Your Genetic Destiny

by Aubrey Milunsky
Perseus Publishing, 2001
Review by Christian Perring, Ph.D. on Nov 25th 2002

In Your Genetic Destiny, Aubrey Milunsky sets out some of the most recent information about genetic medicine. The fundamental premise of the book is simple: there are many genetic disorders, and prospective parents should take whatever steps they can to avoid the terrible outcome of having a baby with a genetic disorder. The book sets out the scientific information about genetic abnormalities in clear language, with explanation of cells, chromosomes, DNA and their role in genetic disorders. In the 27 chapters, Milunsky covers a wide range of disorders, including Down syndrome, Fragile X syndrome, mental retardation, allergies, asthma, emphysema, heart disease, obesity, lipid disorders, abnormalities of heart rhythm, high and low blood pressure, diabetes, cancer, schizophrenia, depression, bipolar disorder, Alzheimer’s Disease, aging, Huntington disease, and polycystic kidney disease. He explains both genetic and environmental factors as causes of these disorders, and steps one can take to reduce one’s chance of falling prey to them.

This is a relatively long book, at over 400 pages, and it is somewhat repetitive. Readers who have some understanding of human biology will probably find the explanations helpful, and it is possible that readers concerned about genetic disorders will also find the information in the book helpful. For women and men wondering about the possible health problems of their children, the book often recommends that they consult with a genetic counseling and testing service. The real flaw is in the book's uncritical and somewhat old-fashioned attitude towards some disorders. Milunsky tells the reader that “you and your partner owe it to yourselves and your future offspring to be as fully informed as possible about your genetic risks and options when considering planned child-bearing” (p. 19). He emphasizes that “the presence of a child or adult with a serious birth defect or genetic disorder in the home becomes a chronic emotional, physical and economic drain on the parents (or family)” (p. 19). His language is often morally loaded: he often uses the phrases “genetic defect” and “flawed genes” and he even uses the phrase “defective child” (p. 7). He discusses the “burden” of families caring for children with Down syndrome, but makes no mention of the rewards of doing so. Many people will find his attitude toward genetic disorders problematic, because he pays so little attention to the question of how we label these disorders and the effects of our labeling. Some may suspect that the shadow of eugenics falls over Milunsky’s approach, suggesting that he takes an intolerant attitude towards people who are different. Disability activists may well find that his language expresses the judgment that people with genetic disorders have less valuable lives. It’s not certain that Milunsky himself would explicitly embrace any sort of eugenic program, but given the history of eugenics in the last century, anyone writing in this area has to show awareness towards these issues. His book strikingly fails to show the appropriate sensitivity.

The book also gives very little discussion of some difficult decisions people may face. For example, people with a family history of Huntington’s Disease can get genetic testing to find out whether they will get the disease which normally starts in mid-life and has a typical course of twenty years. The book reproduces six pages of guidelines about predictive testing from the World Federation of Neurology Research Group on Huntington’s Chorea and the International Huntington Association, which is in the form of a list of more than 80 main points, but there is no discussion of these, nor any consideration of how individuals work through such emotionally hard decisions. The chapter on genetic counseling is short and somewhat perfunctory. The penultimate chapter on ethical issues in the diagnosis and treatment of genetic disorders and the use of genetic information covers a wide variety of issues, but gives little discussion of any particular one. When women are facing questions about whether to have an abortion because there is a strong likelihood their baby has a genetic disorder, or whether to preventatively remove their breasts or ovaries because they are at a high risk for cancer, their values are at the heart of the decision-making. Milunsky’s neglect of these central issues means that Your Genetic Destiny will be of only limited use to people concerned about their genetic predispositions to medical disorders.

Christian Perring, Ph.D., is Chair of the Philosophy Department at Dowling College, Long Island. He is editor of Metapsychology Online Review. His main research is on philosophical issues in psychiatry. He is especially interested in exploring how philosophers can play a greater role in public life, and he is keen to help foster communication between philosophers, mental health professionals, and the general public.

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