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2001
Towards an Adequate Ethical Framework for Setting Biotechnology Policy
Prepared For
The Canadian Biotechnology Advisory Committee Stewardship Standing
Committee
January 2001
Table of Contents
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Introduction
-
Biotechnology
-
Genetic Testing
-
Genetically Modified Food
-
Available Value Systems
-
The Public Interest
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Moral Dimensions (1): Procedural Ethics
-
Moral Dimensions (2): Concepts
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Autonomy
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Justice
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Responsibilities
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Conclusion
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Works Consulted
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Introduction
Biotechnology has the power to generate major social change.
Already, biotechnology has had an impact on the lives of
Canadian citizens and it invites us to reconsider some
fundamental Canadian values and attitudes. It seems certain that
its influence will increase over time. Such power carries with
it significant moral responsibilities; hence, proper management
of this technology requires careful moral deliberation. It is,
therefore, essential to determine what particular moral values
and practices should guide policy in this realm.
This paper is intended to identify and explicate some of the
fundamental ethical components needed for establishing a morally
adequate national biotechnology policy. It is organized to first
clarify its use of the term “biotechnology” and then
to introduce two key examples of biotechnology that will be used
to illuminate the subsequent discussion. Next, it will propose a
multi-part ethical framework to guide moral deliberations
regarding biotechnology policy. It shall than explore some of
the ways in which these various moral considerations can be
translated into assignments of specific responsibilities.
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Biotechnology
In order to develop an ethical framework to guide policymaking
in the realm of biotechnology, the first challenge is to
determine the scope of the subject matter. The fluid and
ambiguous use of the term “biotechnology” adds to
the complexity of setting ethical standards, since the target of
proposed guidelines seems to be so extensive and diverse.2 This ambiguity is evident in
the 1998 documents produced by the Canadian Biotechnology
Strategy Task Force to promote public discussion of government
policy and it is repeated in the summary document pursuant to
those consultations.3 The
principal Roundtable Consultation Document (CBS 1998a) initially
defines biotechnology as “an umbrella term that covers a
broad spectrum of scientific tools …[using] living
organisms, or parts of living organisms to make new products or
provide new methods of production” (CBS 1998a, p. 3). The
examples that follow are of such familiar, unthreatening
practices as the use of yeast to produce beer, bread and wine.4 But the reassuring impact of
associations with long-standing technologies is misleading
since, in fact, the term “biotechnology” is
primarily used to refer to the many new technologies that
identify and manipulate genetic information or modify genetic
structures. In fact, just a few lines later, the very same
document quickly makes clear that its own focus is with
“biotechnology’s newer techniques, such as genetic
engineering or DNA-based technology. . . [including] the
modification or duplication of genetic information or its
transfer from one organism to another”(CBS 1998a, p. 3).5
I shall follow the practice of the Consultation documents and
concentrate my discussion on genetically based forms of
technology. I, too, shall concentrate on biotechnologies in the
realms of health and food production since the principal current
uses of biotechnology fall within these spheres. The
Consultation documents make a persuasive case for the beneficial
potential of these forms of technology. They claim that all
Canadians can hope to benefit from these technologies (CBS
1998b, 2), echoing the enthusiasm of the many authors who
welcome the benefits available through effective and efficient
use of biotechnologies, especially in health and food production
(e.g., Brown 2000; Fletcher 1998; Grace 1997; Khoury 1996).
Before exploring some of the moral questions associated with
these implicitly hopeful forms of biotechnology, however, I
shall briefly diverge from the approach taken in the
Consultation documents. Where these documents refer only to
socially promising areas of biotechnology innovation, I wish to
be clear that some forms of biotechnology are morally
objectionable from the very start. Biotechnology holds the
promise of creating, as well as relieving, enormous amounts of
suffering. For example, it is the source of weapons of
biological warfare which have enormous potential for harm to
humans and other living things. Biotechnology also provides the
means for unprecedented levels of terrorist threats by
facilitating production of powerfully toxic materials with
relatively little infrastructure required for deployment. It
also facilitates efficient eugenics programs and practices of
human genetic enhancement that alter our approach to human
reproduction and diversity. As well, many forms of biotechnology
carry with them the power, and the demand, to invade areas that
were formerly considered the realm of private, personal
information (Murray and Botkin 1995; Shulman 2000). It does not
take much imagination, then, to find cause for worry about the
implications of growing knowledge in biotechnology. Policy
makers must confront honestly the power for harm as well as
benefit that is inherent in these new technological tools. It is
disturbing that the Consultation documents (CBS 1998a) and the
subsequent statement of the Canadian Biotechnology Strategy
(1998b) fail even to acknowledge these dangers.6
I shall now rejoin the agenda set by the Consultation documents
and refrain from further discussion of forms of biotechnology
that can be straightforwardly judged to be primarily harmful. In
contrast to those documents, however, I shall also resist the
presumption that many of the technologies can be simply accepted
as wholly beneficial. I shall concentrate on the messy but
crowded middle ground of technologies that have mixed effects,
i.e., on forms of biotechnology whose benefits are accompanied
by risks, either to their users or to others. To represent this
broad area, I shall look at two types of biotechnology, one each
from the domains of health and food production, the two
principal realms of current applications. I shall briefly review
some of the potential benefits and potential harms associated
with each type of technology.
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Genetic Testing
According to the Consultation documents, “more than
90 percent of the advanced biotechnology products on the
world market are related to health”(CBS 1998a, p.
3). In the Health Sector Consultation Document (Health
Canada et al. 1998), four different areas of
activity are identified in the chapter titled
“Health Protection”: surveillance, diagnosis,
treatment, and prevention. In each category, there are
important ethical questions to raise about the ultimate
impact of existing and anticipated technologies. Let us
focus specifically on genetic testing, an activity
associated with both surveillance and diagnosis (and,
ideally, also with prevention). Genetic testing is said to
be able to “confirm the presence of a particular
disease, indicate that the disease will occur in the
future or reveal an increased susceptibility to a
disease” (Health Canada 1998, p. 4). It is these
latter, future-oriented uses that concern me here.
The attraction of such tests is clear. In this era of
scientific medicine, it seems axiomatic that the more
knowledge available about disease paths, the greater the
likelihood of successfully preventing illness. For many
types of disease, early detection significantly improves
the prospects of cure or at least effective management
(Bansal 2000). Early diagnosis of most forms of cancer,
for instance, tends to improve the odds of long-term
survival. Hence, it seems reasonable to hope that early
identification of genetic susceptibility to a disease will
provide individuals with knowledge that might help them to
avoid contracting that disease. For example, knowledge of
higher than average susceptibility to certain forms of
heart disease may motivate someone to exercise more
frequently, eat a healthier diet, and avoid smoking
(Murray and Botkin 1995).
Of course, the value of this tailored advice is uncertain,
since, for the most part, it consists of public health
advice already recommended to everyone. Since no one is
invulnerable to heart disease, everyone has reason to
follow the rules of a heart-healthy lifestyle. Those who
know there is a history of heart disease in their family
are, generally, already aware of the need for extra
vigilance. It is unclear how helpful it will be for them
to learn that they face a specific degree of risk for
developing some particular variation of heart disease. In
any case, a negative test indicating that they do not
carry the gene that affects family members with early
heart disease could not be interpreted as a license to
smoke or give up exercise, although it might have that
effect.
Not only may this information prove less helpful than we
might hope, it could turn out to be harmful. One
difficulty is that this technology represents
“diagnosis” of probable future, not current,
illness. In other words, it is a means for creating a
category of people who are “pre-symptomatically
ill.” The implications of such a label are very
problematic. For one thing, many people with a higher than
average susceptibility to a disease will never contract
that disease though many will come to think of themselves,
or of certain body parts, as “ticking time
bombs” (Bluman 1999; Geller et al 1997;
Parens 1996).
Consider how the first general genetic test of a
“susceptibility to disease” aimed at a large,
currently healthy adult population has unfolded. This is
the test for BRCA 1 and 2, a set of genetic anomalies
associated with five to ten percent of breast cancers
(Inglehart et al 1998). This test is intended for
women with a family history of certain types of breast
cancer. While a positive test does not definitively signal
that a woman will develop breast cancer (nor a negative
test that she won’t), women who test positive for
either of these genes do face a relatively high risk of
developing the disease at some time in their lives. The
strategies available to them to reduce this risk are grim.
Minimally, they will be advised to undergo constant
monitoring and frequent testing. They may be advised to
undergo a prophylactic double mastectomy and also removal
of their ovaries and/or to begin taking the powerfully
toxic drug tomoxifen with its many serious side effects
(Schrag et al 2000).7 In addition, they may lose
access to health insurance and possibly also face loss of
employment and, in some cases, of partners in intimate
relationships. They will also be faced with the personal
dilemma of deciding what to tell their sisters and
daughters (Steel et al 1999).8
There are other levels of problems present with these
technologies that go beyond the difficult risk-benefit
calculations faced by individual users. Michel Foucault
(1973) argued that routine medical surveillance encourages
each individual to internalize the gaze of the clinician
to the point that we experience our bodies not directly as
aspects of our very selves, but indirectly as objects for
expert approval or concern. In the constant monitoring
implicit in adopting the clinical gaze to our selves, we
treat our bodies (and sometimes our minds) as imperfect
objects in need of regular clinical attention and
adjustment. Use of genetic testing to expand the
repertoire of routine clinical surveillance fosters the
alienating assumption that dangerous disease may erupt at
any time and we are dependent on expert intervention to
recognize and respond to such events. This is a cultural
phenomenon, outside of the control of any particular
individual. So, even if someone makes the private choice
to forgo some of these genetic surveillance/diagnostic
technologies (e.g., genetic and imaging testing for breast
cancer), she will still be confronted by a cultural
understanding of her body as an appropriate object of
routine monitoring.
Moreover, the very development and normalization of
genetic testing technologies contribute to the social
phenomenon that Abby Lippman (1991; 1998) has dubbed
“geneticization.” This is the tendency to
assume that genes alone are primarily responsible for our
health status, that genetic explanations can account for
the major physical and behavioural differences among
people, and that the solution to most health problems can
be found through genetic knowledge and manipulation.
