Genetic testing is a DNA (Deoxyribonucleic acid) based tests. DNA, which is a nucleic acid molecule, is understood to possess all the genetic instructions of vital importance towards the developmental and functional aspects of all living things. D.N.A. is the sole unit in the living things that stores important information necessary to construct components such as RNA molecules, enzymes and proteins (Buchanan, Brock, Daniel, & Wilkler, 2001).
The information in DNA is coherently accurate. Meaning that any information derived out of genetic testing is equally accurate. The technology is at its infancy stages and it is exhibiting potential use in the future as a technology in the field of health care services. Its sophistication adds to its reliability as techniques of vital use to detect and test genetic disorders. The DNA molecule in particular is examined in cases of genetic testing.
Other tissue in the blood can be used for genetic testing which include enzymes, proteins among others. The use of these gene products requires, that chromosomes stains or fluorescent, are examined under high power microscopes (Wasserman, Bickenbach, & Wachbroit 2005).
Genetic Testing and Health care
In the medical profession, genetic testing is day-to-day gaining immense importance. This is due to the high number of diseases that are caused by defects of the genes accompanied by the corresponding high number of genes identifiers. Mutation issues of these genes further complicate the scenario since the already accounted figures are bound to hike in instances of mutation. Definitive diagnosis and treatment of the genetically inherited diseases are highly dependent on genetic testing.
There is a very high likelihood that this technology will be a core part and a routine in all health care fields, which will be compulsory to all irrespective of the genetic position of presence or absence of genetically inherited diseases. This is based on the fact that technology is advancing and scientists’ researches are yielding more and more knowledge especially in the field of health as it relates to genetic variation. From the health care point of view reasons for genetic testing exist (Parents & Asch 2000).
Reasons for Genetic Testing
Prenatal diagnostic genetic testing involves conducting a genetic test in an embryo or fetus with the aim of identifying the possibility of an existing genetic disease in the fetus or embryo. The newborn baby may also be subjected to a genetic test for the same reasons as applies to the fetus or embryo above.
Pre-implantation genetic diagnosis is also conducted aimed at screening the embryo for a disease. Some individuals possess, in their DNA a single pair of genes responsible for a disease, which for its full expression, requires two genes. Such individuals who are unaffected by that particular disease may require a genetic testing to come up with a conclusive result of their carrier position (Sumner, 1999).
Some genetically related diseases in affected may be dormant, with their symptoms not being fully blown. These individuals also need some genetic testing. This form of genetic testing is called presymptomatic testing. Normally done in adults and they are significant to test for the possibility of the onset of disorders. Most of genetic tests of this order have had their application in diseases such as Hunlington’s disease (Lapham, Kozma & Weiss 1996).
Cancer is one of the number one killer diseases. Genetic testing can be of crucial help to individuals willing to gauge their potential risk. They are subjected towards developing cancer. This is also a presymptomatic testing, which is also used in cases of Alzheimer’s diseases, which are equally serious as cancer (Sumner 1999).
Genetic testing also find immense application in confirming diagnosis in the laboratory, of individuals found to have symptoms of a certain genetic related disease as a basis to reference to physician, for the appropriate treatment and action. Genetic testing is also useful in “forensic and identity testing” (Sharpe, & Carter 2006, 89). Genetic testing also finds its application in the family matters. Parents with the appropriate health information about genetic position are better situated to avoid instances of having children who may have devastating diseases in the future. The genetic tests also help the family to identify among the family members those who are at high risks to some conditions and circumstances that can be avoided (Sharpe, & Carter 2006).
The healthiest approach to problem solution is creation of awareness on causes, effects and results of the problem for the appropriate steps involved to gain effectiveness. The society should be exposed to the awareness of their potential risk of being susceptible to some of these genetically inherited diseases in their future. The individual with the relevant awareness is liable to come up with some code of behaviors that minimize the risk (Buchanan, Brock, Daniel, & Wilkler, 2001).
