Video Ideas: Dilemmas & Controversies

ethics_dilemmapdfDownload a PDF of this document (29kb)

The science of genomics offers many potential benefits to society, but it also poses concerns. Most of the ideas will have dilemmas associated with them. We’ve listed a few here but visiting the other “Video Ideas” pages tables will also bring some interesting conflicts forward

  • We are searching for clues to diagnosis, treatment, and prognosis for many illnesses. How do you balance the new knowledge without imparting a sense of determinism? In high school, we learned about single gene disorders that are generally deterministic: if both copies of the Cystic Fibrosis gene is mutated, Cystic Fibrosis results.
  • However, not all genetic disorders are this clear and many single gene mutations that are involved in  disease do not always lead to the disease (e.g. breast cancer genes). It gets more complicated when more than one gene is involved. How does this enter practice? How is it explained to doctors and patients.
  • How do we choose what to treat? If there is a rare genetic illness that is fatal without medication, do we as a society treat that condition? Would it be fair to let the families pay? Would it be better for society if we took that some money and made sure that all children had access to food, shelter, good early childhood education, etc.?


  • Should we allow parents to screen sperm, eggs, or embryos?
    • For lethal conditions?
    • For life-threatening conditions?
    • For life-altering conditions?
    • For abilities?
    • For looks?
  • Some genetic tests may be able to with dosing or choosing the right drug (pharmacogenomcis).
    • Should taking that test be mandatory?
    • What if that same test could also help determine your athletic ability or predisposition to dementia?
  • Some ethnic groups have an increase in some genetic diseases and some matchmakers in these communities have used the information from genetic tests to determine suitability (e.g. two carriers for the same disease are not a good match).
    • Should this practice be mandatory?
    • Should we encourage people to mate outside their ethnic background to reduce the incidence of genetic diseases?
  • With next generation sequencing, which offers the promise of identifying mutations that underlie  mendelian disease or pharmacogenetic effect, it is likely that we will identify unexpected genetic changes that have important medical or social implications unrelated to the reason for testing -incidental findings.  No clinical guidelines have been proposed for disclosure (or non-disclosure) of incidental findings resulting from genomic testing.
    • Who should decide which types of tests results should be disclosed – the doctor or the patient?
    • What types of incidental findings should be disclosed?
      • Findings that don’t impact the patient’s health but could impact their reproductive decisions in the future (ie- carrier status)?
      • Adult onset disorders identified in children?
      • Mutations that cause disease that have no treatment?
      • Mutations with uncertain significance?
      • Non paternity?