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Life's Dominion: An Argument about Abortion, Euthanasia, and Individual

Freedom, Ronald Dworkin. New York: Alfred A. Knopf, 1993. 273 pp

Article  in  Cambridge Quarterly of Healthcare Ethics · March 1994

DOI: 10.1017/S0963180100005065

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Nancy S Jecker Courtney Campbell

University of Washington Seattle Oregon State University
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regarding books they would like to see reviewed or books they

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are interested in reviewing.

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Walters and Julie Gage Palmer. New York: Oxford

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University Press, 1997. 209 pp.

2 3 :586

The story of a Houston boy named Da- in terms that are accessible to laypeo-
vid is familiar to many. David was born ple and to examine the major ethical
with a severe inherited immunodefi- questions that are raised, and that are
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ciency in 1971. The disease prevented likely to be raised in the future, by

both major parts of his immune system
from developing and left him completely
vulnerable to any bacteria or viruses in
his environment. To protect against in-
fection, David lived most of his life in a
sterile, plastic-enclosed environment and
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human genetic intervention. These
goals are formidable, especially con-
sidering the technical complexities
underlying genetic research and the
novel ethical issues that arise out of
genetic interventions. With these aims

experienced physical contact with no in mind, the fewer than 200 pages
D3 6 C C C96 ,2 3 :586 ,

one. He died in 1984, at the age of 12,
from complications of a failed bone mar-
row transplant.
LeRoy Walters and Julie Gage Palmer
seize upon the drama and poignancy
of David's story to open their book,
The Ethics of Human Gene Therapy. They
assert that "it is because of the death
of David and because of thousands of
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of The Ethics of Human Gene Therapy
leave little room for drama like that
exhibited in David's story. The book is
much less a narrative than it is a com-
pendium of points to consider. In a
clear and concise fashion, Walters and
Palmer summarize the science of gene
therapy and briefly examine the major
ethical questions it raises.

other untimely deaths of children and The Ethics of Human Gene Therapy
adults, most of whom we do not even stands in sharp contrast to Lyon and
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know, that the field of human gene Gorner's Altered Fates: Gene Therapy and
therapy is important/' As David was the Retooling of Human Life, a 600-page
losing the battle with his disease, journalistic tour-de-force that dramati-
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scientists were beginning to turn to cally chronicles the history of gene ther-
immune deficiencies like the one that apy through the case histories of many
afflicted David as models for gene ther- individuals afflicted with genetic dis-
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apy. The science and ethics of gene eases and follows the research careers of
therapy, "the attempt to cure or pre- the scientists trying to treat these pa-
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vent disease at the most basic level—at tients.1 David's story, which appears in
2 3 :586

the level of DNA and the genes that
are composed of DNA/' is the subject
of Walters and Palmer's book.
Walters and Palmer have two aims:
to describe the science of gene therapy
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the introduction to The Ethics of Human
Gene Therapy, is the only case presented
in any detail in Walters and Palmer's
book. The remaining five chapters are
tightly organized to present the broad

Cambridge Quarterly of Healthcare Ethics (1997), 6, 494-496. Printed in the USA.

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494 Copyright © 1997 Cambridge University Press 0963-1801/97 $9.00 + .10

 CQ Review
range of scientific and ethical issues as-
sociated with human gene therapy with-
out reference to specific cases. They are
supplemented by five appendixes with
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scientific information on genetics and the
techniques used in gene therapy
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The authors begin with a chapter ex-
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clusively devoted to genes and their
function in heredity The discussion is
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concise and complete—complete almost
to the point of being excessively de-
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tailed. It is apparent that the authors be-
lieve a sophisticated understanding of
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the technical and scientific features of
2 3 :586
gene therapy is crucial for understand-
ing and evaluating the ethical issues as-
sociated with the interventions.
The analysis in the following chap-
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ters is organized along the lines of two
important distinctions. The first is a
distinction between somatic and germ-
line cells. The second distinction is
between prevention, treatment, and
cure of disease, and enhancement of
human characteristics or capabilities.
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Chapter Two discusses somatic gene
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therapy, the kind currently performed
at research centers worldwide. It opens
with a comprehensive discussion of the
science involved in somatic gene ther-
apy and touches on the types of dis-
eases that are candidates, the target
cells that are selected, the vectors that
are employed, and the basic strategy
of gene addition. The ethical discus-
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sion begins with the question, "Is this
type of treatment different from other
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types of medical treatment?" While the
authors conclude that it is not, they
identify seven major ethical questions
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associated with somatic cell gene ther-
apy They also review public attitudes
and policy statements concerning ther-
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apy, and raise several additional pol-
icy questions.
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Chapter Three follows the plan of
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Chapter Two and examines the scien-
tific and ethical, issues associated with
germ-line gene therapy—techniques that
would aim to prevent disease not only
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in an individual patient but also in his
or her offspring. The future of germ-
line gene therapy hinges on a techno-
logical breakthrough yet to be realized
in humans: the ability to efficiently re-
place defective genes. Once this possi-
bility is realized a host of ethical issues
will come to the fore. Walters and Palmer
examine questions about eugenics, and
about the appropriateness of different
diseases as candidates for germ-line
gene therapy They cite five arguments
in favor of germ-line gene therapy and
eight arguments against it. Given that
"the effort to cure and prevent serious
disease and premature death is one of
the noblest of all human undertakings"
and gene therapy may be the only way
to prevent certain diseases, the authors
conclude that voluntary programs of
germ-line gene therapy are in principle
ethically acceptable.
What about the use of gene therapy
to modify traits that are not consid-
ered to be diseases or disease related?
This is the subject of the fourth chap-
ter on genetic enhancement. It exam-
ines the possibility of using gene
therapy, both somatic and germ-line,
to modify traits such as size, sleep,
aging, memory, aggression, and cogni-
tive ability The discussion is divided
into two categories: physical enhance-
ment (health-related, and non-health-
related), and moral and intellectual
enhancement. At the end of the chap-
ter, the authors put forward ethical
positions on several possible applica-
tions of genetic enhancement. Their
brief analysis concludes, "if we have
stimulated readers to think about these
possibilities in. a calm and rational way
and to reach their own moral judg-
ments about them, we will have accom-
plished our mission in writing the
chapter."
The book's final chapter examines
the history of public policy on human
gene-therapy dating back to the 1960s
and summarizes the public review pro-
495
 CQ Review

cess that gene therapy protocols in the superbly researched, containing hun-
United States have been subject to. It dreds of references to the scientific,
provides a very useful historical back- public policy, ethics, and popular lit-
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ground to the rest of the book, thus it erature. It will serve as an excellent
seems better suited to the beginning resource for physicians, scientists, and
than the end. laypersons contemplating the ethics of
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The ethics of gene therapy is a large human gene therapy.

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and difficult subject. Undoubtedly it

warrants further consideration. Two Andrea E. Glassberg
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hundred pages simply is not enough

space to present both the scientific back™
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ground and the detailed, comprehen- Note

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sive ethical analysis of human gene

1. Lyon J, Gorner P. Altered Fates: Gene Therapy
2 3 :586

therapy. The authors have certainly suc- and the Retooling of Human Life. N e w York
ceeded in stimulating readers to think and London: W.W. Norton and Company,
further about the issues. The book is 1995.
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