A short history of the next thirty years: genetic testing, clinical care and personal choices.

Danish physicist Niels Bohr is quoted as saying that ‘prediction is very difficult, especially when it concerns the future’.1 Lawyers usually prefer the safer ground of predicting the recent past. However, let me go way out on a limb and predict what the future will be like. Not the far-flung future, but a measured guess about how things will pan out over the next 20, 30 years or so. My aim is to identify some trends and influences that will shape the future of health care in Australia and, more specifically, the regulation of clinical genetics and genetic testing. One issue to watch will be the extent to which personal autonomy, and its equivalent in the market, personal choice, will remain the dominant values within health care settings, or whether the law will constrain the choices that genetic testing and therapies make available on the basis that they are perverse or against the public interest. There is an enormous body of literature that considers how society should regulate genetic technologies.2 Less attention has been given to how genetic technologies are actually likely to unfold, and how they are likely to be regulated. Frank Lewins argues that the disproportionate focus on normative ethics (what we should do) at the expense of sociological approaches to medicine means that the social forces precipitating debate, as well as the forces that will ‘resolve’ these debates in a political sense, tend to be ignored.3 One thing we can say is that genetics is a highly sensitive political issue, as illustrated by extensive law reform work,4 parliamentary debates and legislation.5 To anticipate the future