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Journal of Medicine and Philosophy Advance Access published online on February 4, 2009
Journal of Medicine and Philosophy, doi:10.1093/jmp/jhn039
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© The Author 2009. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

From a Genetic Predisposition to an Interactive Predisposition: Rethinking the Ethical Implications of Screening for Gene-Environment Interactions

James Tabery1

University of Utah, Salt Lake City, Utah, USA

Address correspondence to: James Tabery, PhD, MA, Department of Philosophy, University of Utah, Salt Lake City, UT, 84112, USA. E-mail: tabery{at}philosophy.utah.edu


  Abstract

In a widely acclaimed study from 2002, researchers found a case of gene-environment interaction for a gene controlling neuroenzymatic activity (low vs. high), exposure to childhood maltreatment, and antisocial personality disorder (ASPD). Cases of gene-environment interaction are generally characterized as evincing a genetic predisposition; for example, individuals with low neuroenzymatic activity are generally characterized as having a genetic predisposition to ASPD. I first argue that the concept of a genetic predisposition fundamentally misconstrues these cases of gene-environment interaction. This misconstrual will be diagnosed, and then a new concept—interactive predisposition—will be introduced. I then show how this conceptual shift reconfigures old questions and raises new questions for genetic screening. Attempts to screen embryos or fetuses for the gene associated with low neuroenzymatic activity with an eye toward selecting against the low-activity variant fall prey to the myth of pre-environmental prediction; attempts to screen newborns for the gene associated with low neuroenzymatic activity with an eye toward early intervention will have to face the interventionist's dilemma.

Keywords: antisocial personality disorder, criminal violence, fetal screening, gene-environment interaction (GxE), genetic predisposition, interactive predisposition, newborn genetic screening, preimplantation genetic diagnosis


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