Chapter
Appendix I Family diagram
Appendix II Patient information leaflet
Is breast cancer inherited?
How are BRCA genes inherited?
How do I know if the cancer in my family is due to a mutation in a BRCA gene?
Can I have a test to see if the breast cancer in my family is due to a mutation in a BRCA gene?
I have got a very strong family history, how do I go about testing?
What if a relative with breast or ovarian cancer is not available? Can I be tested even if I have never had cancer?
So testing is a two-stage process?
Does everyone who inherits a mutation in a BRCA gene get breast or ovarian cancer?
How high is my risk of cancer if I have inherited a BRCA mutation?
If I have not inherited a BRCA mutation can I still get cancer?
What happens if a man has a mutation in a BRCA gene?
Are BRCA1/2 the only genes that can cause hereditary breast cancer?
If I have a BRCA mutation when will I develop cancer?
What can be done about the risk of developing breast or ovarian cancer?
What is the advantage of predictive BRCA testing?
What are the risks of BRCA testing?
Is there an alternative to genetic testing?
I’ve heard of research studies involving people with a family history of cancer. How can I find out more?
3 Family access to shared genetic information: an analysis of the narrative
Piecing the jigsaw puzzle together
What does Jane really think?
Jane and Phyllis’s meeting
Portrayals of Phyllis and Jane
The general practitioners’ perspective
4 A virtue-ethics approach
Introducing virtue ethics
5 Interpretation and dialogue in hermeneutic ethics
Interpretation and ambiguity
Interpretation and ambiguity in the case of Jane and Phyllis
Varying perspectives and fusing horizons
Perspectives and horizons in the story of Jane and Phyllis
Fostering interpretation and sustaining dialogue
6 'Power, corruption and lies' : ethics and power
Power in the story of Jane, Phyllis and the doctors
Suggested further reading
Lost in space: in place of an introduction
A gymnasium called sculptors
Trust me, I’m your psychiatrist
Utilitarianism strongly favours disclosure of the result
Hedonistic utilitarianism
Preference utilitarianism
Act- versus rule-utilitarianism
Other features of utilitarianism
Decisions about right action require empirical evidence, including knowledge of the details (context) of a particular situation and of all alternative courses of action
Intentional omissions are morally equivalent to intentional acts
Utilitarianism is demanding
Utilitarianism is a theory that is ‘spatially and temporally neutral’
Utilitarianism and personal autonomy
Utilitarianism is not retributive
9 A feminist care-ethics approach to genetics
Is care ethics a feminist ethics?
Genetics and the need for a relational perspective
Responsibility and the value of personal autonomy
Practices of responsibility
10 A conversational approach to the ethics of genetic testing
Recognition and respect for personhood
The third necessary aspect of ‘sense of self’ (Self 3)
Informal conversational ethics
Formal deliberative ethics
Implications for the case of Jane and Phyllis
Formal deliberative ethics
Informal conversational ethics
The doctor-patient relationship
11 Families and genetic testing: the case of Jane and Phyllis from a four-principles perspective
The four-principles approach does not purport to resolve moral dilemmas!
Both limbs of this moral dilemma can be defended using a four-principles approach
The dilemma considered in terms of the four principles
Trying to escape from the dilemma: professional and legal obligations
General Medical Council guidelines
British Medical Association Ethics Department guidance
Legal obligations: self-interest and morality
Can ‘scope’ considerations resolve the dilemma?
Can virtue ethics resolve the dilemma?
Can utilitarianism solve the dilemma?
Other ways of trying to resolve the dilemma
The dilemma remains: using a sort of casuistry to choose between the horns
12 A phenomenological approach to bioethics
A phenomenological analysis
The theory-ladenness of social knowledge
Identifying empirical premises
Men: the forgotten group in genetic counselling
Some further observations on the role of the counsellor
14 Response to ethical dissections of the case
A bit about the characters
Consent for disclosure as a precondition to testing
Some technical aspects of the case
Anxiety in the medical profession
15 Philosophical reflections
Case Analysis in Clinical Ethics
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