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Dialogues@RU is published
annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume 4
Fall 2005
Genetic Enhancement: Distinctions And Regulation - Page 4
Virginia Mensah
This issue, however, calls into question the definition of disease, since it is entirely possible that in the future people might question whether diminished physical capacity or short stature can be considered disease. Juengst offers a potential answer: "[w]here the human problems anticipated by an intervention cannot be tied together into a diagnosable disease entity, with its recognizable constellation of subjective symptoms, physical signs and causes, it should not be adopted as a proper part of medical practice" (139). Thus, genetic enhancement should not be used to foster "social hopes." Unless there is a legitimate deficiency or quality that necessitates use of the technology, there is an obligation by the doctor or physician, as well as society, to refuse access.
Another basis for regulation derives from current medical knowledge constructions as explained by Lupton: "power relations in the medical encounter [are] 'everywhere,' enforced as much by the individuals unconscious self surveillance as by the authority figures" (129). Therefore, just as the social "system" potentially gives more access to gene technology to the wealthy, the medical system potentially allocates a more substantial role in medical discourse to the doctor, thereby allowing doctor-sponsored patient restrictions (or restricted access). Although the patient retains a substantial role the medical encounter, the present medical system may empower doctors to ensure enhancement techniques are obtained only by those whose condition merits them. For instance, in terms of present germ-line therapies, such as in vitro fertilization and prenatal genetic diagnosis (IVF/PGD), techniques are employed only if there was "prior birth of a child with a genetic disease, prior spontaneous abortions, or abortions after a prenatal diagnosis of a genetic disease" ("Staff Background Paper" 6). Existing medical parameters in this case not only confine the technology within disease bounds, they also exhibit doctor-sponsored limitations. Such interventions may give an initial stance for regulation, which in turn will help separate legitimate therapeutic uses of enhancement from illegitimate self-serving ones. Hence, to the extent that the doctor-patient relationship provides a platform from which initial access regulation may arise, the decision to dispense genetic medicine could be partly left up to the discretion of the doctor. Doctors maintain the power to apply the technology in medically-necessary cases and at the same time prohibit its use in frivolous instances, which will alleviate some concerns about genetic enhancement. This is a hefty responsibility, one not necessarily to be undertaken by individual physicians but allocated to the greater medical community involved in the production and application of genetic enhancement technologies.
Even this option may be troubling, though, since it relies on the notion that all doctors are trustworthy and can effectively distinguish between appropriate and improper uses of the technology. The perspective that medical professionals will use their power for strictly beneficial purposes may prove shortsighted. Therefore, not only do we need to be wary of self-serving uses of enhancement by patients, but we also need to be cautious concerning self-interested doctors. In particular, Maxwell Mehlman, author of Wondergenes: Genetic Enhancement and the Future of Society, argues that although "professional self-regulation might play a role in limiting access to genetic enhancements . . . under certain circumstances, health care professionals may be unable to resist the economic lure of the enhancement business" (137). Genetic knowledge, in this case, acts directly in the interest of the doctor, who might utilize his or her power to survey both medical and social aspects of the patient and consequently succumb to economic temptation. This is entirely possible considering that medical knowledge is diffuse and "should be considered the product of power relations, and as such, is never neutral, but always acting in the interests of someone" (Lupton 111). Use of technologies could therefore be dependent on both the doctor's or the patient's personal needs and value system which could influence the use of medical power for self-interested purposes.
Additionally, assuming some rogue doctors or patients do use the system for personal gain, an important concern would be the detection of the illegitimate enhancement. As Matt Crenson, in his article "Tomorrow's doping scandal? It could be genetic enhancement," notes that "like the technology itself, testing for genetic modification is still in its infancy - and it may never be easy to detect" (2).