Geneticization ignores the fact that genes act in specific
environments and seldom provide unambiguous evidence of an
individual’s traits or prospects.9 The attitude of
geneticization detracts attention from social and
environmental factors (e.g., poor nutrition) that are
known to affect health in favour of efforts to identify
and respond to individual genetic variations.10
This tendency to overlook social and environmental
dimensions of health in favour of biological features is
not unique to the technologies of genetic testing for
susceptibility to disease. It is common to many other
technological innovations in health care. Each carries
with it the costs of lost opportunities to pursue other
strategies for improving the health of Canadians and
others (Gorenstein 1996). As governments encourage and
support investment in biotech solutions to health
problems, they are likely to find themselves with fewer
resources – financial and human – available to
pursue other strategies for improving people’s
health. Focus on genetic testing and other types of
technological solutions to health problems tends to fall
within a biomedical worldview that assumes health problems
are best addressed by identifying and correcting flaws
within individual patients. The approach of looking for
genetic pre-dispositions to disease in order to try to
modify an individual’s life experience (or, someday,
her genetic makeup) is based on the problematic
assumptions that the social and physical environments she
inhabits are acceptable as they are and that we need only
ensure that individuals are better adapted to their
environment. Moreover, insofar as genetic testing drains
limited public resources away from needed social reforms
and creates confusion about the role of social factors in
illness and injustice, it may well work against the
overall health interests of disadvantaged members of
society (Bowman 1995; Caplan 1994; Lebacqz 1998; Sagar
et al 2000).
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Genetically Modified Food
On the food production front, it is again easy to see the
potential advantages of biotechnology. For example, the
consultation documents speak enthusiastically about the
capacity of transgenic crops and animals to improve global
nutrition. In particular, advances in biotechnology are
said to be “the key to increasing the world’s
food production in the face of environmental concerns,
limited arable land and population increases” (CBS
1998a, 2). In addition, the Health Sector Consultation
Document lists several ways in which agricultural
biotechnology can contribute to human health and
well-being. It lists: “the development of more
healthful food with higher nutritional quality”;
crop modifications that will lead to the virtual
elimination of “human and animal nutritional
deficiencies”; improved “availability of
therapeutic products”; production of “an
inexpensive and abundant supply of compounds with
potential health benefits”; and disease prevention
“by enhancing the levels of those compounds in food
that are known to have beneficial physiological
effects” (e.g., carotenoids and quercetina); and the
“development of new foods for Canadians who suffer
from food intolerance disorders” (e.g. coeliac
disease). (Health Canada et al 1998, 6-7).
Exciting as these prospects are, however, there is
significant public wariness about transgenic foods. The
Canadian Biotechnology Strategy makes reference to public
concerns, but describes them as a result of
“information gaps” and lack of “consumer
awareness and understanding” (CBS 1998b, 2-3),
implicitly dismissing any empirical basis for worry. All
concerns cannot be reduced, however, to questions of
ignorance, superstition, or resistance to change. There
are some solid scientific arguments identifying risks
attached to some agricultural uses of biotechnology.11
Some of the concerns are quite familiar: many people worry
about the safety of foods produced through transgenic
molecular transformations. For example, there is
widespread worry that genetically modified foods carry a
certain risk of generating new food-borne allergies. These
worries stem from the fact that genetic modifications
involve introduction of new proteins to traditional foods,
and allergies are protein-based (FAO/WHO 2000). Some fear
that transmission of genes from one species to another may
be accompanied by transmission of new micro-organisms or
new types of toxic substances to which humans have not had
time to evolve adequate resistance (FAO/WHO 2000).
Moreover, some of the effects feared may not be
immediately apparent. Yet, the rapid changes generated by
biotechnology do not allow much time for full
investigation of long-term effects and many critics
believe that there is often inadequate safety testing of
new products ( De Angelis 1992; Goldsmith et al
1992; Pimm 1991).
Another common concern has to do with the environmental
impact of the introduction of newly manufactured
agricultural species. There is worry about the ways that
new species (or, more likely, modifications of existing
species) will affect the ecology into which they are
placed (Fox 1996; Mikkelson et al 1996;
Paulkaitis and Roossinck 1996). The fact that agricultural
practices have historically always damaged existing
ecologies (Thompson 2000) is of little comfort to citizens
worried about rapidly expanded environmental degradation.
Of particular concern to environmentalists is the fact
that most of the uses of agricultural biotechnology to
date have been aimed at developing plants that are more
tolerant of herbicides and pesticides than other plants;
that is, they are designed to allow greater use of certain
toxic chemicals in agriculture (Goldsmith and Hildyard
1990; Shiva 1993).12
Moreover, there are reasons to worry even about the
promise expressed in the consultation documents of the
ability of biotechnology to help to feed the hungry in the
developing world. Of particular concern has been the
development of “genetic use restriction
technology” (GURTs) designed to create sterile
seeds. Known by such intimidating trade names as
“Terminator” and “Traitor,” these
are genes whose sole purpose is to ensure the failure of
reproduction in second-generation plants. The introduction
of such genes may be important if wide scale production of
some genetically modified crops does result in serious
environmental threats, since, in theory at least, the use
of these genes will permit effective termination of
dangerous new species. But their routine use also means
that farmers who plant the genetically-altered seeds will
be unable to rely on the age-old tradition of using seeds
harvested from one year’s crop to produce the next.
They will be compelled to return each year to the
manufacturer for a new supply that can be sold at whatever
price the market will bear. Moreover, this technology will
allow producers to engineer seeds to perform only with the
application of specially designed fertilizers or
pesticides. It is, then, a technology that will increase
the dependence of farmers on marketers of seeds and
related products; such a change is very likely to increase
the costs of farming. For subsistence farmers in
particular, this is likely to be a devastating change. The
potential for accelerated – rather than reduced
– rates of malnutrition in the developing world is
significant (Goldsmith and Hildyard 1991; Shiva 1993).13
In a similar vein, questions have been raised about the
likelihood that biotechnology will actually improve
nutrition in the developing world. The most frequently
touted example of the nutritional value of biotechnology
to the developing world is the production of genetically
engineered Vitamin A enriched rice (so-called Golden
Rice). This project is still years from release. Moreover,
although it has been developed through public funding, the
research has been turned over to a multinational seed
producer (AstraZeneca, now Syngenta) for patenting and
marketing (RAFI September/October 2000). Thus, its
ultimate availability and the impact it will have on the
health of people in poor countries are still difficult to
measure. In the meantime, industry-based researchers are
primarily pursuing nutritional plant modifications aimed
at more affluent consumers.
The conundrums evident in even these cursory discussions
of but two varieties of biotechnology make evident the
necessity of attending to ethical values in setting
policies regulating the development and introduction of
specific forms of biotechnology. The potential
consequences for specific innovations in each type of
biotechnology – and for the changes likely to be
wrought by the combined impact of multiple examples of
each sort of technology – are great. In some cases
singly, and, surely, collectively, they can be expected to
make dramatic changes in the lives of individuals and
societies.
Moreover, the impact of these technologies is unlikely to
be evenly distributed. It is readily apparent that certain
types of risks largely fall either on those who choose to
invest in particular technologies or on the immediate
consumers of that technology. Less apparent is the fact
that there are other types of risks that primarily
threaten individuals who, as third parties, have no direct
control over the deployment of the technology. For
instance, siblings of individuals who choose genetic
testing may be refused health or life insurance unless
they agree to undergo the same tests (Boetzkes 1999;
Rhodes 1998; Steele et al 1999). And salmon
fishers may find their livelihood destroyed by the impact
of pesticides created to work in combination with certain
genetically modified crops (Birmingham and Tinker 1999;
Tangwa 1999). It is the responsibility of governments to
protect the interests of everyone affected by the new
technologies, whether by direct consumption or by
accidental “fall-out.” Given the complex and
mixed sorts of consequences associated with these
technologies, it is especially urgent that public policy
be grounded in clear moral analysis.
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Available Value Systems
In order to conduct the requisite moral analysis, we need to
appeal to an adequate ethical framework that will help us to
identify and explore the full range of moral values at issue. In
particular, we need to find ways to ensure recognition and
adequate analysis of all relevant moral considerations. While
many ethicists would recommend adoption of a particular moral
theory as the framework for all moral inquiry, I do not believe
that any single value system can capture and order all the
relevant moral considerations. Therefore, I propose that we
concentrate on two complementary strategies (one procedural and
the other substantive) that can jointly help to ensure that
adequate attention gets paid to all relevant moral
considerations.
First, though, I shall offer a brief explanation for why I
resist selection of a single theoretical perspective. This
resistance derives from my appreciation of the fact that there
are many different value systems that could be invoked to help
set policy governing biotechnology. As I have argued elsewhere,
selection of any particular value system largely determines the
sorts of ethical considerations one perceives as relevant to the
question explored (Sherwin 1999, Sherwin 2000). If we adopt a
consequentialist (utilitarian) moral framework, for example, we
will concentrate (solely) on trying to anticipate and compare
the likely consequences of alternative policy options. In
contrast, if we adopt a deontological (duty-oriented) moral
perspective, our attention will be directed towards trying to
ensure that the policies in question are consistent with a set
of fundamental moral obligations. Because both sorts of
considerations have moral weight, both should be part of our
moral deliberations. So, too, should important moral aspects of
the problem that are suggested by such other major moral
theories as ethics of care and feminist ethics.14 Different moral theories help
develop our moral perceptual capacities in complementary
directions. No single theoretical perspective will suffice to
capture all of the morally relevant aspects of the policy
options under review.
Thus, when approaching complex policy matters, we should
actively seek out moral perspectives that help to identify and
explore as many moral dimensions of the problem as possible.
