Personalized Genomic Medicine: Rough Justice, Ragged Edges, Rugged Moral Terrain

In the age of genomic medicine, genetic testing permits more accurate personal tailoring of medications for best therapeutic results. These genetic tests promise nothing but unvarnished good for individuals (spared pointless suffering from side effects) and society (spared wasted financial resources). However, such advances raise challenging justice issues. In expensive targeted cancer therapies, we are buying extra weeks or months of life on average, with wide variations. But what if the gains are linked to patients with a specific genotype and we have the capacity to test for that genotype before these costly cancer drugs are given? What if only a small fraction of patients with a specific end-stage cancer would gain significant life prolongation (two years or more) because they have a very responsive genotype? Should they alone have a just claim to these drugs at social expense? And what if another fraction of that patient group would gain five extra months of life? Should they too have a just claim to those drugs at social expense? That is the “ragged edge.” Can we live with “rough justice”?
Leonard Fleck, PhD
Professor in the Center for Ethics and Humanities in the Life Sciences and Department of Philosophy at MSU
Recorded November 10, 2010