Genetic testing is a moral discipline and therefore the relevant ethics involved should be put in place. This involves a philosophical analysis of moral issues and the efforts to differentiate between what is right and what is wrong. Ethics is a vital tool towards understanding of the existing tensions that come up out of differences in the values inherent in different people. The explanation does not necessarily fall on morality but rather on logical attempts to formulate a set of rules towards the conducts expected out of a distinct category of human action (Sharpe, & Carter 2006).
The incorporation of ethics into the science of genetic testing is due to its inherent similarity to public health. Public health has had a lot of impact to societies from the past. There existed cases of highly contagious diseases, majority of which were untreatable and fatal causes of human death. The public health concern in this scenario of contagious diseases is rooted to appreciation of the fact that, while one individual is affected, uncountable number of other people may become ill or even die out of this single case. These cases are of life and death making the society to assign to the physician immense importance who is taken to possess some substantial jurisdiction over life and death. The skills, expertise knowledge and training relevant to treat these diseases is the ultimate qualifying factor for the position There is an expected balance by the society of the good of the entire public and the good of an individual member of the public. The physician in the first place should uphold a highest degree of the ethical tradition of doctor- patient relationship (Post & Whitehouse 1998).
Genetic testing gives information of the individual tested which in some way bears some adverse effects to the particular individual and the family of the individual. The results of the tests project the future health status of the individual and in an instance where critical illness or even death is foreseen, serious implications on family life and socio-economic life are felt by the individual and the family of the individual. Employment and insurance of the positively tested person is put at peril. The information on genetic testing should therefore be confidential and its handling should be highly considered to safeguard the owner and the family at large. The access to such information should be restricted to only the persons authorized to access it (Sumner 1999).
Duty –base Theory
Any scientific research has some ethical dimensions to the society. The duty-base theory is a good model to use while comparisons between the scientific technologies and ethical theories are being put on a balance. Ethical theories are out of ethical analysis as an appropriate tool subjected to the society to be an aid to individuals for the determination of the appropriate decisions, which are made, and their possibility to be tested against ethical theories. This brings the scientist to the choice of the morally appropriate decision to make.
The theory challenges the scientists and professionals with obligations that they should withhold in order that they are objective, unbiased and even honest in their practice when using the deemed appropriate methods (Sharpe, & Carter 2006).
To resolve most of these tensions in the public health, the utilitarian theory is of immensely vital contribution. Essentially any action taken in the society should have results providing the “greatest good for the greater number of the people” (Buchanan, Brock, Daniel, & Wilkler, 2001, 56) in that society.
The utilitarian theory therefore gives preferences to the public at the expense of the individual. A good example of the application of utilitarian theory is a situation of government laws and legislatures that the society should report to the authority any experienced case of a communicable disease. Another example may be vaccination programs being made mandatory. This is a similar case of a compulsory genetic testing and any case of a genetic related disease being referred to the relevant physicians for appropriate action towards its control and treatment. This is done for the interest of the general public and at the expense of the ethical moral status of the affected person. According to the utilitarian theory the public health decision-making is rooted to the derivation of more good than harm to the greatest number of people (Buchanan, Brock, Daniel, & Wilkler, 2001).
In the community it is just and fair to treat all members to be of equal importance. The least person in terms of well being is no different from the esteemed person in terms of social status. Solidarity should be expressed to exist across social classes; this is the ethic of egalitarianism. In genetic testing egalitarian ethics should have its application in a sense that the decision to take a genetic test should not have the influence of any other member of the community. For the cases of the unborn, information should be strictly limited to only the authorized and the future access to the information should be restricted (Buchanan, Brock, Daniel, & Wilkler, 2001).
Ethics of Public Health
In the process of human beings, interacting with each other, there looms a potential danger of some ethical tensions to arise. The ethical tensions usually exhibit a particular, unique context which is particular to the individual and totally conflicting the opponents side. Each member of the society is entitled to obey some definite and unique values, which are guided by some moral judgment. The opponent is in a potentially equal but opposite distinctively opposite position
Principles of Bioethics
A part from the known theories already discussed, ethical tensions can vehemently be illustrated by the use of some principles that are simultaneously a firm foundation towards the accurate decision making as regards the issue of genetic testing. These principles are: –
Respect for Autonomy: The principle of autonomy is based on the assumption that each individual in the society is independent and solitary in the sense of decision-making. Out of this principle each individual member in the society is liable to make a personal decision as regards the issue of genetic testing. The principle has the relevant respect for the dignity of the human unlike the principle of paternalism. The decision for or against genetic testing therefore lies explicitly on the individual person supposed to take the test (Sumner 1999).
