Walker for giving us this one to read!

    One part of Little’s discussion that really caught my curiosity as it might be applied to genomics was her discussion of the male as biologically normative. In medical anthropology, we are well familiar with this concept and examples abound in the history of medicine– developments and understanding are driven by the male body as normative and the female body as derivative or deviant. Applying this directly to genomics, I wonder how this tradition carries over. The obvious starting places are in issues like prenatal testing. But does this dynamic reach into our methods of interpreting genetic tests writ large, understanding new genomic information, or how we deploy emergent forms of clinical care based on molecular diagnoses? Are our interpretations or presentations of sex-linked characteristics / disorders impacted by these dynamics?

  3. Rachel said

    The casuistical method is especially interesting to consider in the face of changing high school and undergraduate science courses. When I was in school, it was common to swipe saliva samples for gel electrolysis. As I entered college courses, we would submit samples for class wide analysis of certain genetic markers. These genetic markers were supposed to conform to certain geographic areas, and though the samples were not identified by names, professors and teaching assistants encouraged students to speak about their results. If this type of instruction become more common, student attitudes concerning genetic testing may shift as well.

  4. Wendell said

    The casuistical method to create an ethical analysis with regard to genetic testing issues is one that can be used. But, the causuistical method may inhibit rather than advance the progress of science because its principles are based on previous case studies. These case studies may be out of date and no longer applicable to current genetic issues.

    Interestingly, the casuistical method is analogous to the doctrine of precedent. Precedent provides guidance to judges when they are required to decide similar cases. Equity is one of the primary reasons of the doctrine of precedent- to prevent courts from using their own discretion when making a ruling.

    As stated above, the casuistical method is one that can be used to decide an ethical genetic issue. However, it may be better to independently look at all the facts and circumstances of a case to effectively perform an ethical analysis.

    • Kelly Hogan said

      Yes, a good point. We can see from various case study courses that the current context is just as important as the precedent. For example at Berkeley, the program for genetic testing was being pushed by the administration for a “general public” of incoming undergraduates. At Stanford, the students were far from naive, they were medical students and the exercise served a role in their specific training. Time also makes using preceding cases a challenge with technology that is quickly changing. For example, a course that considered the technology several years ago, may reconsider its use in light of new types of information that can be learned from the changes in technology today. Thus, I agree that context, audience, time, etc all make using the causistical method a bit inhibitive. Yet, a good place to begin to frame an issue.

      • Rebecca Walker said

        This is an interesting discussion. Casuistry has been criticized as being morally conservative, but the reasons for this are somewhat different than those pointed to above. In particular, since decisions about how to respond to new cases are based in our responses to past cases and our “settled” norms, it is hard to argue from a casuistical point of view for a radically different or new way of addressing those moral issues. With regard to the comments above I do think it is important that we don’t confuse what is current science with what is current ethics as scientific aspects of a case being “out of date” does not mean that the moral values are out of date. In philosophy at least we are still drawing from the ethics of Aristotle. Does that mean philosophy is out of date? Maybe. But I’d guess instead that our foundational moral norms, as they are based in core problems of social organization, relationship, and reciprocity are fairly stable. At the same time, if there is any such thing as a “foundational moral norm” these certainly do need to be interpreted in light of particular contexts, but I don’t think casuistry is prohibitive in that regard. In fact, those contextual considerations are exactly what casuistry brings to light through analogical, case-based, reasoning.

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