I heard Brad Allenby, an ASU professor who is both a lawyer and PhD environmental scientist, speak on the subject Can Technology Save Us? Allenby defined technology as the expression of a dominant species’ ability to control the established order. He said that human beings are the dominant species on this planet and will define who and what we and the planet will become. He cautioned that whoever gets to define what it means to be human could get ugly. I believe him and we need to address these issues in healthcare delivery.
The new genomic research has given us capacity to create a new and enhanced variety of human. We now have the ability to eliminate diseases, predict a person’s future health problems, eliminate imperfections and also enhance desirable qualities. Testing a patient’s genes will allow doctors to tailor treatment options for an individual. It can predict who will or won’t respond to specific drugs and the potential for side-effects. Pharmacogenomics will design genetically engineered drugs that will maximize a person’s ability to be cured from cancer. This whole new area of healthcare is called “Personalized Medicine,” and it’s the wave of the future.
Personalized Medicine raises interesting ethical issues; these tests and drugs are expensive and third-party payers don’t cover them. Most doctors are not trained to administer, assess, or use the tests for patient care. Now, lawyers are getting involved because patients will sue doctors who fail to order genetic tests before prescribing drugs, or their insurers for withholding payment. Insurers will want genetic profiles before providing coverage and will exclude high risk applicants.
Lawyers are becoming the catalysts that are getting us to address these serious ethical issues. Last week, I attended a meeting at the Arizona State University Law School where these issues were addressed, and it became clearer to me that humans are a design space and economics is the driving force in its evolution. We are on a potential course to create a caste system of individuals and nations who can afford these advances and those who can’t.
I applaud this discussion, and lawyers may be able to illuminate these issues (perhaps even help us with the process), but we can’t let lawyers define a culture’s morality. Economics and legal liabilities can’t be the only incentives that determine our medical future. Surely we cannot re-design ourselves by elevating some at the expense of others. The practice of medicine must still be values-based rather than economic; we must still take care of souls and not just bodies.
If we become just another genetically modified organism, we may have created a disease resistant, long-lived synthetic species, but we will have lost our souls. The soul of our humanity is worth saving, or as Duke Ellington said, “It don’t mean a thing, if you ain’t got that swing.”