Deep Insight Section

The history of medical ethics has provided, at various junctures, focus on major principles such as justice, fidelity, autonomy, beneficence, etc. When deontological (rule-based) perspectives received competition from utilitarian (resultsbased) methods of analysis in the 19th century, changes in emphasis helped pave the way for ethical assessment of the Darwinian, Mendelian, Freudian and Einsteinian revolutions. Modern frameworks in medical ethics have returned to principalism (which has its roots in the ancient Greek philosophical tradition that directs our attention to the Good, the True and the Beautiful). This in turn has conditioned much of the underpinning of genetics counseling, with emphases on justice, beneficence and autonomy. The recent opening up of oncogenetics offers an opportunity to revisit the insights of the past and refine them for clinical oncology settings. There are important problems and issues which arise in several contexts: intrafamilial dynamics, economic concerns, professional qualifications, research settings, and most recently reproductive decision-making.