This requires us to pursue deliberative strategies that will
promote sensitivity to the multiple moral considerations that
are relevant to the issues before us. Nevertheless, the
identification of morally relevant factors does not always
produce a unique moral solution. Hence, even if we were able to
identify all the morally relevant aspects of a situation, we
might still not know how to resolve the specific moral dilemma
before us. Although these substantive moral tools (theories)
will exclude certain options, they sometimes fail to select a
single best solution. In such cases, we must rely on effective
strategies that can produce an ethically acceptable decision.
Only an ethically adequate procedure can resolve these various
types of ambiguity.
We need, then, to make use of two complementary approaches, one
procedural and the other substantive. While I shall discuss
these two strategies separately, in practice they should be
pursued simultaneously in an integrated fashion. Together, they
provide some of the key tools necessary to ensure the requisite
consideration of diverse moral perspectives throughout the
policy setting process. Interestingly, both come together in one
realm of moral consideration inherent in the setting of public
policy: the public interest. I shall begin explication of these
complementary aspects of moral deliberation by reflecting on the
topic of the public interest because it makes use of both
procedural and substantive dimensions of ethics and because it
seems to be the subject most central to government’s role
in managing biotechnology development and use.
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The Public Interest
The scale and dimensions of possible consequences arising from
biotechnology innovations supports a strong moral argument for
establishing public policies that will manage the complex array
of benefits and risks attached to these technologies in the best
interests of Canadians. Indeed, the entire consultation
exercise, aimed at producing a revised national biotechnology
policy, is an implicit statement of the federal
government’s sense of responsibility to influence the
development and production of biotechnologies in Canada. The
various Consultation documents explicitly acknowledge the
government’s sense of responsibility to develop a
comprehensive and coherent biotechnology policy that is centred
on “Canadian values” (CBS 1998b, 8). That policy
consists of a vision (or statement of the ideal pursued), a set
of guiding (normative) principles, and a defined set of specific
goals (CBS 1998b, 8-9).15
Each of these components involves a normative (or value-laden)
dimension and represents particular ethical choices that merit
careful scrutiny.
Government must assume leadership in setting biotechnology
policy. It is simply not possible for individuals acting alone
to protect themselves from some of the potential hazards of this
technology, nor is it likely that individuals will be able to
take full advantage of many of the benefits without collective
action. Hence, it is essential that government take the
initiative and develop and implement policies that will protect
the well-being of its citizens and preserve society’s
valued institutions. This moral responsibility is commonly
described as a duty to act in the public interest.
It is, therefore, striking that none of the Consultation
documents make any explicit reference to the concept of the
public interest. The closest they come is to express an
underlying intent to promote the interests of Canadians. The
primary Roundtable Consultation Document begins by declaring its
agenda is to find “. . . mechanisms to ensure that
biotechnology products enhance our health, quality of life and
environment as they generate jobs and economic growth”
(CBS 1998a, 1). It goes on to report that “The Government
of Canada is working with partners to determine the best ways
and means to realize the potential benefits of biotechnology for
Canadians” (CBS 1998a, 1). Its proposed vision is
“For Canada to be a world leader in biotechnology and
through it, to enhance the quality of life of Canadians in terms
of health, safety, the environment and economic
development” (CBS 1998a, 8). The post-Consultation
Document offers a no longer qualified version of the Vision
where the components remain (almost) the same, but the order of
emphasis has shifted:
The CBS vision is:
To enhance the quality of life of Canadians in terms of
health, safety, the environment and social and economic
development by positioning Canada as a responsible world leader
in biotechnology. (CBS 1998b, 8, emphasis in original)
We can, presumably, infer from such statements that the
Government of Canada is pursuing these goals in terms of its
over-arching responsibility to protect and promote the public
interest.
The absence of an explicit reference to the public interest
could be a reflection of the ambiguity attached to the term
“public interest.” It is a vague concept that has
political theorists divided about the value of its use.
“The public” does not appear to be a single entity
with clear and obvious interests. It consists of many different
individuals and groups who have diverse, overlapping, and
sometimes conflicting interests. Nonetheless, there is some
common ground. Most modern theorists can at least agree with
John Locke that the state has a duty to safeguard the natural
rights of individuals. Many define the public interest as
protection of individual rights and provision of fair procedures
for arbitrating between competing interests in an impartial way
(Benn 1967). (In other words, while commitment to the public
interest seems to be commitment to a substantive moral value, it
is best pursued through procedural efforts.)
Some theorists, for example Virginia Held (1984), have suggested
that we use the concept of the common good to
represent specific things that are of benefit to all members of
a state. Thus, the term “common good” stands for the
things that are of shared interest to all members of society.
Held cites the example of avoiding nuclear holocaust as a clear
case of a common good: every member of society has an interest
in this state of affairs. Similarly, it is in the common good to
avoid ecological disaster such as destruction of fresh water
supplies by overuse of toxic agricultural chemicals.
To complicate matters yet further, there is a third concept to
be considered, namely that of collective goods.
Collective goods are benefits that can only be achieved through
collective action. For example, legal contracts can only exist
within the context of a state and a form of legal institution.
There is no such thing as a private legal system (although there
certainly are some that favour particular private interests).
There are also many services that are only practical if citizens
cooperate in establishing and supporting them: for example,
health care, national defense, policing and firefighting, and
pollution controls are services that benefit everyone and are
best run as public institutions. While many collective goods are
also common goods, some are not since some practices that
require collective action across a society fail to benefit all
members of that society. (An extreme example would be a legally
sanctioned institution of slavery.)
A system of regulation and evaluation of new biotechnologies is
a collective good in that it can only be achieved through
collective action. To show that it is also part of the
common good, we would need to demonstrate that
(virtually) all citizens benefit from such a system. Given the
scale of risks and potential benefits of many new
biotechnologies, it seems likely that a publicly supported
structure to evaluate and regulate new biotechnologies would fit
into the category of common good as well as that of
collective good.16 Moreover, such a system falls
within the technical sense of the public
interest since some biotechnologies may threaten the
human rights of members of society. For example, use of genetic
tests to exclude people with a susceptibility to some form of
cancer from certain occupations would raise human rights
concerns.
In popular usage, the term “public interest” is used
to capture all three concepts. That is, it includes not only the
technical interpretation (i.e., protection of individual rights
and fair procedures for arbitrating among competing interests),
but also promotion of common goods and of collective goods
requiring state coordination. There are, in other words,
substantive values sought by citizens in the development of
public policies. Citizens depend on their governments to put in
place safety provisions that will ensure no new technologies
will be introduced that might bring serious harm to them or to
the society they depend upon.17 When the impact of specific
technologies is unclear or when the benefits and risks are
unevenly distributed, they expect government to establish
appropriate procedures to decide when to authorize
implementation and when to demand restrictions. It is common to
read public interest as including such institutions as are
needed to protect citizens from foreseeable harms as well as
those required to promote the welfare of all.
In this sense, the public interest has both positive and
negative dimensions; that is, it reflects an interest in
promoting well-being and also an interest in avoiding harms.
Governments have a responsibility to attend to both types of
concerns, and the Consultation Documents, especially the
post-consultation document (CBS1998b), cite commitments to both
sorts of activities.18 When
these two goals conflict, governments must decide on which
should take priority. It is the potential for serious conflict
between the welfare of some and the risks faced by others that
makes biotechnology policy so fraught with difficulty.
The tone of the Consultation documents makes clear that the
Canadian government is preoccupied by its responsibility to
attend to the positive dimension of the public interest. The
documents insist that a strong biotechnology policy will benefit
Canadians and thereby serve the positive dimension of its regard
for the public interest. For instance, one of the goals listed
for the biotechnology renewal process is to ensure “that
biotechnology is developed responsibly for the maximum benefits
of Canadians, both now and in the future” (CBS 1998a, 1).
The post-consultation document opens with a description of
biotechnology as offering “significant economic benefits,
particularly in exports and job creation, as well as important
health, safety and environmental benefits” (CBS 1998b, 1).
While the documents circulated before the public consultations
were unclear as to whether the goal is to benefit all Canadians,
most Canadians, or merely some Canadians, the later document
promises explicitly that “All Canadians … will
benefit from the new transformation” (CBS 1998b, 2).
In its implicit interpretation of the public interest as
residing with a policy that maximizes the benefits of
biotechnology, the Biotechnology Strategy Task Force has chosen
to “accentuate the positive” and largely ignore the
negative possibilities of biotechnology development. Indeed, as
noted above, the consultation documents are filled with examples
of the possible benefits that will flow from biotechnology; they
make no explicit reference to the potential harms. Even the
post-consultation document, while reporting on the wariness
expressed by Canadians regarding the risks of some
biotechnologies, speaks primarily of “gaps in consumer
awareness and understanding” (CBS 1998b, 3), not of actual
hazards associated with some technologies. In casting its lot in
favour of fostering positive benefits, these documents
implicitly commit government to a default position that places
the burden of proof on those who would limit development of
technology. That is, they presume the overall benefit of
development in biotechnology and resist placing limits on new
technologies unless well-defined issues of safety can be shown.
This approach departs from popular sentiment and from some
important international conventions. Public and scientific
concerns about the inherent risks associated with many forms of
biotechnology are expressed in the widely cited
precautionary principle. This principle has
been enshrined in numerous international treaties and
declarations, including the United Nations Rio Declaration on
Environment and Development (UN 1992) and the Treaty on European
Union (1992). Unfortunately, there is no single authoritative
definition available for this widely recommended principle. 19 In an attempt to fill this
vacuum, an international group of scientists, government
officials, lawyers, and environmental activists met in January
1998 at Wingspread in Wisconsin and drafted a consensus
statement. The statement identified four parts to the
precautionary principle:
-
People have a duty to take anticipatory action to prevent
harm.
-
The burden of proof of harmlessness of a new technology,
process, activity, or chemical lies with the proponents, not
the general public.
-
Before using a new technology, process, or chemical, or
starting a new activity, people have an obligation to examine
“a full range of alternatives” including the
alternative of doing nothing.
