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Submission from CMF to the Nuffield Council on Bioethics' Working Party on 'Mental Disorders and Genetics: The Ethical Context'

Published: 1st May 1997

Introduction

Christian Medical Fellowship is interdenominational and has as members well over 4,000 British doctors who are Christians and who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. We have members in all branches of the profession and through the International Christian Medical and Dental Association are linked with like-minded colleagues in more than 60 other countries.

We regularly make submissions on a whole range of ethical matters to Governmental and other bodies, and welcome this opportunity to comment on 'mental disorders and genetics: the ethical context'. We are encouraged that the Council is making a special issue of this topic.

This Submission has been produced after discussion by our Specialist Standing Committee on Genetics and by our Medical Study Group, which in addition to membership from across the medical profession has nursing and theological inputs.

Preamble

Christians believe that God has made the world and everything in it, and that, uniquely among the animals, man and woman are created 'in the image of God'. This image is present in all human beings, no matter what the extent of any physical or mental disability.

All human beings have a responsibility in stewardship to look after every aspect of God's creation, and that responsibility remains after the Fall. For health professionals this constitutes a general mandate for healthcare. We are accountable to God for our actions.

Christ's command to 'love your neighbour as yourself' is also highly relevant, and these theological principles apply to the ethics of genetics, to the ethics of care for people with mental disorders, and to the complex relations between the two.

Genetics and mental disorders

Genetic research, testing and treatment per se are a perfectly proper part of Christian healthcare, as the large number of committed Christians working in the field proves. However, genetics involves many specific ethical questions, discussed in part in other documents of CMF and of the Council.

Because the mentally disordered are among the most vulnerable members of our society, it is right that their interests should be safeguarded with particular care, and considering applying the advances in genetics to the field of mental disorders leads to especially difficult problems. These are clearly recognised by the Council in the excellent papers which accompanied the Invitation to Comment, and we are not sure we necessarily have any specific answers.

We therefore emphasise briefly those points we consider particularly important.

We must recognise that we are more than the sum of our genes

Every human being is far more than the sum of his or her genetic endowment. Just because we discover genetic factors underlying the development of traits and predispositions, that does not remove from individuals all their capacity for freewill and the exercise of moral choice.

Whatever our genetic make-up, our character, personality and behaviour are moulded by many other factors, particularly our relationships with:

  • God
  • other people
  • 'ourselves'
  • the environment

Indeed, we would define being human in terms of such relationships.

Historically, others have believed in 'fate' and 'hubris' - malign forces directing life. As genetic knowledge advances, it is essential we do not return to crude mechanistic concepts of determinism. We are made 'in the image of God'. He wishes to change us through a new relationship with Himself through Christ. We can make choices and genetic predisposition does not take that capacity away.

We must protect the vulnerable

No matter how disabled, nor however bizarre behaviour may be, those with mental ill-health remain individuals loved by God and for whom Christ died. They should therefore always be treated with the dignity and respect warranted by this status.

If genetic interventions are to be considered for such individuals, this principle of respect will need to be put into practice in different ways depending on the circumstances.

It need not necessarily preclude physically invasive procedures such as venepuncture if this can be accomplished without causing undue distress, and psychologically invasive procedures can also be performed so as to minimise distress - for example, questionnaires can be both worded and administered sensitively.

Protecting the vulnerable applies to the unborn. We oppose abortion in relation to the possible development of mental disorders.

We must accept that we may make things worse before we make them better

Research in this area may well give us knowledge about brain development and function which could have major ethical implications with regard to the genetic control of personality traits and inherent intelligence. In spite of these eugenic dangers we believe the research itself is ethical and should be undertaken. An increased understanding could lead eventually to improved treatment for distressing disorders which are becoming more important causes of ill-health worldwide.

However, there is a real danger we will make things worse before we make them better. We are more likely to get disease markers than cures. Before there is any significant gain in relation to improved treatment, an increased burden of stress and even actual illness can be predicted. Morbidity and even mortality may rise first. Whilst accepting research, we think even the best application of it could overall have adverse outcomes initially.

We cannot currently afford the resource implications

Current provision for those with mental disorders in hospital and community is still in a transitional state, with the closure of long-stay institutions and the failure of community care to cope with the resulting demands made on it. Particularly in the inner cities, pressures on Health and Social Services are unacceptably high.

If presymptomatic testing for those with a family history of mental disorder became possible there would be a considerable increase in the need for counselling and support services. Follow-up studies of those tested presymptomatically for Huntington's disease are generally encouraging so far, but only a few hundred people are tested in the UK each year so intensive support can be provided. With disorders that were more common, the numbers involved would be far greater and as inheritance patterns are less straightforward, the stress engendered by a 'positive' test result could well be greater too.

With the current underprovision for mental disorders, where we are not coping with those patients we know about, we do not believe limited resources should be diverted from care to seeking those who may develop disorders and in whom genetic knowledge may or may not enable us to help.

Any progress in this whole area should be contingent upon improved organisation and resourcing of services for those currently mentally disordered, and upon the development of strategies to cope with the increased demand that would inherently accompany presymptomatic testing.

We believe this is the most important practical issue the Council needs to consider.

Genetic testing of children

The Council has addressed this matter in general before, and those recommendations should stand. However, should tests for vulnerability to mental disorder become available, then children seeking adoption may become a group under particular pressure for testing to be performed.

The child of a schizophrenic parent, for example, has a 10% chance of developing the condition. Such information is often sought by adoption agencies and prospective adoptive parents before legalities are finalised. If it were possible to provide more definite information still, prospective adoptive parents could well request a test and with the age of onset of schizophrenia being so much earlier than in Huntington's disease, it could be argued that the potential adoptive parents had a reasonable case.

But would children thus shown to be at higher risk become stigmatised and unadoptable, despite perhaps being even more needy? There are of course some parents prepared to adopt or foster children with special problems, so testing might work to the child's advantage, but clearly the whole question of genetics and children seeking adoption requires careful consideration.

Stigma

We share the Council's whole concern about stigma and misconceptions associated with mental disorders, believe this situation could go either way, and trust that the Working Party's conclusions and any other publicity will succeed in improving public understanding.

Summary

People with mental disorders deserve the best possible care, and genetic interventions have the potential to improve that care. As Christians, we can support some applications of genetics to mental disorders.

However, we acknowledge the many different concerns raised by the Council, suspect that nobody has the answers, and in particular argue that we do not currently have the resources to justify these developments.

For further information:

Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

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.

Christian Medical Fellowship:
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