John C. Fletcher 
ethics cannot completely stand outside of its cultural setting, but it 
can be more critical than Rifkin’s view allows. 
CONCLUSION 
In historical perspective, one can trace two streams of evolving ethical 
issues in medical genetics. The older and wider stream includes moral 
problems in genetic screening and prenatal diagnosis. A newer stream 
emerged with moral concern about creating new knowledge and new 
life forms by molecular biologists in recombinant DNA research. The 
use of human DNA itself in prenatal diagnosis, screening, and now 
perhaps for treatment, links the two streams and makes the issues 
more complex but not less resolvable. 
A well-defined moral approach to the most frequent and difficult 
problems of moral choice in genetic counseling, screening, and 
prenatal diagnosis has evolved in the societies with the longest experi- 
ence in medical genetics. This approach is based primarily on respect 
for parental autonomy, voluntaristic methods of genetic screening 
and diagnosis, and efforts to educate the population about genetic 
risks (Fletcher et al ., 1985). Likewise, a carefully defined moral 
approach, sketched in the first section of this essay, exists for plan- 
ning, reviewing, and conducting of experimental gene therapy. Each 
of these approaches has required years of debate and adaptation to 
create and each is still in the process of evolution. However, a wide 
consensus exists that each of these approaches is adequate for prac- 
tice in the current situation. No persuasive case has been made, in 
my view, that experiments in somatic cell gene therapy would be 
morally objectionable, as long as the preparation and conduct for 
such studies follow the well-defined steps of research ethics. 
In perspective, the objections of Rifkin and others to the first 
experiments in human gene therapy appear to be misplaced and 
largely emotional criticisms based upon the lack of consensus about 
approaches to future moral conflicts about germline animal and 
human experiments. A rational response to this criticism does not 
require any action with respect to somatic cell experiments other 
than the preparations now being made. The most important contri- 
bution of Rifkin and others is to show that no viable moral approach 
has yet been charted for preventive gene therapy experiments or 
alteration of physiological or other characteristics that may or may 
not be sources of real suffering. As the technological and scientific 
realities of such developments are still at some distance in time, it is 
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