-
Decisions applying the precautionary principle must be
“open, informed, and democratic” and “must
include affected parties.” (Wingspread 1998)
In other words, the precautionary principle expresses the
requirement that concern about risks must be considered before
proceeding with the development of any new technology. It
requires that new technologies only be pursued if they can be
shown to be harmless or necessary. The emphasis is placed on the
negative dimension of the public interest by insisting on the
duty to protect the public from future harms.
The precautionary principle is subject to considerable, vigorous
debate and its precise interpretation involves moral and
political analysis. Nonetheless, given the prominence of the
precautionary principle in other nations’ approach to
biotechnology and in various international agreements –
including some that Canada has signed (e.g., the 1992 Rio
Declaration on the Environment) – it is striking that
discussion of this principle is wholly absent from the
Consultation documents. As the Pollara and Earnscliffe (2000)
study demonstrates, most Canadians assume that something like
this principle is already in effect in Canada. Certainly, many
knowledgeable Canadians have proposed a version of the
precautionary principle as the basis for Canadian biotechnology
policy (e.g., the Canadian Institute for Environmental Law and
Policy).20 It seems, then,
that we need Canadian debate on the appropriate interpretation
of this principle and a formal process for determining which
version of it Canadians want to endorse. The underlying spirit
of protection of individual and collective interests has a
fundamental role to play in government’s responsibilities
to the public interest.
Now that we have seen one sphere in which substantive and
procedural ethical questions are deeply intertwined, it is time
to look more closely at these two aspects of moral deliberation
and see how disentangling them can illuminate the prominent role
of each.
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Moral Dimensions (1): Procedural Ethics
Procedural approaches to ethics are essential since, in many
cases, it is difficult to specify a precise moral solution to a
problem.21 There is no
objective Archimedian point from which one can survey all
relevant moral perspectives and confidently identify the morally
best answer. Particularly in the face of complex issues where
reasonable people disagree about the morally appropriate
response, it is often preferable to establish fair procedures
for addressing difficult matters than to try to decide from the
outset the moral conclusions that should be binding. Indeed,
part of the motivation for establishing the Canadian
Biotechnology Advisory Committee (CBAC) is that it can provide
meaningful debate to help inform government policy in this
complex area. The procedural question, then, is how should CBAC
go about fulfilling its mandate to foster debate and help to
resolve moral conflicts.
Perhaps the most straightforward task CBAC faces is establishing
where there are matters that fall within the scope of the common
good in the realm of biotechnology. An example of this is the
establishment of reasonable procedures to make certain that no
products are introduced that will cause significant harm to the
health of Canadians, to the environment, or to the economy on
which Canadian prosperity depends. Such procedures would include
a system to monitor safety and efficacy of products, as well as
honesty in communication. Consideration of the common good
requires attention to the long-term as well as the short-term
impacts of various technological innovations evaluated in terms
of their effects on the well-being of Canadians and Canadian
society. As noted above, it entails adoption of specific
measures that will protect as well as promote the public
interest, such as the precautionary principle.
Beyond these specific examples of common Canadian interests, I
suggest there is also a shared interest in acting morally on a
global scale; such an interest is a clear example of a
collective good, in that it can only be achieved through
collective action to regulate individual initiatives. This type
of consideration requires the development of policies aimed at
ensuring that our government and industries do not engage in
practices that undermine the welfare of people in economically
vulnerable parts of the world.22
As I argued above, government has a moral duty to protect and
promote the public interest of justly arbitrating among
competing interests by establishing fair procedures that are
responsive to the full range of interests at stake. A principal
difficulty in fulfilling this duty is that of identifying the
many interests that may be involved. Developing skills at moral
perception (through knowledge of multiple ethical theories and
knowledge of different cultural perspectives) can help to make
clear where many of the relevant interests lie (Sherwin 2000).
But it is also essential to put in place an open and responsive
process that will allow input from those whose interests might
often be overlooked or misunderstood.
Typically, bodies asked to adjudicate among conflicting
interests invite representatives to meet and seek a mediated or
negotiated resolution of the conflict. In such circumstances, it
is appropriate to use the language of “stakeholders”
and invite interested parties from affected groups to
participate jointly in providing policy advice. In the context
of biotechnology, obvious stakeholders are researchers,
producers, and consumers. Each group has explicit interests at
stake that may, or may not, coincide with the interests of
others, so it is important to have representatives of each of
the affected groups actively engaged to identify and promote
their specific interests.
It is not always obvious, however, who should count as a
stakeholder. Often those who will be most profoundly affected by
a policy do not perceive its effects in advance. For example, if
a form of agricultural biotechnology pollutes the environment by
generating increased use of chemical fertilizers, many people
who had not thought of themselves as having any
“positive” interest in the development of the
technology may be seriously harmed by its use. Alternatively, if
some type of technology such as genetic testing for a
predisposition to Alzheimer’s Disease becomes the norm,
then many people will find themselves required to make use of
such testing whether they wish to or not.23 One of the reasons consumer groups
object to the sale of unlabeled genetically modified foods is
the fact that the absence of labels prevents consumers from
being able to avoid these types of products if that is their
intent. Many of the people who ultimately become stakeholders by
virtue of imposition of new products on their lives do not
immediately perceive their eventual interest in the policy in
question. In other cases, people are affected by practices to
which they have no direct connection. For example, many people
with disabilities argue that that their community is affected by
the validation of prejudicial public attitudes against
disabilities that is implicit in the routine use by others of
prenatal testing of fetuses (Asch and Geller 1996).
Thus, the public interest in protecting human rights and
arbitrating between competing interests can only be properly
served by taking measures to ensure that all relevant interests
are represented. One important strategy for this end is to
include in the discussion participants who will look beyond the
expressed interests of those who identify as stakeholders. This
role is typically played either by experts who assume a position
of neutrality or by citizens who have no expressed prior
self-interest in the outcome. In fact, a full exploration of
relevant moral perspectives is likely to require both types of
participants. Experts can bring needed background information to
the table, and citizen participants bring a position of
concerned public interest. Both act in ways that are distinctly
different from that of identified stakeholders whose role is
defined as representative of specific sets of interests.
There is another type of participant that should be present at
the table as well, and that is citizen activists who have taken
a specific interest in the policies in question. Typically
associated with grass roots or not-for-profit NGOs
(non-government organizations), these individuals have actively
investigated the subject matter and seek political influence in
the relevant policies. They are not stakeholders in the usual
sense, for they do not stand to benefit personally from
introduction of the technologies in question, though they do
provide a specific point of view that must be present in
discussions. (Generally, they speak from an interested, but not
a self-interested position.) Often, they represent the indirect
interests of people who will be affected by technologies without
specifically choosing to make use of them. This type of person
brings important information and defined interests to the debate
and, therefore, offers a perspective that must be heard in
policy-making forums.
The distinction between the role of citizen and the role of
stakeholder should be as clear as possible. It is not that
stakeholders are not citizens, or that citizens do not have
interests; rather, it is that participation as representative of
a specific interest group is quite different from participation
as a concerned citizen acting in the interest of the collective
good of the public interest. Both roles are important when
seeking a policy that adjudicates among competing interests, but
they are not equivalent and they must not be confused with one
another.
Nor should the role of citizen be reduced to that of consumer.
Consumers of technology are stakeholders with defined interests:
they need safe, reliable, affordable products supported by
accurate information and protection from exploitation. When
wearing their consumer hats, such people will assume that the
products in question will be developed and marketed and they
will seek to influence the terms of their distribution. In
contrast, those acting primarily as citizens – that is,
acting without specified interests – will want to be able
to question the value of even pursuing some products. They will
be expected to reflect on the likely impact these products will
have on society as a whole, not just on those who choose to
acquire or employ them.24
Moreover, it is especially important that panels charged with
adjudicating among competing interests be attentive to voices
that are most frequently overlooked in society. They should be
particularly attentive to the situation of groups who bear the
greatest risks if particular technologies are implemented. They
should be aware of ways in which existing structures favour some
social groups at the expense of others in order to take steps to
avoid repeating these patterns (Bulger 1996; Bowman 1995; Dove
2000; Lebacqz a998). Representatives of groups that are already
disadvantaged in society and stand to lose more ground with the
introduction of certain technologies should be granted special
status. For example, people with disabilities should be present
at debates about expanded genetic testing programs, and those
focused on hunger in the developing world must be present when
decisions are made regarding approval of patents on such life
staples as Basmati rice.25
The role of such representatives is distinctly different both
from that of representatives of groups who stand to benefit from
the technology in question and also from that of generic citizen
participants who are expected to take into account all relevant
perspectives.
When inviting input from declared stakeholders, then, it is
important that government not limit discussions to those who
have a clear financial interest at stake. Moreover, it is also
important that procedures reflect the different amounts of power
associated with different stakeholder positions. Industries with
significant financial investments and hopes for major profits
may have far greater resources to support education and training
of their representatives than do volunteer groups of concerned
citizens. The former may also have more influence with
politicians and policy makers, greater access to the media to
get their message across, and more experience in negotiations.
When dealing with stakeholder groups, then, it is important to
seek procedures that will reflect the degree of interest
represented by participants and that will strive to avoid
distortion by powerful specific interest groups.
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Moral Dimensions (2): Concepts
While a morally appropriate process is an essential component of
good policy in the morally complex realm of biotechnology, it
cannot operate in a vacuum. We need some substantive moral
values to help guide the process and sort out the morally
acceptable from the morally problematic solutions available.
Above (Section 3), I argued above that all the leading moral
theories have something to contribute to our deliberations in
this regard. I shall not, however, attempt the very large
project of presenting the various moral theories that can shed
light on various moral aspects of biotechnology policy. Instead,
I will focus on two key concepts – autonomy and justice
– that are central to most of the dominant moral theories.
Because of their prominent role in so many ethical theories,
these two concepts represent an important element of the
substantive requirements of moral deliberation in setting public
policy. By exploring some of the ways these concepts function
within different moral theoretical perspectives, and also within
public policy debates, I hope to make them accessible as
valuable tools for identifying and responding to the complex
moral demands of setting biotechnology policy.
