Speculative Ethics: Valid Enterprise or Tragic Cul-De-Sac?

Abstract

The excitement generated by major scientific advances almost inevitably leads to intense speculation concerning the uses to which these advances will be put. Since some of these will be accompanied by ethical challenges, it is appropriate for bioethicists to delve into their potential ethical implications. If the ethical dimensions of such advances can be outlined and analyzed in advance, this would appear to be a welcome contribution to any public debate that may ensue. However, the speculations range from those that could eventuate within the near future and would represent an incremental change to present practices, to those that are vastly less likely to come to pass and predict paradigmatic shifts of momentous proportions. The challenge for bioethicists is to determine whether they should devote their attention to such extreme speculative possibilities, or to more circumscribed speculations, or indeed whether it is better to focus on existing issues, rather than those that are merely possible. An illustration of more circumscribed speculation is provided by no less a scientific authority than Francis Collins in his 1999 Shattuck Lecture, in which he speculated on the medical and societal consequences of the Human Genome Project in 2010, just 11 years into the future. He described this as a hypothetical clinical encounter in which a 23-year-old undergoes a battery of genetic tests. This was because by 2010 Collins speculated that the field of pharmacogenetics would have blossomed to such an extent that a prophylactic drug regimen based on personal genetic data could be prescribed to reduce cholesterol level and the risk of coronary artery disease (Collins, 1999). As we look back at 2010 we can see that these goals have not as yet been realized at the level hypothesized by Collins. The question then is whether bioethical enquiry into the prospects opened up by genomic medicine has been weakened by this excessive optimism. Interestingly, at much the same time, Holtzman and Marteau (2000) contended that the new genetics would not revolutionize the way in which common diseases are identified or prevented. In wanting people to see beyond the genetic hype, they pointed to the importance of existing issues, such as social structures, lifestyle and environment, for much of disease. They also questioned how much interest would be shown in being tested genetically and even more in making appropriate lifestyle choices. These too are considerations calling for the attention of bioethicists. It is evident then that even relatively focused speculation has its problems. What about far more exploratory and aggressive speculation? Garreau (2005) considers that we are at a