Published: 1st May 1997
Christian Medical Fellowship has made a Submission to the Nuffield Council on Bioethics Working Party on Mental Disorders and Genetics: the Ethical Context. A copy of this submission is attached. It sets out at some length CMF's status and basis, our theological position on genetics and on mental disorders and on the complex relations between the two, and makes some specific and detailed practical comments.
We intend this Submission to be seen as a Supplement to that one, focusing on your specific interest in behavioural disorders, and these brief comments should therefore be seen in that perspective.
These comments on behavioural disorders come from the Chairman of the CMF Specialist Standing Committee on Genetics, who retired this year as a consultant clinical geneticist, and from the CMF General Secretary, an experienced former general practitioner with a particular interest in psychiatry.
May we begin by commending the MRC for an excellent attempt in Genes and the Mind at conveying the vitally important but difficult concept that individuals may be genetically 'at risk' of developing a problem without being predetermined to one.
Where genetics apply to mental disorders it is far more about predisposition than about prediction, as might be the case with physical disorders, and this principle of predisposition is even more true where 'behavioural disorders' are concerned than with the classical psychotic illnesses. Our experience is that the general public makes the mistake of assuming that if you've got the gene you get the condition. As scientific doctors and as Christians, we are opposed to this crude determinism.
Educating the public about genetics is therefore essential, and sensitive use needs to be made of all the available media. We believe the 'road signs' motif of the booklet is a good start.
As amplified in our attached Submission, we believe that the research suggested should be performed, with full professional and public recognition of the 'possible pitfalls' and the 'potential benefits'. Subsequent use of any knowledge obtained should be subject to conclusions reached after the widest possible discussion, and some of these conclusions might need the force of law behind them.
We would reiterate our strong concern about the resource implications. We cannot afford to divert limited funds from care.
We have no other general comments to make here, and will therefore address specifically the two clinical conditions suggested for further study.
We note the proposal to mount 'nature-nurture studies' on mild depression. Our only comment is to wonder when low mood moves from being a normal part of the rich tapestry of life to being abnormal and requiring treatment, be it pharmacological or psychotherapeutic. Whilst recognising the real misery that 'mild' depression can bring, we do need the spiritual insights we find for example in the Bible book of Job or in some of the Psalms. We must beware any tendency to medicalise real life, and the booklet does not give adequate weight here to this 'possible pitfall'.
We recognise one very specific and entirely genetic disorder (Smith Magenis Syndrome) where gross hyperactivity leading to severe psychosocial consequences is a feature, and where knowledge of the diagnosis can bring great relief to families, but are concerned that there may currently be cultural pressures to make the diagnosis of AD-HD too often. There may be other causes of the phenomenon such as social deprivation and poor parenting. Perhaps the phenomenon illustrates the general 'nature-nurture' conflict well.
However, regarding genetic elements, we think there are 'possible pitfalls' associated with the potential results of this proposed research:
These 'possible pitfalls' we have suggested regarding the two behavioural disorders you propose studying underline the concern you have mentioned and which we endorse about the dangers of deterministic thinking. Education of the professions and the public is going to be essential if we are to keep the possible results of research in their proper perspective.
Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 4,000 British doctor members in all branches of medicine. A registered charity, it is linked to about 65 similar bodies in other countries throughout the world.
CMF exists to unite Christian doctors to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.