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Clinical Commentary: The Law of Unintended Ethics

Published online by Cambridge University Press:  01 January 2021

Extract

The law of unintended consequences is generally applied to technological advances that solve one problem but cause another. In this view, the problem created may be worse than that which was solved, hence the law is used as an argument against technological advances. Concern about intent and consequence comes to mind when reading the article by Ronald Green on parental decision making and prenatal genetics. Green's analysis, combined with the realities of genetic practice, raises questions about parental power, eugenics, and the interests of children affected by genetic or congenital disorders. Green proposes rules and draws conclusions that are not useful for clinicians and that promise harm to families and individuals affected by genetic disorders. Green's analysis may be an example of a corollary that could be viewed as the Law of Unintended Ethics.

Green's paper begins with an apparently contradictory dual thesis. First, he supports unfettered parental decision making about their fetuses and children. Second, he suggests that we should strive to give our children lives unimpaired by serious genetic (or congenital) disorders.

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Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1997

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References

Green, R.M., “Parental Autonomy and the Obligation Not to Harm One's Child Genetically,” Journal of Law, Medicine & Ethics, 25 (1997): 515.CrossRefGoogle Scholar
See id. at 6.Google Scholar
Id. at 10.Google Scholar
Id. Geneticists and counselors are trained never to suggest to a parent that a lost child or fetus can be replaced by a subsequent child. The lost child generally occupies an absent position in the family, often holding a name or another identity.Google Scholar
Nondirectiveness is not a literal absence of effect of professionals on the decisions that patients make. It is impossible for a health professional not to impart cues to families about his/her views of the decision being faced. Mannerisms, choice of words, vocal inflections, and many other behaviors impart cues to families that can be correctly or incorrectly interpreted to indicate the professional's opinion.Google Scholar
Down syndrome is a common example of this problem. The affected individuals who do not have severe congenital heart defects are generally happy and healthy. However, because of their retardation, they are commonly believed to suffer because of the disorder. The suffering is mainly in the minds of the parents and other caretakers who transfer their views of suffering onto the affected persons.Google Scholar
See Green, , supra note 1, at 7.Google Scholar
Although the debate over maternal substance abuse is contentious, some malformations, such as fetal alcohol syndrome, can be caused by maternal behaviors. Even in this case, the assignment of maternal blame is very unlikely to resolve the issue.Google Scholar
See Green, , supra note 1, at 8 (original emphasis).Google Scholar
See id. at 9.Google Scholar
This issue is further complicated by consideration of the value of abnormal children. In Green's analysis, this consideration is conspicuously absent.Google Scholar

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Clinical Commentary: The Law of Unintended Ethics
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