Books Reviewed
The Triple Helix: Gene, Organism, and Environment.
Richard Lewontin.
Cambridge, Mass.: Harvard University Press, 2000. 136 pp. $22.95 (Hardcover).

Although these two books address issues raised by advances in genetics, they are hardly similar in other ways. The Triple Helix (TH) targets a fairly widespread assumption that genetics alone determines how living things work, amply illustrating that life, in all of its forms, is much more complex. Maverick biologist Richard Lewontin refutes the thesis of genetic determinism—or what might be called "just genetics," meaning only genetics. Lewontin is highly regarded not only for his research in population biology but also for his empirically grounded and challenging critiques of the field.

In contrast, From Chance to Choice (CC) develops a sustained critique of discriminatory practices that arise in applications of genetic information, arguing for policies intended to reduce or avoid injustice. Four mainstream philosophers advocate moral or social ideals of fairness or justice, calling for what could be dubbed as "just genetics," meaning fair genetics. Authors Allen Buchanan, Dan W. Brock, Norman Daniels, and Daniel Wikler have often collaborated in their applications of Rawlsian theory to biomedical problems.

The emphases of the two books, empirical in TH and theoretical in CC, befit their authors' expertise and complement each other: CC may be seen as building on the descriptive material provided by TH, or TH may be viewed as lending empirical support to positions articulated in CC. Lewontin himself apparently construes the work of Buchanan et al. as complementing his own; in the blurb on the jacket he praises the authors for demonstrating "how professional moral philosophers can help us work through a major social issue of immediate concern."

I doubt, however, that Buchanan et al.'s exposition of justice in genetics within the context of liberal individualism is compatible with the more radical critique to which Lewontin alludes when he identifies the cause of "degradation of the conditions of human life." That cause, he says, is not the alterations of the natural world that environmentalists castigate but "the narrow rationality of an anarchic scheme of production that was developed by industrial capitalism and adopted by industrial socialism." "The environment," he claims, "does not exist to be saved." We cannot prevent environmental change or species extinction, nor should we, because there is no evidence that this is either possible or desirable. Eventually, no matter what we do, all life on earth will be extinct; in fact, having originated over two billion years ago, life on earth is already half over. Rather than engage in futile efforts to "keep things as they are," Lewontin counsels us "to try to affect the rate of extinction and direction of environmental change in such a way as to make a decent life for human beings possible." Although death cannot be prevented, we can eliminate or at least reduce the overwork and undernourishment that still lead to premature deaths in countries less "advanced" than ours. Obviously, Lewontin's concerns are global rather than parochial. In contrast, Buchanan et al. tend to limit their discussion to conditions in the United States.

Lewontin's slim tome, readable within a few hours, is replete with provocative prose and graphs, sketches, and tables. Lewontin describes behavior in various species of plants and animals, ranging from simple to complex organisms, including those that have been extinct for millennia. Fruit flies (Drosophila), with which the author has long been familiar through his own research, figure more prominently than other organisms as examples of the ongoing interactions of genes, organism, and environment that form the triple helix.

Although many scholars have explored the interaction between environment and genes, few have accorded influence to the organism itself. But different phenotypes can and do develop from identical sets of genes and with identical environments; in both cases, this signals the impact of the particular organism on either of the other strands of the triple helix. Just as phenotype is an indicator of genotype, "if one wants to know what the environment of an organism is, one must ask the organism." For Lewontin, then, "all organisms construct their own environments," and "there are no environments without organisms." His view coincides with the literal meaning of "environment" as "surrounding": there must be an organism for an environment to surround. Consequently, to consider features of the environment, such as rain forests and river systems, as if they exist apart from native organisms misrepresents environment, exemplifying what philosophers call the fallacy of abstraction.¹

Some might argue that Lewontin's critique is directed at a straw person. Any respected or respectable scientist, they would claim, is well aware that genes and organisms and environment interact, affecting each other in myriad ways. Lewontin is surely right, however, that genetics has become "the reigning mode of explanation" not only among biologists but also among the public at large. In general, it has replaced the environmental model that prevailed years ago, when B. F. Skinner published his famous defense of social behaviorism.² Neither environmental nor genetic determinism makes room for human freedom. As Lewontin makes abundantly clear, however, neither model is adequate. Moreover, his triple helix account allows us to impute the capacity to exercise free choice to human organisms. While the author does not examine this possibility, humans may then be properly construed not only as interactive with but directive of genetic and environmental influences on their development.