The principle of Nonmaleficence: According to this principle the right cause of decision should not in any way portly any harmful effects to other people. Therefore the decision against or for the genetic test should be made from the viewpoint of protecting the harm of any possible genetic disease to the public. The individual taking the test has no much influence on the decision arrived at the principle is derived from the Hippocratic injunction to “First do no harm” (Sharpe, & Carter 2006).
The principle of Beneficence: The benefits of the society at large are further compounded by the principle of beneficence. The public should receive the maximum benefits out of an action of an individual and therefore the decision to take a genetic test according to this principle should be dictated by the project benefits to the public.
The principle of Justice and rights: This principle tends to assume a neutral perspective of decision-making. It has got some related ideologies such impartial, equity, fairness etc. According to the principles, the benefits and harm of genetic testing should be a burden of every member of the society shared and distributed equally across the board (Post & Whitehouse 1998).
Comment on the principles and theories
Although these principles are sound and logical a conclusive solution can never be derived from any one or all of them as a break through of the dilemma of genetic testing. The problem facing people requires an elaborated framework as a principal guide towards looking for solution. In the field of public health, the theories and principles form an essential framework as a guide towards information, possible cause of action and intervention, a basis of policy and research in the field of public health (Lapham Kozma & Weiss 1996).
Potential tension between theories
Tension may occur for example between the principle of beneficence and the principle of respect for autonomy in the decision towards genetic testing. This is quite in order in the principle-based approach. However solutions must be sort whereby the resolution of such a tension is reached at, through an appropriate effort to explore the entire context of the issue at hand for a balanced solution (Sharpe, & Carter 2006).
An ethical analysis of the situation at hand should be out of a thoughtful appraisal of the totality of related concerns while the societal context is given the first hand priority, at the expense of the individual stand point which is the cause of tension.
Major Ethical tensions in the public health
The tensions experienced as regards genetic testing are out of the conflict between the rights of the individual relative to the rights of the community. The public health has to deal with a situation whereby an individual is found to have a communicable disease, looking at the two perspectives of the individual and the public. The tension occurs out of the efforts to strike a balance between the rights of an individual and the right of the public at large.
The middle ages expressed some form of witch-hunts to victims of communicable diseases. The victims were discriminated from the rest of the community, expelled from their jobs and children denied places in schools. This danger is also imminent if victims of genetically related diseases which are communicable are to be subjected to genetic testing and the necessary actions and measures taken to protect the interests of the public (Buchanan, Brock, Daniel, & Wilkler, 2001).
Genetic testing poses some undesirable effects to the individual tested and the family as a whole. This is a technology of the new millennium and it is bound to have serious repercussions on the fields of information “confidentiality, insurability and employability” (Post & Whitehouse, 1998,102), of the target individual revealed to be a potential danger to the public out of results of genetic testing. The results are ability to result to stigmatization and general decline of self-esteem and individuals hope in the future career and family life. The positive result of a genetic testing are liable to increase the fear to the uncertain risk of sickness of the individual in the future and to the extreme, the occurrence of untimely and premature death.
Apart from the already living and aware, the unborn and honest are not being spared by the ethical tensions that result from the results of genetic testing results. By the virtue of the fact that genetic testing is a new technology and bound to be a mandatory public health procedure, the concerns are traumatizing. Before its full integration into the public health genetic testing requires to be fully evaluated for it to be accurate and an important tool for clinical productiveness (Post & Whitehouse 1998).
The technologies at the modern times have facilitated the storage of consolidated information in a single computer. This has some negative consequences as regards the privacy and confidentiality of the genetic testing, information of individuals. Anybody can access the information in contrast to the dire need for the privacy of such sensitive information. There is therefore an amicable need for the authorities responsible to implement possible policies aimed at the right steps to protect the private and confidential data of the people (Sharpe, & Carter 2006).