In pursuing analysis of these concepts I shall again diverge
from the framework provided by the Consultation documents, since
they pay very little attention to either autonomy or justice.
The role of these concepts there is, largely, an implicit one,
appearing – presumably – under the generic label of
“the values of Canadians” and inherent in general
expressions of the importance of ensuring that the benefits of
biotechnology accrue to Canadians.
Because there is significant variation in how each of these
concepts is interpreted even by ethicists, I will spend some
time reflecting on how each term should operate in the context
of discussions regarding national policymaking in biotechnology.
I shall first introduce the most common usage of each term and
then propose an alternative, “relational”
interpretation that captures some of the neglected moral
dimensions of the dominant approach. I will argue that the
latter, less familiar interpretation captures essential moral
dimensions to be addressed when setting biotechnology policy and
better captures the spirit of the procedural recommendations.
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Autonomy
The term “autonomy” literally means self-rule;
it is frequently translated as selfdetermination. The term
is at the heart of much modern philosophical literature
ranging from ethics and political philosophy to
metaphysics and personal identity theory; its
interpretation varies depending on the context in which it
appears. For my purposes here, I shall limit discussion to
its role in ethics and political debates. Within this
context, the term is popularly understood to represent
individual liberty or freedom from interference by others,
especially by the state. Respect for individual autonomy
is a touchstone of modern liberal states; it is often
expressed in the language of human rights (Kymlicka 1990).
In its most basic meaning, autonomy represents action that
is free from controlling influence by others (literally
“heteronomy” or rule by others) through
coercion or manipulation. Generally, it is used to
represent action that is also free from personal
limitations (e.g., compulsion, lack of understanding) that
prevent meaningful choice. Philosophers typically treat it
as an expression of deliberate action on the part of a
rational, independent agent, who is acting in pursuit of
her chosen interests. Hence, a principle of respect for
autonomy is a commitment to recognizing the right of
individuals to make certain sorts of decisions for
themselves free of coercion, manipulation, deceit, or
interference. In health care contexts, the principle of
autonomy is often asserted in opposition to paternalism
– the practice by which health care professionals
make treatment decisions based on their own idea of what
is in their patients’ best interests without
obtaining voluntary informed consent from the patients
(Beauchamp and Childress 1994). Governments also sometimes
act paternalistically, for example when they override
personal preferences and compel citizens to use seat belts
or wear motorcycle helmets in order to protect them from
preventable serious injury.
Although there is not much use of the term
“autonomy” in the Consultation documents,
there is, at least, an implicit recognition of the
importance of autonomy considerations running throughout
the documents. For instance, the central document has a
section titled “Ethical and Social Aspects”
which speaks of Canadian “beliefs regarding freedom,
human dignity and non-discrimination” (CBS 1998a,
11). It also refers explicitly to the context created by
the Canadian Constitution and the Canadian Charter of
Rights and Freedoms, documents that place high priority on
respect for individual autonomy.
When the term “autonomy” is explicitly used in
the Consultation documents, it is defined very narrowly as
being equivalent to consumer choice. This definition
occurs in a list of prominent ethical principles and
values that are identified as important in other
countries’ approaches to biotechnology. In that
context individual autonomy is defined as
“recognition of each individual’s right to
make informed decisions about his or her use of
biotechnology” (CBS 1998a, 12; CBS 1998b, 7).
Indeed, the importance of supporting consumers’
informed choice in the use of biotechnology is described
as central to the entire consultation process: “A
key question at the heart of biotechnology discussions is
the matter of consumer confidence and comfort with the new
DNA-based technologies” (CBS 1998a, 3). The first
goal listed in the post-consultation Report is to
“ensure that Canadians have access to, confidence in
and benefit from safe and effective biotechnology products
and services” (CBS 1998b, 8).
Interpreting autonomy as informed personal choice reflects
a popular understanding of the concept as it is frequently
invoked in political contexts. This usage captures deeply
held views about citizens’ relationship to the
state. It speaks specifically to the need to restrict the
state from undue interference in individuals’
pursuit of their personal preferences. One of the common
assumptions of the modern democratic state is that there
must be a sphere of individual privacy outside of the
reach of state intrusion. Thus, there is virtual consensus
within Canada on the view that the state should refrain
from interfering in matters of personal freedom unless
there is a very clear risk of harm to specific others.26 Many proponents of the
decriminalization of abortion have embraced this notion of
autonomy, framing their position as one of being
“pro-choice” in support of women’s right
to make their own decisions regarding pregnancy
continuation or termination. Autonomy language is often
used to assert individual rights against state
interference with matters of personal morality and action.
This basic interpretation of autonomy looms large in many
debates about biotechnology policy (e.g., Geller 1995;
Goldworth 1999; Haseltine 2000; Karjaleinen 1995;
McCullough 1998). Both producers and consumers (current
and potential) tend to appeal to the idea of personal
choice as the appropriate policy governing biotechnology.
Both groups resist the very idea that government might
impede their ability to buy or sell products and services
according to their personal judgments about what is in
their best interests. There is significant public support
for the view that autonomy, in the sense of freedom from
government restriction, should be the default position. In
other words, people should be free to sell and purchase
products as they see fit unless there is an overriding
reason for government to limit commerce in this area.
There are, of course, many sources of overriding reason.
They include unacceptably high risks to consumers (e.g.,
heroin), threats to the environment (e.g., the
transportation of radioactive materials), threats to the
fabric of Canadian society (e.g., hate literature), and so
on. The burden of proof, however, is always on those who
would argue that the potential harms are too large to
allow individuals the freedom to choose to purchase the
product in question. The principle of autonomy interpreted
as freedom of consumer choice suggests a position
diametrically opposed to that of the precautionary
principle. It implies that so long as someone chooses to
buy a given product or service, producers should be free
to sell it unless clear and specific harms can be proven.
This interpretation of autonomy as consumer choice fits
nicely within the framework of the marketplace where the
primary concern is to protect individual freedom of choice
to acquire desirable services and products. (Recall the
statement of purpose in the Roundtable Discussion Document
CBS 1998a that a fundamental goal of public discussion is
to increase “consumer confidence and
comfort.”) According to this consumer model of
freedom, the role of the state is two-fold. The state has
the responsibility of ensuring that the risks associated
with specific products are within acceptable levels, a
duty frequently interpreted to mean that the risks faced
by immediate consumers are reasonable. It also has the
responsibility to make certain that individuals are able
to choose well by having access to clear, comprehensive,
and reliable information and being free from coercion. The
various Consultation Documents focus heavily on these two
types of concerns.
It is undoubtedly important to meet the requirements of
the consumer model of autonomy in setting biotechnology
policy. That is, it is essential that the marketing of any
biotechnology products be done under conditions that
ensure consumers can make voluntary, informed decisions.
In fact, much of the literature that discusses moral
considerations associated with biotechnology focuses on
concerns of safety and standards of information (e.g.,
Parker and Gettig 1995; Modell 1996; Masood 1999; Hoskins
et al 1995). These criteria are not
straightforward, however. Consider the requirement for
sufficient information to make an autonomous choice in the
context of genetic testing. It is very difficult to make
sense of genetic information about susceptibility to
particular types of disease. It demands understanding of
probability theory, genetics, the range of symptoms
associated with the condition in question, the safety and
efficacy of early interventions, and many other factors
(Parens 1996; Boetzkes 1999; Dickens et al 1996;
Gannett 1999). Most experts insist that genetic testing
can only be responsibly provided in the context of
excellent genetic counseling (Biesecker 1998; Marteau and
Bisecker 1999), but there are not enough trained
counselors available to meet the demand of genetic tests
already available, let alone those on the near
horizon.
In the context of genetically modified foods, many people
demand labels that would inform consumers that the
products before them contain genetically altered products.
Yet labels are unlikely to produce the level of
understanding required for informed choice regarding what
specific modifications are involved and what their
implications might be. For example, how much explanation
is required for informed choice regarding the purchase of
a candy bar containing genetically modified canola oil?
Moreover, in many cases the knowledge base does not exist
to provide information on the long-term safety of
consumption, the effects of the new species on the
environment, or the possibility of new allergies arising
from transgenic alterations (Lagay 1999; Lappé
1994; Reiss 1998). It is questionable whether informed
choice is even possible in the absence of such important
information.
Furthermore, even if we could provide adequate
information, it might still not ensure informed consumer
choice. That would require that the information be
provided in a form that is accessible to the consumer. If
the language of labeling is too technical for the intended
audience, the mere presence of information is no assurance
that consumers are informed to the level required for
autonomous consent. And if the information is incomplete
or distorted, as is common in advertising, then it may
well undermine rather than support autonomy.27 Even on the most
straightforward conception of autonomy, then, selling many
biotechnology products to consumers who cannot be
adequately informed represents a violation of their
autonomy. Canadians need a regulatory system to ensure
that their assumptions of consumer safety are well founded
and to help promote the understanding necessary to
constitute informed consumer choice.
Important though informed choice is to achievement of
individual autonomy, it is not the whole story of
autonomy. After all, it is not choice per se that merits
moral concern; rather, it is the freedom of individuals to
pursue their fundamental values and interests. The
underlying moral motivation for respecting individual
autonomy is not to support pursuit of preferences per se
but to respect each individual’s interest in
furthering her or his fundamental values.
There are several reasons why the exercise of informed
consumer choice may fail to capture this deeper sense of
autonomy. One difficulty is that consumer choice is
limited to the options that producers happen to make
available; unless producers provide options that allow
individuals to pursue their fundamental values and
interests, consumer choice will not coincide with
individual autonomy. For example, if all or most farmers
are persuaded to plant genetically modified crops or to
grow transgenic animals for sale, individual consumers
will lose the freedom to buy unmodified
food products. Already, many processed foods in Canadian
supermarkets contain ingredients made from genetically
modified products such as canola oil (Luoma 2000). Even if
labelling regulations were introduced, most consumers
would likely find it difficult to avoid the use of all
forms of genetically modified products. Moreover, if the
crops produced by genetically modified seeds prove
invasive to other crops, or if they allow purchasers to
produce crops at vastly reduced rates for a few years,
independent farmers may be unable to continue to plant
traditional seeds in an economically viable way. If it is
not economically possible to produce unmodified crops, or
if distribution of such crops is limited by restrictive
arrangements with major producers, individual consumers
will not have access to the products they might wish to
obtain. In such ways, new products sometimes reduce,
rather than expand, consumer choices.
