The Decision Trap by Silja Samerski

Author:Silja Samerski
Language: eng
Format: epub
Tags: Genetic education, genes, genetics, autonomy, genetic risks, genetic testing, biology, genetic counselling, amniocentesis, Down's syndrome, cancer risks, eugenics, heredity, responsibility, informed decision making, self-determination, gene carrier, statistics, medical, medicine, risk, diagnosis, irrealis mood
ISBN: 9781845408305
Publisher: Andrews UK Limited 2015
Published: 2015-06-15T00:00:00+00:00

3.2.3. The pathogenic effects of physician-attested risks

The idea that people can have risks is a relatively new phenomenon. The generation of my grandparents still feared concrete dangers but not quantified risks. The risk that can be anticipated, calculated, and insured has long been reserved for merchants and insurance. The German “ Risiko ” (first spelled risico ) appeared in the sixteenth century as a commercial term, as did the English “risk” in the seventeenth century. The word emigrated from business and insurance to German colloquial language only at the beginning of the twentieth century, where it gained acceptance as a synonym for “danger” and “daring”. In 1934 there was talk about the risks inherent in street traffic, and in the 1960s health apostles promoted filter cigarettes as “risk-free tobacco products”.

Nowadays, in contrast, the epistemic transformation of persons into risk profiles is routine. Doctors’ offices are filled with people robbed of their sense of well-being not by an adversity but by a risk prediction. Whether pandemics, early aging, an exceptional child, or lumps in a breast - in the “risk society” [29] everything that may happen is anticipated as a risk. However, “risk” does not identify a concrete reality but only a specific form of objectifying potential events. Risks in themselves do not exist. Conversely, this means that everything can be made into a risk: “Nothing is a risk in itself. There is no risk in reality. But, on the other hand, anything can be a risk” (Ewald, 1991, p. 199).

For the most part it is left in the shadows what this form of objectification of possible events as “risks” theoretically presupposes, namely the generation of faceless cases. Therefore the epistemic transformation of clients into risk profiles almost inevitably leads to epistemic confusion: to the confusion of the “I” or “you” in a colloquial statement with the statistical construct upon which the geneticist is basing her statements. The geneticist is personally talking to her client; she addresses her explanation of “genes” and “risks” directly to the woman sitting across from her, to a “you”. But the addressee and referent of her statements are miles apart: what she is saying does not refer to Ms M. but to a statistical construct. Probabilities by definition do not refer to a concrete person but to a constructed “case”; never to an “I” or “you” in a colloquial statement, always only to a “case” from a statistical population.

The epistemic confusion between a statistical construction and a colloquial “you” is not only misleading but also pathogenic. When Ms M. sought out genetic counselling she was afraid that she may develop colon cancer. Nevertheless she is still shocked when the counsellor categorizes her as a “high-risk person”. “That sounds bad”, she responds. Obviously the risk attestation has conveyed a different message to her than what she already suspects: she may develop colon cancer. Since the counsellor has portrayed her risk as a concrete statement, even as a type of diagnosis, it must seem as if Ms M.’s future is no longer open.

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