Self-knowledge and Risk in Stratified Medicine

3 April 2017

Authors: Joshua Hordern
Editors: Therese Feiler, Kezia Gaitskell, Tim Maughan, Joshua Hordern
 

 

Journal: The New Bioethics. Volume: 23. Issue:1 pp.55 - 63

Abstract:

This article considers why and how self-knowledge is important to communication about risk and behaviour change by arguing for four claims. First, it is doubtful that genetic knowledge should properly be called ‘self-knowledge’ when its ordinary effects on self-motivation and behaviour change seem so slight. Second, temptations towards a reductionist, fatalist, construal of persons’ futures through a ‘molecular optic’ should be resisted. Third, any plausible effort to change people’s behaviour must engage with cultural self-knowledge, values and beliefs, catalysed by the communication of genetic risk. For example, while a Judaeo-Christian notion of self-knowledge is distinctively theological, people’s self-knowledge is plural in its insight and sources. Fourth, self-knowledge is found in compassionate, if tense, communion which yields freedom from determinism even amidst suffering. Stratified medicine thus offers a newly precise kind of humanising health care through societal solidarity with the riskiest. However, stratification may also mean that molecularly unstratified, ‘B’ patients’ experience involves accentuated suffering and disappointment, a concern requiring further research.

Keywords (6): Self-knowledge, risk communication, values, behaviour change, compassion, stratified medicine

Funding details:

This work was supported by the University of Oxford Wellcome Trust Institutional Strategic Support Fund (grant number 105605/Z/14/Z); and the Arts and Humanities Research Council (grant number: AH/N009770/1). The author gratefully acknowledges this funding and also that of the Sir Halley Stewart Trust. The views expressed within this article are those of the author and not necessarily those of the Sir Halley Stewart Trust. 

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