There are further difficulties with the consumer choice
interpretation of autonomy. It ignores the fact that
individual agents are differently situated with respect to
the choices that are available to them and the freedom
each has to act in accordance with his or her particular
needs and values. For example, women’s ability to
make informed choices about using various prescription
drugs is limited by research protocols that sometimes
investigate only the drug’s impact on male subjects
(Mastroianni et al 1994). Also, access to
organically grown food is restricted to people with
sufficient land to grow their own food or with enough
disposable income to pay the higher premiums on organic
food. If consumers remain wary of the safety of
genetically modified foods, we can anticipate that the
affluent may be able to exercise their choice and buy
“traditional” foods, but the poor will be
limited to less popular (and, hence, less expensive)
alternatives. While all individuals face limits on the
options they can choose, those with relatively less social
or economic power are likely to face even more
restrictions than most people; they will more often find
themselves with no option before them that will meet their
particular interests and needs.
As we have seen, many technologies carry with them the
power to redefine “normal” human experience
and expectations in ways that individuals cannot control
through private acts. As individuals, we cannot control
whether or not our bodies will be culturally read as sites
for medical surveillance. While an individual may be able
to choose not to undergo certain diagnostic tests, she
cannot choose the ways various parts of her body (e.g.,
her breasts or bones) and her life cycle stage are defined
as potential sites of serious illness. A woman whose
sister, mother, or aunt contracts breast cancer may object
to being tested for BRCA 1, but if her physician, insurer,
or employer judge such tests desirable, she will find her
breasts and genes the proposed targets of surveillance
whether or not she consents to testing. Once employment of
a particular type of technology becomes widely understood
as constituting normal and responsible healthpromoting
behaviour, individuals who decline it automatically become
classified as irresponsible (ColeTurner 1998; Geller
et al 1997; Harper et al 2000). That
means that as tests for genetic predispositions to late
onset disease (e.g., heart disease, colon cancer,
Alzheimer’s disease) become available, they may
carry with them cultural expectations that responsible
individuals ought to undergo such
procedures as a matter of routine health care.
Hence, our understanding of personal autonomy must address
the ways that it can be undermined by political, economic,
social, and cultural policies that are well beyond the
reach of individual choice. If we truly wish to promote
individual autonomy, we need to develop policies that will
allow all individuals room to pursue their own values and
interests. These policies must not only attend to the
preferences that people express in the face of a
pre-defined array of options, but also investigate the
nature of the choices that are made available to them. We
must not lose sight of the fact that prevailing social
circumstances and political and economic policies
influence the range of choices that are available to
individuals and that these choices may well be different
for members of different social groups. In other words,
protecting and promoting autonomy requires more than
refraining from interference in the pursuit of current
preferences. It also requires active attempts to foster
the conditions under which all individuals can pursue
their fundamental values and interests.
This alternative conception, called “relational
autonomy” is an approach that views individual
persons as socially embedded, with identities forged
within the contexts of personal and political
relationships and shaped by a range of social determinants
such as gender, race, and class (Sherwin 1998, Mackenzie
and Stoljar 2000). It requires that we look beyond the
individual as she or he is presently constituted and
explore the social conditions that support (or inhibit)
each person’s ability to identify and pursue her or
his own interests. From this level, it appears that there
is reason to consider how the very availability of certain
types of choices, and the absence of others, can interfere
with some individuals’ ability to be
self-determining (or autonomous). This interpretation
requires investigation at the societal level of ways to
promote the types of technologies that will foster
personal autonomy and ways to restrict technologies and
products that interfere with personal autonomy. It
suggests thoughtful consideration about the social, as
well as physical, impacts of proposed new technologies.
Developing biotechnology policies that are responsible to
the concerns of relational autonomy will require careful
attention to the procedural requirement of including
frequently marginalized social perspectives.
Furthermore, even an enriched relational understanding of
autonomy is not by itself a sufficient moral basis for
setting public policy. It must be reconciled with other
relevant moral values. For example, we need to be aware of
the fact that individual interests frequently conflict
with society's interests. Such analysis is evident in
the final report of The Royal Commission on New
Reproductive Technologies (Royal Commission 1992). The
Commission observed that many approaches to assisted
reproduction pose a danger of treating (some) women and
children as commodities. Hence, it urged speedy passage of
legislation (still pending) that would limit the scope of
personal choice in some reproductive practices by
prohibiting commercial traffic in reproductive materials
and services (e.g., gametes, embryos and gestational
services). It understood that without such restrictions
many infertile individuals and couples would find it
difficult to refrain from engaging in commercial
transactions to facilitate their quest for children.
And as we have already observed, personal choices
regarding some types of biotechnology use will have
financial impacts on other members of society. Provincial
governments in Canada have the unenviable task of setting
priorities for spending scarce health care dollars;
clearly, they cannot provide all requested resources.
Introduction of many new technology-intensive approaches
to health care is already putting dangerous pressure on
limited health budgets. Yet, as many important Canadian
reports have noted (e.g. the Lalonde Report, the Ottawa
Charter, the Report of the National Forum on Health, and
Health Canada’s recent Women’s Health Strategy
Report), technological medical interventions in the face
or threat of illness is only one component of a proper
health agenda. To promote health, governments must also
undertake various positive efforts aimed at such factors
as environmental safety, supportive social conditions
(e.g. economic, physical and emotional security) and
modifications of individual behaviour (e.g. diet, exercise
and avoidance of tobacco). We must be mindful not to let
individual preferences for (bio)technological approaches
to human health exhaust resources that are better directed
at addressing social determinants of health. This
observation brings us into the realm of the other central
moral value: justice.
-
Justice
Autonomy is an individual-centered value, even on a
relational interpretation. It focuses our attention on the
choices and actions of individuals and it urges us to
grant moral status to the informed choices of individuals.
But society is composed of many individuals and, as we
know, their values and interests do not always coincide.
Hence, a full moral analysis must also find ways of
reconciling the interests of all individuals. The concept
of justice provides the theoretical basis for this
comparative dimension of moral reasoning and action.
Justice, like respect for autonomy, is considered a
fundamental value of modern liberal states. It, too, can
be seen at the heart of the Canadian Constitution and
Charter of Rights and Freedoms.
Like autonomy, the term “justice” is also
subject to many diverse interpretations associated with
different theoretical perspectives. At the most basic
level, the term means fair, equitable, or appropriate
treatment, such that each individual receives what he or
she is entitled to. Typically, philosophical discussions
of justice are divided between two different senses:
retributive or distributive. Retributive justice is
concerned with people getting what they deserve, be it
punishment or reward. It involves both criminal justice
and rectificatory justice (compensating people who have
been wronged). This sense of justice has limited currency
in the context of biotechnology policy. It would come into
play in setting up mechanisms to provide for penalties to
be assigned for the manufacture and distribution of
products that cause harm to people or the environment.
Such issues are best addressed through legal channels.
From a moral point of view it is only necessary to observe
the importance of ensuring access to legal challenges and
reasonable financial relief for damages caused by new
technologies.
Most discussions of justice and biotechnology policy are
structured by the notion of distributive justice (e.g.,
Fleck 1998; Karjaleinen 1995; Lappé 1994).
Distributive justice is concerned with ensuring a fair
distribution of the benefits and burdens that fall on a
group (which may be a family, a community, or an entire
nation). Questions of distributive justice generally arise
under conditions of scarcity and competition. Most
theorists accept a form of Aristotle’s formal
principle of justice that requires us to treat similar
cases similarly and dissimilar cases differently. The task
is to determine what constitutes a morally relevant
criterion for similar or different treatment. In other
words, the substantive problem of distributive justice
requires us to determine what is the right principle of
distribution for the benefit (or burden) at issue. For
example, Canadians generally view the principle “to
each according to need” as appropriate for
distribution of health care benefits, but most prefer the
principle “to each according to merit” for
distribution of desirable jobs and salary levels, and
“to each according to ability to pay” for
luxury items. For distributing burdens, some useful
principles are “from each an equal share,”
“from each according to ability,” and
“from each according to use.” The appropriate
choice again varies with the nature of the burden
(examples, respectively, are military service, progressive
taxes, and user fees).
Biotechnologies raise significant problems of distributive
justice. Hence, many authors concerned with ethical
problems associated with biotechnologies, especially in
the realm of health care, focus on questions of
distributive justice (e.g., Caulfield 1998;
O’Mathúna 1999; Peters 1998; Steel et
al 1999). Typically, they ask who should pay for
these expensive new services and who will benefit from
them. These are central questions that must be considered
before introducing more genetic tests to the Canadian
market. For each new genetic test, every province and
territory will be confronted by the problem of deciding
whether it is morally obligated to absorb the costs of
this test in its already dangerously stretched budget.
Each must decide whether genetic testing for dispositions
to late onset diseases is to be considered a medical need
covered by the universality requirement of the Canada
Health Act. The alternative is to judge the tests optional
and make them available on a fee for service basis like
private hospital rooms, dental surgery, and certain types
of eye surgery.28
If provinces do regard genetic tests as medically
necessary for some patients, the cost of providing the
tests will have an impact on other services now covered.
Not only do the tests themselves cost something to
administer, but, as noted above, they require significant
amounts of counselling to make the results meaningful to
patients. Patients who test positive will presumably be
entitled to follow-up medical care. For example, if they
test positive for BRCA 1, they might choose to undergo
prophylactic double mastectomies and removal of their
ovaries and also use of expensive preventative drugs. If
provinces declare the tests not medically necessary and
decline to absorb the costs for all who are eligible,
then, unless the tests are made illegal in Canada, they
will only be accessible to those who can afford them. If
the tests are truly of medical value, this response would
be unfair and probably illegal. If they are not of much
value, they should not be offered to anyone, especially
not to those who are terrified of contracting a serious
disease that runs in their family.
