Genomics and Environmental Regulation: Science, Ethics, and Law

16 (Almost) Equal Protection for Genetically Susceptible Subpopulations: A Hybrid Regulatory-Compensation Proposal

C H A P T E R 16 (Almost) Equal Protection for Genetically Susceptible Subpopulations A Hybrid Regulatory-Compensation Proposal CARL CRANOR What would it be like to have legal procedures that exemplify thoroughgoing protection of all the public from harm caused by toxic substances? The moral views we use to guide our deliberations about law and regulatory policy can greatly shape the proposals we make. This is not a surprise, because, if our arguments are persuasive, our recommendations follow from the moral premises that support them. I, thus, argue against some quite limited moral theories in the utilitarian tradition. The chapter seeks to exemplify a deeper point, however. Our underlying moral views importantly shape our imagination in conceptualizing possible policies and alternatives to existing practices. Thus, one aim of this chapter is expand our ideas of the extent to which it is possible to protect even quite susceptible persons from harm by suggesting a moral principle by which everyone—even the most susceptible or the most biologically vulnerable—has moral standing to be protected from exposure to toxic substances. I then propose one way in which this principle could be represented in legal structures. I present a hybrid regulatorycompensation proposal to protect susceptible subpopulations from harm that could result from toxic substances. While it is possible that not quite all who will be exposed to toxicants will be protected from harm, the suggestion appears to greatly increase protections compared with current policies and some theoretical alternatives. If the requisite genetic sciences were developed, such legal structures would better protect genetically susceptible subpopulations than do current legal structures. A Note about Susceptibility Before turning to moral issues and some institutional devices to protect (almost) all from harm, I want to note a complication with the idea of susceptibility; genetic susceptibility is somewhat subtler than it appears on the surface. For example, people with ataxia telangiectasia, a DNA repair disorder, are highly susceptible to exposure to ionizing radiation (Swift et al., 1991). Persons with xeroderma pigmentosum, another DNA repair disorder, are highly susceptible to ultraviolet radiation (Halpern and Altman, 1999). These appear to be comparatively simple instances of genetic susceptibility. The existence of a genetic tendency makes anyone who has it more susceptible to a particular disease, given a particular exposure, and appears to confer no particular biological advantage. However, there are genetic susceptibilities that present more varied relationships. For example, people who are “fast acetylators” are less likely than “slow acetylators” to “develop bladder cancer from cigarette smoking and from occupational exposure to bycyclic aromatic amines” (Parkinson, 2001). At the same time, they are at higher risk of cancer from heterocyclic amines (Deitz et al., 2000). Acetylation is a biological process by means of which any chemical substance is transformed in the body to assist in its elimination and excretion. This can be a comparatively quicker or slower process in individuals. Acetylation can facilitate the detoxification of some substances and the activation of the toxicity of others (Deitz et al., 2000). Moreover, the particular features of acetylation appear to vary with population groups: populations of Middle Eastern descent appear to be slow acetylators whereas those of Asian descent tend to be faster acetylators (Deitz et al., 2000). So far, so good. Here is the complication: the same genetic property in a person, fast acetylation, that increases the toxicity of one substance, decreases the toxicity of another. That is, the property constitutes susceptibility with one 268 E T H I C A L A N D P H I L O S O P H I C A L P E R S P E C T I V E S exposure and biological strength with another. Is fast acetylation (or slow acetylation, for that matter) a special vulnerability or not? The answer seems to be that often a particular biological state may not by itself always be a special susceptibility. Rather, we should think of at least some susceptibilities as relational properties between the biological state of an organism and the conditions of exposure; for some cases, it appears they cannot be separated. More generally, it is a relation between all the conditions necessary for the induction of a disease—and what one singles out for attention may not be a trivial issue (Rothman, 1986, pp. 19–20). The larger point that emerges here is that there may be some pure, unequivocal genetic vulnerabilities per se, such...