Biomedical Engineering Reference
In-Depth Information
But one may still regard the genome as natural and the natural as nor-
mative without requiring such strict construction. For one thing, the indi-
vidual's genome may contain “contradictory” instructions, so technology
may assist nature in one sense by overcoming it in another. Or some
harmful instructions may have their source in the mutation of ancestral
genes, including mutations caused by such “unnatural” insults as radia-
tion from a nuclear power plant. Moreover, the specific configuration of
genes in the individual patient result, in part, from the myriad of social
decisions that shaped that individual's pedigree. Accordingly, the con-
struction of what is natural in the genome may involve many of the same
moral and logical issues that arise in the decision about whether to regard
the natural as normative in the first place.
On a looser or more flexible construction of the genetic code, the
physician can abet salutary tendencies or strains within the genome
against less salutary ones; the physician can engage in selective genetic
engineering and still be regarded as working with, or assisting, nature.
But even in this more flexible view, the genome is not simply the raw
material with which the physician has to work to produce desired results.
The physician must be guided by, and work to reinforce, the protective
or healing tendencies discerned in it. The physician's interventions have
to maintain a consistency or harmony with the original genome if they
are to preserve the role of the physician and the identity of the patient.
It is important to note that on this more flexible interpretation, the
first view of medicine and nature does not preclude either germ line
therapy or enhancement, as long as the changes wrought by those inter-
ventions can be seen as strengthening what is already present or implicit
in the individual's genome. Of course, given the loose, metaphoric char-
acter of this standard, it is difficult to tell how demanding it would be.
For proponents of the opposing view, however, the human genome must
be reckoned with, not respected. It imposes practical limits, not moral
constraints.
The Distinction between Born and Made
In the literature on assisted reproductive technology, the idea of nature
as a norm has been vigorously invoked and challenged.
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As those tech-
nologies progressed, critics of appeals to nature appear to have prevailed.