Distributive justice questions in health care must address
macro as well as micro allocation problems. That is, they
must provide guidance on how to apportion health resources
among large scale categories such as preventive measures,
diagnosis, acute care, and chronic care services, as well
as deciding who should have access to a particular
procedure (e.g., hip replacement) and on what basis.
Increasingly, health research proceeds under the auspices
of private funding (either in conjunction with public
funding or on its own). Because private investment is only
made on the expectation of eventual profits resulting, and
because future profits can be anticipated only when there
are marketable goods or services to be distributed, health
research is skewed towards technological approaches.
Health innovations that depend on social change, such as
protection of the environment, improvement of social
conditions, improved safety for those at risk of domestic
violence, public health measures (such as safe drinking
water), health education, and effective mental health
services tend not to be amenable to profit-making. If
health budgets become absorbed with responding to
expensive biotechnology innovations, there is likely to be
less money available to pursue proven public health
measures such as these. Clearly, there are important
questions of distributive justice to be addressed
regarding the organization of health research and the
introduction of new forms of biotechnology in health care.
In the area of biotechnology and agriculture, questions of
distributive justice concern the implications of patenting
traditional and genetically modified seeds and animals
such that access becomes more expensive and less available
to the poor. Concentration of economic interests in the
hands of a small number of multinational corporations that
control distribution of seeds, production of chemicals
needed to produce growth, and markets for the resulting
crops could produce disproportionate burdens on consumers
relative to the benefits of producers (RAFI
November/December 2000). If the costs of
biotechnologysupported innovations in agriculture fall
largely on people living at the margins of survival, the
questions of justice become particularly acute.
Important though the questions of distributive justice
are, a justice framework that is limited to questions of
fair distribution is insufficient to capture all relevant
concerns about justice in the area of biotechnology. As
Iris Marion Young (1990) argues, the distributive paradigm
of justice tends to improperly exclude questions of social
justice, particularly those concerned with “the
elimination of institutionalized domination and
oppression” (p. 15). A focus on distributive justice
directs our attention to the allocation of material goods
and resources and allows us to ignore the social and
institutional structures that influence patterns of
distribution. Attention to social justice expands our
focus from questions of distribution in which people are
viewed as “primarily possessors and consumers of
goods to a wider context that also includes action,
decisions about action, and provision of the means to
develop and exercise capacities” (Young 1990, p.
16). Social goods such as rights, opportunity, power, and
self-respect cannot be adequately addressed within a
framework designed to govern the distribution of material
things. Social justice requires that we reflect on the
unjust distribution of these types of social goods in a
society plagued by sexism, racism, and other forms of
oppression. It requires us to think of ways to provide
greater equality in these less tangible benefits that
cannot be apportioned in units to discrete individuals as
can a quantity of material goods.
To capture the concerns of social justice we must develop
a relational understanding of justice that is parallel to
the relational conception of autonomy discussed earlier.29 Here, too, we need to
move away from the naïve view of people as discrete,
independent individuals, unaffected by their relationships
to others. People are not interchangeable abstract
entities comparably affected by each policy. Rather, they
are socially situated in specific historical
circumstances, shaped by their complex social and
political relationships. They belong to a variety of
social groups and these groups are caught in complex
relations of power – especially relations of
oppression and domination – with respect to one
another. To capture the significance of this phenomenon,
we need to look at patterns and processes of distribution
over time. To promote justice among individuals we need to
identify the ways in which institutional structures
disadvantage certain groups and privilege others.
Attention to social justice guides us towards different
questions regarding biotechnology policy than a focus on
distributive justice. It expands the agenda from questions
of payment and access to one that includes questions of
how we can promote greater equality of respect, status,
and influence in society. It asks us to look at structural
barriers to equality and consider how proposed innovations
are likely to affect these features. From the perspective
of social justice, it is no longer sufficient to ask
whether someone wants a given product and can afford to
purchase it. We need also ask how availability of that
product or service will affect others, particularly
members of oppressed groups. For example, we need to take
very seriously the ways that the move to technological
solutions to health problems favour the interests of the
privileged who can afford such innovations, and
disadvantage the poor. The latter face the dual problem of
being unable to afford these products and also losing
access to basic health requirements (e.g., nutrition) when
limited public resources are redirected to provide the
infrastructure required by expensive technological
approaches. Hence, a social justice framework suggests
that we must do more than try to ensure that the poor as
well as the rich can get genetic testing; it requires us
to address the social as well as the genetic causes of
illness.
The pursuit of genetically modified foods holds out great
promise of benefiting the hungry as well as the
prosperous. There is reason to fear that, without it, the
earth will not be able to generate sufficient supplies of
traditional foods to feed the growing human population.
Genetically modified foods offer hope of making more
efficient use of dwindling supplies of fresh water and
arable land. But, as we have seen, unless social justice
considerations are pursued, we run the risk of
concentrating power in the hands of those who produce the
needed technology and increasing the dependence of those
who are destitute (Tangwa 1999). No national biotechnology
policy can resolve the huge income disparity between the
rich and the poor of the world, but it is possible to
demand that new innovations be pursued in areas that will
increase the relative power of the worst off. For
instance, it is possible to ensure that subsistence
farmers not be forced to use seeds that work only in
conjunction with expensive fertilizers and herbicides.
Canada needs a biotechnology policy that is sensitive and
responsive to social, as well as distributive, justice
concerns.
-
Responsibilities
It is very clear that emerging biotechnology will present us
with an ongoing series of difficult moral challenges.
Individuals cannot control the social and material conditions
that structure the options they face. Moreover, many of the
preconditions for autonomy and social justice can only be
achieved through political action. Hence, it is essential that
governments assume the responsibility to regulate and manage
these powerful technologies in the interest of their citizens.
Moreover, as we have seen, citizens expect their governments to
protect and promote common goods as well as the public interest
of fairly arbitrating among conflicting interests. They also
expect them to organize and facilitate collective interests that
benefit most citizens and do not violate the rights of anyone.
Indeed, these are principal responsibilities for governments.
The government is the agent charged with creating and
maintaining the institutions required for ensuring pursuit of
these different types of goods. Thus, it is responsible for
assuming leadership in ensuring that collective and common goods
are met, and that the public interest in resolving conflicting
interests in a just and fair manner is achieved.
In order to know how best to do that, government must foster
conversations about the appropriate values to use in guiding
policies. Indeed, that was the declared intent of the
Consultation documents in Canada. But the effort to solicit
input was too narrowly directed and too tilted towards industry.
It consisted of brief roundtable discussions based on one-sided
information. Moreover, government made the unacceptable decision
to equate concerned citizens with other
“stakeholders” – that is, to treat them simply
as one more self-interested voice in a chorus of lobbyists. A
better approach would provide interested citizens with the
opportunity to become informed about the complex and ambiguous
nature of these technologies in order to allow them to speak
thoughtfully on the issues. Strategies such as the creation of
citizen forums hold more promise of better capturing the values
of Canadians than do invitational workshops of specific
stakeholders (Koshland 1996; Gaskell et al 2000; Loka
1999; Masood 1999; Priest 2000).
The Canadian Biotechnology Advisory Committee (CBAC) has been
established to help educate Canadians and to promote discussion
of the moral and social implications of these new technologies.
In order to fulfill its mandate, it must be clear on the ethical
criteria to be met by any biotechnology policy. It should, for
example, establish its position with respect to the widely
adopted precautionary principle. It should also establish clear
moral guidelines with respect to the important values of
autonomy and justice. Moreover, it must develop morally
defensible procedures to ensure that it is sensitive to all
relevant moral perspectives and is able to give voice to
vulnerable groups who may not be present at important policy
forums. This requires that CBAC pursue openness, inclusiveness,
and responsiveness in its practices in order to establish the
trust of concerned citizens representing perspectives now
excluded from direct participation in policy-making.
Moreover, once it “discovers” national values on
these matters, government has a responsibility to enact
appropriate policies that are informed by these reflections and
conversations. It must pass and enforce legislation that
reflects the interests and values of its citizens, particularly
the most vulnerable segments of the population. Thus, it is
essential to clarify the relationship between CBAC and
government policy-makers. Canadians need assurance that once
CBAC garners their views, its insights will be influential in
setting national policy and its message will not be lost in the
differing mandates of the sponsoring ministries.
There is, of course, a limit to what any national government can
accomplish in the realm of biotechnology. The industries
involved are not respectful of national boundaries; most are
engaged in a global, not a national, marketplace. Producers
resist national regulations on the grounds that local
restrictions would put them at an unfair economic disadvantage
in a competitive global market. They threaten to move production
to a different jurisdiction if their interests are ignored. At
the same time, consumers use the Internet to shop beyond their
national borders, making it almost impossible for governments to
prohibit access to any products for which there is a market.
Just as individuals cannot achieve autonomy in isolation from
the activities of others, neither can nations establish
industrial strategies in isolation of the policies of other
countries. No country can afford an industrial strategy that is
too far out of step with those of its neighbours. Hence, our
political leaders must move beyond our nation’s borders
and lobby on the world stage for international regulations that
will promote safe and healthy uses of biotechnology, while
prohibiting the development of dangerous forms. Canadians expect
their government to exercise leadership within such
international bodies as the United Nations (including UNESCO,
the United Nations Educational, Social, and Cultural
Organization), the World Health Organization, the World Bank,
CODEX, and the World Trade Organization with respect to
appropriate regulation of biotechnologies.30
Citizens have responsibilities as well. Although none of us can
shape biotechnology policy on our own, we cannot afford to sit
quietly by and wait for our government to act responsibly in the
realm of biotechnology. In Canada, the conflicting agendas of
the many departments responsible for setting the national
biotechnology strategy are overwhelmingly weighted toward those
whose mission it is to promote, not restrain, industries. As
citizens, all Canadians need to educate themselves about both
the hazards and the benefits of various biotechnologies.