Impartiality Advocacy and Genetic Testing
An impartial genetic testing officer is likely to encounter a potential conflict from an advocate of public health. It is a normal procedure for human beings to life in an environment of conflict due to the simple reasons that the means and ends to different goals in life take different courses of actions and that each an every individual has to accomplish the designated duties at the end of the day. The objectives of the genetic testing may face conflicts from the interests of protecting the public health. The epidemiologist has a moral ethical duty to act on the findings of the genetic tests on one hand while the public health advocate is entitled to protect the public from a possible outbreak (Post & Whitehouse 1998).
Public health and the state: beneficence or paternalism
The government in power is solely responsible to set up in place the relevant policies and enforce the policies under the public health domain. The government policies are intended to be beneficial to all citizens. However in cases of policies on genetic testing with the aim of protecting the entire public, the autonomy of the individual is more oftenly than not, undermined. For the case of those whose autonomy is being undermined, their inherent feelings are that the government is acting in a paternistic manner towards them (Sharpe, & Carter 2006).
Genetic testing Legal Issues: Accountability and Responsibility: –
The results of genetic testing posses dangers, to the affected, of contracting a disease, which is to the high degree fatal. For such a person the marital life, in the first place is in danger. A spouse to such an individual would be in a dilemma as whether to be involved in a relationship and child bearing to a partner who has potential danger of future illness or even death.
The situation as well poses an equal dilemma to a potential employer. The current state of talent development is an investment facing any employer. The employer would therefore, be in a dilemma whether to hire and train a talent that is faced with a dire danger of future illness or even death.
Other areas of dilemma include the insurers. Insurance companies are gamblers of the first degree. The act of insurance is also gambling on both parties where the insured gables for imminent sickness while the insurer gables against such a sickness. Results of genetic testing if positive, ends the gabbling since the insurer cannot gamble against the obvious. This leaves the insured party in the cold (Buchanan, Brock, Daniel, & Wilkler, 2001).
Although the results of genetic testing are relatively accurate, it is not usually healthy for anybody to take results to mean genetic determinism. The human being is genetically and phenotypically made up. The affected individual may modify their behaviour to make use of the environmental component of the human being make up.
It is the positive aim of public health to see that the majority of the public achieves goodness. It is out of this moral spirit that in the past epidemics that threatened mankind have been contained almost to zero levels, which in the past existed as the primary killers.
More complicated cases are associated with the current millennium such as cancer and heart diseases, majority of which are genetically inherited. The potential in genetic testing has been analyzed and found to be of immense contribution towards a step in the fight against these diseases. However, the approach is faced with a lot of tensions between the individual right of autonomy and the society. To strike a balance between the two a conscious understanding of the danger posed by these diseases needs to be made clear.
Allen Buchanan, Dan W. Brock, Norman Daniel, Daniel Wilkler (2001), From Chance to Choice: Genetics and Justice, Cambridge University Press; New Ed. Edition ISBN- 13-978-0521669771, 213-231.
David Wasserman, Jerome Bickenbach, Robert Wachbroit (2005), Quality of Life and Human Difference: Genetic Testing, Health Care, and Disability, Cambridge Press ISBN-14: 978-0521539715, 116-124.
Erik Parents, Adrienne Asch (2000), Parental Testing and Disability Rights. Georgetown University Press, Hastings Center Studies in Ethics. ISBN-13: 978-0878408047, 257-264.
Lapham EV, Kozma C, Weiss JO (1996), Genetic Discrimination: Perspectives of Consumers, Science, 621 – 624.
L. w. Sumner (1999) Welfare, Happiness and Ethics, oxford University Press, USA; New Ed. Edition ISBN-13: 978-0198238782,58-68.
Neil F. Sharpe, Ronald F. Carter. (2006), Genetic Testing: Care, Consent and Liability, Wilrey-liss ISBN -13:978-047 71649878, 164-178.
Stephen G. Post, Peter J. Whitehouse (1998), Genetic Testing for Alzheimer Disease. The Johns Hopkins University Press. ISBN-13: 978-0801858406, 73-83.