Marc Lappé

Values and public health: Value considerations in setting health policy

This paper uses six policy problems in public health to illustrate the complexity of value considerations in decision-making, and derives an ethic for health protection policies based on the primacy of non-harming. In the first part, health policy is shown to require value considerations beyond simple utilitarianism. In the second, the author posits that much of health impairment can be traced to erosions of health outside the immediate control and consent of the individual. Accordingly, he argues that health impairing actions on the part of others warrant strict regulations in spite of the paternalistic nature of such interventions. The priority for these interventions should be set along a gradient of vulnerability and autonomy, with the greatest hazards to non-consent giving persons warranting the greatest controls. Special attention to fetuses and developing infants is thereby justified, and actions which prevent harms are shown to have priority over those which mitigate harms, ameliorate their effects or promote good.

Let no one split asunder: controversy in human genetic engineering.

In 1980 the first recombinant genetic engineering experiments on humans were performed. These experiments sparked a major controversy, international in scope and potentially profound in its implications for genetic science. We develop four perspectives—substantive, network, organizational, and societal—from which science can be seen as a process having differing social implication and meaning. The research and controversy are discussed with attention to the conflicts and their resolutions from each perspective and among them. Taken together, the four perspectives are used as a single basis for understanding the social processes involved in this case study and the more general workings of science.

Why Shouldn’t We Have a Eugenic Policy?

It is remarkable to me that the century which has elapsed since Darwin’s pronouncement in The Descent of Man has brought forth no better analogy for the practice of human genetics than the breeding of animals. Another reflection of this curious persistence can be found today in the human application of the selfsame equations for heritability developed by Lerner and Dempster in the 1940’s for poultry breeding (1). No matter that the metric traits used by Lerner and Dempster are not analogous to I.Q. scores, or that the confounding of genetic estimates by interactional components greatly reduces the potency of the equations (2). The assumption remains that somewhere underneath that labyrinth of culturally distorted behaviors and attributes, lurks the animal known as Homo sapiens sapiens.

REFLECTIONS ON THE COST OF DOING SCIENCE

Scientists must consider not only the direct hazards of virulence or oncogenicity in genetic research but the possibility of indirect harm or costs. This 2nd-order or world-view effect is the concept whereby the kinds of models that society adapt influence their ideas about the casual ordering of the world. A genetic model encourages a view containing moral assumptions about the relationship of people to their environment and responsibility for their disease or behavior not tenable from an environmental standpoint. 3 related questions are: 1) possible human costs by erroneously or prematurely incorporating unsubstantiated genetic models into social policy 2) potential costs of inappropriately utilizing valid genetic models of behavior or disability and 3) costs to using genetic models per se for studying human traits or behaviors. Genetic hypotheses are usually tentative to facilitate investigation into complex areas. Nonscientists may move such theory into the area of social policy reordering our values and social priorities to the detriment of our society.