Although Lewontin employs the triple helix as a new metaphor, his critique challenges the adequacy of metaphors in general. Even the metaphor of "development" comes under fire because it suggests that each individual is entirely defined by "the unfolding of a genetic program immanent in the fertilized egg." The metaphor of "adaptation," once useful in explaining evolution, currently serves to support the wrong-headed notion that environment is causally independent of the organism. To correct the flaws of these metaphors, Lewontin proposes one of "construction." "The constructionist view," he says, "is that the world is changing because the organisms are changing."

TH provides clarification of scientific concepts that underlie the discussion of policy issues undertaken by CC. Philosophically demanding but fluidly and accessibly written, CC is an impressive example of collaboration and careful scholarship. Although Buchanan is the first author, the principal philosophical source for all four authors is John Rawls,³ whose theory of justice was applied to health care in Norman Daniels's earlier work.⁴ To his credit, Daniels has acknowledged that the theory of justice he then presented did not allow for social factors that impede access to health care, such as gender, race, and class bias. In its account of the history of eugenics and its examination of current issues involving people with disabilities, CC substantially reduces this limitation of Daniels's earlier work.

Interestingly, another body of work that has clearly left its mark on the authors of CC is not explicitly acknowledged for its influence: the work of Tom Beauchamp and James Childress in various editions of Principles of Biomedical Ethics.⁵ Like Beauchamp and Childress, Buchanan et al. invoke "common sense morality" and Rawlsian "wide reflective equilibrium" while identifying principles that are applicable to a variety of ethical issues. The "method" of wide reflective equilibrium is defined as follows:

we test various parts of our system of moral beliefs against other parts of our general system of beliefs, seeking coherence among the widest set of moral and nonmoral beliefs by revising or refining them at all levels.

This methodology resembles Beauchamp and Childress's defense of coherence as a method of justification.⁶ In addition, the principles through which they defend their positions are substantively the same as those developed in Principles of Biomedical Ethics, albeit with a different vocabulary than the Georgetown mantra of respect for autonomy, beneficence, nonmaleficence, and justice.⁷ The term "justice" is retained in both accounts, but "beneficence" and "nonmaleficence" are mainly discussed as "harms" and "benefits" in CC, and "respect for autonomy" is mainly considered in the context of "liberty rights" or as "freedom," especially "reproductive freedom." Although the same principles are used by both sets of authors, Buchanan et al. focus on justice, discussing the other principles mainly or only to the extent that they relate to justice.

The authors of CC describe themselves as performing an "ethical autopsy" not only on the history of eugenics but also on current and anticipated issues raised by advances in genetics. While their book explores philosophically rich issues such as genetic determinism, concepts such as "wrongful life" and "normal species function," and the treatment/enhancement distinction, they mainly ignore the philosophical question that is unavoidable if a thorough ethical autopsy of access to genetic services is conducted: the moral status of the fetus. Their book, they say, is about "problems raised by advances in genetics, not about abortion, and so we limit ourselves to showing the connections between the issues of the prevention of genetic disease, wrongful life and abortion, but cannot pursue the moral and policy complexities of abortion itself." Yet consideration of the connection between "wrongful life and abortion" is inseparable from examination of "the moral and policy complexities of abortion," and the core issue to be addressed in examining those complexities is the moral status of the fetus. The genetic services to which Buchanan et al. believe everyone should have routine access include abortion following a positive prenatal diagnosis. By advocating permissive policies in this regard, they inevitably support a position they decline to defend on the spurious grounds that it is separable from their concluding recommendations.

In a pluralistic culture such as ours, it is not surprising that the authors demur from engaging in philosophical or ethical conflicts that seem irresolvable. The probability that their input will in fact influence the development of public policy may well depend on their not taking sides in such emotionally charged debates. My point here, however, is that they do take a side. Like it or not, their positions assume the permissibility of abortion, and that assumption demands defense or refutation. Acceptance or rejection of at least some of their recommendations rests on the adequacy of the arguments on either side.

Nor is it surprising that Buchanan et al. subscribe to a Rawlsian view of justice, i.e., one that alternates between the emphases on individual liberty and on social equality that mark libertarian and socialist theories, respectively. Most Americans want both liberty and equality, despite the incompatibility between the two if either is construed as an absolute value. Buchanan et al. also want to affirm both values. But this particular rendition of Rawls is more egalitarian than some accounts, and clearly more egalitarian than his more recent work.⁸ The authors' recurrent, well-reasoned concerns about genetic enhancement show their willingness to limit autonomy so as to promote equality: they support a parental right to avoid the birth of children with disabilities while rejecting policies through which enhancement of some people disadvantages others. In addition, they argue strenuously for social accommodations that would reduce the disadvantages endured by people with disabilities solely because currently able individuals have ignored their interests.