Individually and collectively, we need to make very clear our
desire for policies that reflect moral, as well as economic,
values.
-
Conclusion
Biotechnology presents a great many moral challenges. Some are
variations of traditional problems (e.g., the damage
agricultural practices do to the existing environment). Others
are new (e.g., the difficulty in tracking dietary restrictions
through transgenic permutations of food products31). Many of these challenges must be
identified and addressed by individual consumers and producers.
But many cannot be resolved through private action. Collective
action is required if Canadians are to succeed at identifying
and responding to the moral challenges of biotechnology. It is
the responsibility of government to provide the leadership
necessary for conducting this moral evaluation and action.
This essay has been designed to illustrate some of the moral
challenges posed by biotechnology by focusing on two types of
technology: genetic testing for susceptibility to particular
diseases, and the production of genetically modified foods. It
briefly surveys some of the complex advantages and risks
associated with each of these types of biotechnology, noting
that often the benefits accrue to different people than those
who are assigned the risks of a technology. It then provides
some of the central components of an ethical framework that can
be used to identify and resolve the many moral questions posed
by various forms of biotechnology.
It explores the specific moral obligation of government to
protect and promote the public interest defined as protection of
individual rights and development of fair procedures for
resolving conflicts. It also explores the related notions of
common good and collective good. Together, these three concepts
make vivid the moral importance of government action in
regulating biotechnologies. They provide a moral imperative to
set in place principles and procedures (such as a clarification
of the precautionary principle) that will protect Canadians (and
others) from harm while promoting access to the benefits of
biotechnology.
Next, the paper explores two key components of the proposed
ethical framework to be used in developing public policy
governing biotechnology:
-
Development of procedural approaches to ethical deliberation.
These involve genuine public consultations and open
deliberations that include participation by a wide variety of
Canadians, particularly general citizens, stakeholders,
representatives of NGOs, and representatives of disadvantaged
groups that might be specifically affected by the technology
in question.
-
Development of two concepts (autonomy and justice) that must
play a central role in any ethical investigation of
biotechnology. Both concepts are explored in their
traditional interpretations (respect for individual choice
and fair distribution of burdens and benefits). An
alternative interpretation of each, described as relational,
is also provided and recommended for use in development of
biotechnology policy.
The essay argues that biotechnology policy must be respectful of
both these values – autonomy and justice –
interpreted relationally as well as traditionally.
Finally, the essay draws some specific moral conclusions
regarding the various responsibilities of the Canadian
government, CBAC, and individual citizens in ensuring a morally
adequate national biotechnology policy. These recommendations
are illustrative and not exhaustive. The essay does not propose
to represent a full accounting of the moral considerations and
strategies essential to the setting of a national biotechnology
policy. Its aim is more modest. It is to provide and illuminate
some key elements that are essential components of a morally
adequate framework for establishing and pursuing a national
biotechnology strategy.
-
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1 With assistance from Patrycja
Maksalon.
-
2 Moreover, Canadian government policy has viewed some
areas of biotechnology as sufficiently distinct as to require their
own ethical analysis. For example, human reproductive and related
genetic technologies have merited a Royal Commission study and an
advisory committee to the Deputy Minister of Health. Research in
biotechnology involving human (or animal) subjects has been
primarily addressed under procedures governing all types of human
(or animal) subject research.
-
3 Although these documents were created with the
specific purpose of initiating public discussion at a given point
in time, they have not yet been replaced by extensively revised
documents that reflect the outcome of public consultations. There
is a single, brief summary document that was prepared immediately
after the public consultations (CBS 1998b). This follow-up document
proposes virtually identical policy proposals while addressing
fewer issues with less depth of analysis than the earlier set of
Consultation Documents. Moreover, it has had a very limited
distribution. Hence, I shall primarily rely on the more widely
known Consultation Documents (CBS 1998a) as the most complete
expression to date of Canadian government understandings and
attitudes regarding biotechnology.
-
4 This same wording is repeated in the document produced
in response to that public consultation process (CBS 1998b), p.2.
-
5 As Reiss 1998 demonstrates, most literature follows
this practice of reserving the term “biotechnology” for
new genetically-based technologies.
-
6 For example, the Statement of the 1998 Canadian
Biotechnology Strategy (CBS 1998b) simply states: “All
Canadians – producers and consumers across the country,
including people in smaller communities and rural areas –
will benefit from the new transformation.” (p. 2) It is
completely silent on the possibility of harms inherent in this
technology.
-
7 A recent European study has concluded that prescribing
tomoxifen for women who have not yet contracted breast cancer but
are considered high risk for future disease creates an unacceptably
high risk of endometrial cancer for them (Bergman et al.
2000).
-
8 Moreover, there is the possibility of inaccurate
results according to which false positive or false negative results
triggers inappropriate conclusions and mistaken actions. See
Collins 1996; Eccles 2000; Inglehart et al 1998.
-
9 The complexity of gene activity and interaction is
well known in science but tends to be downplayed in public promises
about the fruits of genetic research. See, for example, Dover and
Flavell 1982; Ho 1987; Miller 1997; Pollard 1988.
-
10 See, for example, the report released last year by
Health Canada entitled “Health Canada’s Women’s
Health Strategy” (1999).
-
11 Many experts insist that these risks are low, but few
claim that there are no substantial risks involved. (For a fuller
discussion of this and other public concerns agricultural
biotechnology, see Thompson, 2000.)
-
12 See RAFI (November/December 2000 for development of
this view.
-
13 In the face of strong public pressure, officers of
two of the “Gene Giants,” Zeneca and Monsanto, publicly
promised to refrain from commercial development of this technology
(Open Letter from Monsanto CEO Robert B. Shapiro to Rockefeller
Foundation President Gordon Conway and others, 4 October 1999. On
the internet: (http://www.monsanto.com/monsanto/gurt/default.htm).
Letter from Dr. D.A. Evans, Research & Development Director,
Zeneca Agrochemicals, to Prof. Richard Jefferson, CAMBIA,
Australia, dated 24 February 1999, published in
UNEP/CBD/SBSTTA/4/Inf.3 Supplementary information to
UNEP/CBD/SBSTTA/4/9/Rev.1, 'Consequences of the Use of the New
Technology for the Control of Plant Gene Expression for the
Conservation and Sustainable Use of Biological Diversity, 18 May
1999. Shapiro 1999). Nonetheless, despite opposition from the
public, national governments and the United Nations, nearly 40
patents exist in this area and testing of this technology is
proceeding. Harry Collins, the vice-president of the principal
company involved (Delta and Pine Land Seed Company) has announced
“We never really slowed down. We are on target, moving ahead
to commercialize it. We never really backed off.” (RAFI
March/April 2000).
-
14 Ethics of care requires us to investigate the
implications of our policies for meeting human needs and promoting
healthy relationships among people. Feminist ethics directs us to
seek policies that will reduce rather than exacerbate the effects
of existing patterns of systematic oppression in society.
-
15 One of the expressed goals is to “position
Canada as an ethically and socially responsible world leader in the
development, commercialization, sale and use of biotechnology
products and services” (CBS 1998b, 9).
-
16 It is not difficult, however, to imagine that some
people’s short term interest in unfettered market access as
either producers or potential consumers of specific product might
interfere with their ability to recognize the benefits to them of
such a system.
-
17 Evidence that Canadians’ expect such
stewardship from their government can be found in Pollara and
Earnscliffe (2000). They conclude that “there is a general
presumption that someone, somewhere, is in charge of monitoring and
regulating food safety” and that most Canadians “would
re-balance government activity to provide a dual focus for
government: to limit or regulate practices in order to minimize
risks, and to promote development so as to maximize
benefits.”
-
18 In CBS 1998b Annex A: Ten Key Themes in the CBS
Workplan, items 2, 4, 5, 6, 8, and 10 are clearly focused on
efforts to promote well-being while items 3 and some aspects of 1
and 7 seem to focus primarily on protection against harms.
-
19 D. Vanderzwaag (1999) has identified fourteen
different formulations in treaties and other declarations.
-
20 See Winfield 1996.
-
21 In fact, one particular theoretical position in
ethics – communicative ethics – can be seen as
primarily committed to procedural strategies. See Benhabib and
Dallmayr 1990.
-
22 For examples of global moral considerations, see
Marteau and Biesecker 1999; Sagar et al 2000; Tangwa 1999.
-
23 They may, for instance, be denied access to life or
health insurance unless they agree to be tested.
-
24 For example, those who have close relatives with
breast cancer will have a different perspective on the desirability
of introducing nationwide testing for BRCA1 and BRCA2 than citizens
who are concerned with the implications of such tests on public
attitudes towards geneticization and existing health care budgets.
-
25 The controversy over the patenting of Basmati rice is
documented in several publications available at the RAFI website:
(http://www.etcgroup.org/).
-
26 Its most famous expression in Canada was provided by
Prime Minister Pierre Elliot Trudeau, who introduced sweeping
changes to the sexuality provisions in the Criminal Code in 1969
with the caveat that the state has no business in the bedrooms of
the nation.
-
27 A major reason for federal laws prohibiting direct to
consumer advertising of prescription drugs is that evidence shows
such advertising almost always misleads the public into a false
understanding of the advantages and risks of the drugs in question.
-
28 In some cases, medical services that would fall under
the medical necessity requirement, such as some types of
chemotherapy, are simply not offered to anyone rather than have
them available on a fee for service basis only to those who can
afford them.
-
29 A relational account of equality and its relevance
for a theory of justice is spelled out in detail by Christine
Koggel (1998).
-
30 The post-consultation document makes explicit the
Canadian government’s sense of commitment to working through
these international channels (CBS 1998b, 6).
-
31 For instance, some people who avoid eating animal
products for spiritual or health reasons may be uncomfortable with
the prospect of eating vegetables that have been modified to resist
frost damage through incorporation of cold-resistant genes from
penguins or Arctic char.
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