For thousands of years man has had to face the problem of how to recover from diseases, with little knowledge, insufficient tools and very limited resources. Health was a wealth that was chiefly viewed as a godsend, or as depending on chance or on specific situations, rather than on a project or on a purpose. Today a new age is dawning, and this significantly alters the above perspective.
We now have available an increasingly adequate and detailed knowledge, growingly accurate and sophisticated tools, but we still have to deal with insufficient resources, unable to meet man’s health expectations.
Health has been increasingly playing a leading role, within national healthcare policies themselves, by becoming a purpose, a project coordinating and involving multidirectional research work and influencing the very laws of economic development. Within this historical and theoretical framework, which chiefly relates to the West but has worldwide repercussions, special care should be devoted to the issue of genetic research and of the development of biotechnologies.
Whereas it is quite easy to identify and make a list of the hopes that are taking form in connection with the expansion of biomedicine, the issue relating to the practical large-scale application of such researches proves to be more complex. In particular, among the various issues that are emerging as part of the bioethical debate resulting from the genome project, we are faced with the problem of “how and through which criteria to handle” the expansion of our biological knowledge.
This problem proves particularly urgent at a time in which a transition from diagnostic and preventive medicine to a “predictive” form of medicine is obviously brewing.
For instance, the use of predictive forms of genetic tests, concerning not only the ante- or neonatal stages, but also adult population itself, rises questions, both of an ethical and of an economical and social nature, in connection with both individuals and the general public.



Although on one side, through genetic tests, it will become increasingly easier for us to know, even in the absence of symptoms, which diseases we are most susceptible to, on the other side this knowledge will not only prove useful, but also potentially ‘harmful’. Indeed, this ability to “predict” the future of our health will also apply to diseases for which no adequate therapies exist. Now, faced with this situation, the impact that such a knowledge may have in existential terms is quite obvious.
Those who will discover to be prone to developing a specific pathology will be tempted to monitor, possibly through invasive examinations, their state of health, and this situation will most certainly affect their life style.
Besides, from a social point of view, this knowledge may be used to bring about discrimination in the labour and insurance markets. In this regard, an appeal to a twofold right is gaining growing substance: the right not to know, and the right not to let others know.
Such rights are based on the acknowledgement of a person’s autonomy, which may lead him/her to choose not to be heavily affected by the outcome of a possible genetic test, and to claim their right not to suffer from social discrimination.
But with respect to this right, there also is an interest (if not an actual right) by third parties (as one’s partner, for instance) or by the general public, to access such data. Furthermore, as part of the ongoing bioethical debate, the “duty to know” has also been stressed when this involves a means to protect the next generations from future suffering, especially when one chooses to procreate.
But claiming this right may also lead to eugenic practices, which have in fact already become established in those cases in which prenatal diagnostic tests lead to the so called “therapeutic abortion”. Even the role of medicine is changing as it broadens its field of action, coming to include a particular character, that of the potential patient.
The risks and costs, both human and financial, associated with the development of this field of research raise the urgent question as to the criteria to be used to handle this new biotechnological “gamble”. However, what cannot be put at stake in this gamble with our future, is a full and complete respect for the human condition. In particular, the twofold risk of social discrimination and of “creeping” eugenetics can only be avoided if scientific research and medical practice do not break off their vital connection with anthropologic and ethical considerations. Undoubtedly, it is not easy to establish a hierarchy of values capable of highlighting how to put predictive medicine to “good” use when the only reference criterion is human health, or the so-called “quality of life”.
Failing a complex reflection which may again place the issue of human health within a broader range of values concerning man and his existence, it will be difficult to avoid a drift towards reductionism.
The future framework of predictive medicine is also further complicated by the epistemological hypothesis that rules it.
The connection between genetic factors and the possible occurrence of disease is a connection that cannot simply be researched on empirical bases, but depends a lot on the basic theories of genetics itself. In other words, trying to put it in the simplest and most concise manner, the reliability degree of a predictive test also depends on the value of the theoretical hypotheses of genetic determinism, which has raised a number of theoretical objections.
In fact, today we are able to carry out tests that are highly reliable for certain diseases, but we still have to prove that the factors that are valid in certain cases also apply to the whole range of human diseases.
Although, as a rule, it is still correct to try and avoid a polarization between demonising and overemphasizing innovatory researches, we should however not neglect the fact that we can only avoid this polarity by accessing a more composite approach to the human condition and to the tasks that medicine must and can take upon itself with regards to man’s health. (traslated by Interpres)
Adriano Pessina
Cattedra di Bioetica Università Cattolica di Milano