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The tension between autonomy and justice…These two principles are in tension as well. What the individual wants may be impossible for the group to provide, with any kind of equity, so that autonomous demands may in fact be inimical to the common good. That's a result of the high value we place, again, in our society, on the individual and the individual's rights. Contrast that, say, with the People's Republic of China where the emphasis is much more on the common good than on the individual. So societal values play crucial roles. 
By the way, just to complete this picture, managed care has now come into the equation as well, joining the physician and the patient and looking not only at benefits and harms but at costs and benefits in a big time way. Managed care will think about the cost of the treatment rather than just benefits, as well as the harms of the treatment relative to its benefits, and in some ways limit the autonomy of the patient and the physician, to make the decisions of choice. Cost benefit really does apply, I think, to when you move from genetic screening to genetic analysis, when you're thinking of looking at whole populations, you have to think very hard about the cost of that, relative to the benefits. In one of the Scandinavian countries, I think it was Denmark, they did adopt a screening program for a certain genetic condition, and it proved to be highly cost ineffective. It was very costly to do, and the results, or the lives saved as a result of the screening, really didn't warrant the huge national expenditure on the screening program. So these are some of the principles that one is weighing in trying to decide which way to go. And I think the final point I want to make before leaving this is that none of these automatically trumps the others. They are all in tension, they all have to be weighed, balanced. Then you have to say: I think--and I stress that (it's not that I know but I think) that given my evaluation I'm going to proceed this way or that way on the basis of the weights I give to each of these principles. continued...
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AE Partners Collection Index