Buchanan et al. interpret the normal function model of Daniels, based on the concept of fair equality of opportunity in Rawls, as superior to models based on equal capabilities or equal opportunity for welfare or advantage. The latter models, they argue, betray the diversity and complexity of egalitarian concerns. To better capture this complexity, the authors purport to move beyond Rawls's "veil of ignorance," that is, an effort to overcome potential bias, through a "morality of inclusion." This approach would in fact reduce the inevitable nearsightedness of policymakers such as themselves.⁹ Of course, all of us are nearsighted in that we cannot adequately see what others see from where they are in the world; from a policy standpoint, this myopia is most troublesome if the policymakers consist only of those who are already dominant in society, i.e., affluent, white, well-educated, currently able, heterosexual men.

Over a decade ago, feminist standpoint theorists elaborated and defended a "morality of inclusion" as a means of promoting justice (including but not limited to gender justice).¹⁰ Their proposal, however, goes farther than that of Buchanan et al. because, on epistemological and ethical grounds, they attribute "privileged status" to the input of those who are nondominant. The privileged status of the nondominant individuals who are typically excluded from policymaking is based on the expectation that they bring to the table relevant content that would otherwise be missing. Ironically, the morality of inclusion of those who have been least represented (if at all) in the development of policies about genetics might exclude some of the authors of CC from their own involvement in that development.

Whether the normal function model defended by Buchanan et al. is morally superior to other models is of course debatable. Because they straddle opposing views on many issues, some of which may be more coherent than those the authors defend, the policies that Buchanan et al. ultimately support seem to this reviewer rather obvious or wishy-washy. On pragmatic grounds, their recommendations may be the best that policymakers who serve a diverse constituency can hope for. On idealistic grounds, however, I would have preferred a more radical critique, one such as Lewontin's book invites. Nobel laureate Amartya Sen's model of equal capabilities is much more likely, I believe, to remedy the central flaw of Daniels's earlier theory, its neglect of social and cultural impediments to human development. While Buchanan et al. have admirably addressed this flaw with regard to race and disabilities, they largely ignore sex, cultural, and class differences as obstacles to the full and free fulfillment of human capabilities.

CC does fulfill another ideal quite successfully: the principle that intellectual inquiry is most fruitfully conducted collaboratively. Although multi-authoring typically poses risks of disjointedness, incoherence, inconsistency and repetition in the resultant text, Buchanan et al. have not only overcome these risks but produced a work that is probably of higher caliber than any one of them would have produced on his own. In a limited way, then, the authors exemplify the benefits of the morality of inclusion in their own scholarly pursuits. Moreover, even as Lewontin demurs from addressing substantive ethical or policy issues, Buchanan et al. acknowledge their lack of expertise in relevant areas of the biological sciences. To facilitate the reader's understanding of these areas, they append an excellent contribution on the meaning of genetic causation by Elliott Sober. Lest their speculative considerations become inaccessible to readers who are less philosophically minded, the authors intersperse descriptions of cases and issues throughout the text, enhancing its readability while clarifying their exposition. The final fruit of their collaborative labor is not an easy read, but certainly a worthwhile one.

NOTES
1. Cf. Mary B. Mahowald, "As If There Were Fetuses without Women: A Remedial Essay," in Joan Callahan, ed., Reproduction, Ethics, and the Law: Feminist Perspectives (Bloomington: Indiana University Press, 1995), 199–218.

2. B. F. Skinner, Beyond Freedom and Dignity (New York: Alfred A. Knopf, 1971).

3. John Rawls, A Theory of Justice (Cambridge: Harvard University Press, 1971).

4. Norman Daniels, Just Health Care (Cambridge: Cambridge University Press, 1985).

5. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1979, 1983, 1989, 1994).

6. Beauchamp and Childress, Principles, p. 24.

7. As Buchanan et al. observe, these principles have been dubbed the Georgetown mantra because Georgetown is the home institution of one of the authors, Tom Beauchamp.

8. John Rawls, Political Liberalism (New York: Columbia University Press, 1993).

9. Mary B. Mahowald, "On Treatment of Myopia: Feminism, Standpoint Theory, and Bioethics," in Susan Wolf, ed., Feminism and Bioethics: Beyond Reproduction (New York: Oxford University Press, 1995), 95–115.