Future Perfect: Confronting Decisions About Genetics.

Lori B. Andrews. Columbia University Press, New York. 2001. Pp. 264. Price $19.69, hardback. ISBN 0-231-12162-8.

Lori Andrews' Future Perfect attempts two tasks, one descriptive, and one argumentative. It succeeds at the former, but fares less well in the latter.

Andrews' first task is to describe the ethical problems related to genetic testing. While the book claims to be about ‘genetics,’ it is really only about genetic testing, and to some extent genetic research carried out by means of such testing. Granted, that in itself is a broad and worthy topic; but readers who hope for discussions of other genetic issues such as gene therapy, agricultural genetics, cloning, or the human genome project itself, will likely be disappointed. I however, count Andrews' effort here as a success, though a qualified one. Andrews is to be commended for amassing, in one relatively brief volume, references to an enormous quantity of research material related to the social and psychological effects of genetic testing. There is much to be said about the negative implications, and potential implications, of genetic testing (including availability) for women, people of colour, and individuals with disabilities, as well as for the way we think about reproduction and children; many readers will find Andrews' efforts here revealing.

I count this task as only a qualified success, however. Much of the discussion is simply too thin. Andrews makes reference to a dizzying array of sources, and these sources are cited in rapid-fire succession. Many of her paragraphs consist of only three sentences, each backed by a different endnote. A single sentence apparently suffices to summarize a finding or fact as interesting, and likely controversial, as “Thomas Jefferson used an experimental cowpox vaccine on two hundred slaves” (p. 91) or “In the context of breast cancer genetic testing, a biotechnology company exaggerated the risk of cancer that women with the genetic mutation faced” (p. 103).

Andrews' second stated project is to evaluate three competing frameworks for their suitability as paradigms for genetics policies. She dubs these the “medical model,” the “public health model,” and the “fundamental rights model.” “Which model,” she asks, “provides an appropriate starting place for genetics policy?” Must a single model be chosen? Andrews says no; but she argues, reasonably, that we should choose one model as a suitable default, and then deviations from that default should require justification.

Unfortunately, her analysis of these three frameworks is vanishingly thin. Indeed, in the chapter in which the three frameworks are compared, the “medical model” is disposed of in slightly more than one page. Very little is said about how these three frameworks interact, or about what variations on them might look like. Further, Andrews' analysis of her favoured model, the individualistic “fundamental rights model”, evidences a failure to appreciate the significance of the fact that genes are shared within families and communities, and neglects to show how the mere adoption of a rights-based framework would work to ensure both that the right rights are supported, and that appropriate limits to those rights are respected.

This kind of under-argumentation has a tendency to trivialize the subject matter. Genetic technologies present pressing challenges, both for clinical decision-making and for policy-making. The intelligent reader will surely see from Andrews' work that there is a deeply interesting book to be written about this topic. That reader will just as surely see that this is not it.