Risk in Christianity and Personalized Medicine: Three Frameworks for Understanding Risk in Scripture
Paul Scherz, Ph.D., Assistant Professor of Moral Theology and Ethics, Catholic University of America
Inspired by the increasing power and decreasing cost of genetic sequencing and analysis, healthcare analysts, pharmaceutical companies, and funding agencies are investing in the paradigm of personalized or precision medicine. Personalized medicine attempts to develop finer-grained risk profiles for diseases in which to slot patients based on genetics and lifestyle. By defining patients in terms of a risk profile, doctors can deploy pharmaceutical, surgical, and lifestyle interventions before disease occurs, such as surgeries for women with the oncogenic BRCA1 allele or widespread use of statins. Anticipation of and response to biological risk is becoming a defining feature of contemporary subjectivity.
Both religious and secular bioethics have addressed the category of risk, but there is little agreement on how to deal with risk beyond weighing the risks and benefits of a possible intervention for a present illness. These disciplines have fewer resources to address the way that risk can now define a person. Religious bioethics needs normative resources to address proper subjective attitudes towards risk, or else patients will having nothing but the considerations of genomic science to guide them.
In this paper, I outline three stances toward risk found in Scripture. The first is most obvious and is found in the gospels although it occurs throughout Hebrew and Christian Scriptures. This stance rejects anxiety over risk by thinking only of following Jesus and leaving worldly concerns to God’s care, as exemplified by Jesus pointing to the birds of the air and the lilies of the field (Mt 6:25-34, Lk 12:22-34) or the story of Mary and Martha (Lk 10:38-42). This attitude seems to reject the focus on risk of personalized medicine. A second stance towards risk is found in the Wisdom literature, especially Proverbs. In this perspective, one should use natural regularities to provide security, even while recognizing that the future is in the hands of the Lord. Such a stance encourages patients to use the possibilities of risk amelioration of contemporary science. Finally, aspects of the Law, such as the Jubilee, suggest that the consequences of individual risks must be limited through social structures. Poor choices or bad luck should not define a family forever. This stance toward risk suggests that instead of looking solely to personal risks, such as oncogenes or lifestyle choices, Christian bioethicists should also look to social factors that structure risk, such as pollution or stressful working conditions.
The combination of these three perspectives does not give specific prescriptive judgments but provides a lens through which to analyze contemporary developments. On the one hand, these stances encourage the patient to reject an anxious definition of the self in terms of risk instead of primarily trusting in God and focusing efforts on the kingdom. Yet, they could also encourage patients to use the knowledge of personal and social risk factors to alleviate disease and suffering. The challenge is to care for the things of this world like health without placing one’s ultimate good in them so as to become anxious.
Inspired by the increasing power and decreasing cost of genetic sequencing and analysis, healthcare analysts, pharmaceutical companies, and funding agencies are investing in the paradigm of personalized or precision medicine. Personalized medicine attempts to develop finer-grained risk profiles for diseases in which to slot patients based on genetics and lifestyle. By defining patients in terms of a risk profile, doctors can deploy pharmaceutical, surgical, and lifestyle interventions before disease occurs, such as surgeries for women with the oncogenic BRCA1 allele or widespread use of statins. Anticipation of and response to biological risk is becoming a defining feature of contemporary subjectivity.
Both religious and secular bioethics have addressed the category of risk, but there is little agreement on how to deal with risk beyond weighing the risks and benefits of a possible intervention for a present illness. These disciplines have fewer resources to address the way that risk can now define a person. Religious bioethics needs normative resources to address proper subjective attitudes towards risk, or else patients will having nothing but the considerations of genomic science to guide them.
In this paper, I outline three stances toward risk found in Scripture. The first is most obvious and is found in the gospels although it occurs throughout Hebrew and Christian Scriptures. This stance rejects anxiety over risk by thinking only of following Jesus and leaving worldly concerns to God’s care, as exemplified by Jesus pointing to the birds of the air and the lilies of the field (Mt 6:25-34, Lk 12:22-34) or the story of Mary and Martha (Lk 10:38-42). This attitude seems to reject the focus on risk of personalized medicine. A second stance towards risk is found in the Wisdom literature, especially Proverbs. In this perspective, one should use natural regularities to provide security, even while recognizing that the future is in the hands of the Lord. Such a stance encourages patients to use the possibilities of risk amelioration of contemporary science. Finally, aspects of the Law, such as the Jubilee, suggest that the consequences of individual risks must be limited through social structures. Poor choices or bad luck should not define a family forever. This stance toward risk suggests that instead of looking solely to personal risks, such as oncogenes or lifestyle choices, Christian bioethicists should also look to social factors that structure risk, such as pollution or stressful working conditions.
The combination of these three perspectives does not give specific prescriptive judgments but provides a lens through which to analyze contemporary developments. On the one hand, these stances encourage the patient to reject an anxious definition of the self in terms of risk instead of primarily trusting in God and focusing efforts on the kingdom. Yet, they could also encourage patients to use the knowledge of personal and social risk factors to alleviate disease and suffering. The challenge is to care for the things of this world like health without placing one’s ultimate good in them so as to become anxious.