Editor's note II The tradition is, in fact, well documented in authentic Roman Catholic scholarship. Many of the evidences for it are set out in the Dictionnaire de Theologie Catholique (2) and the Dictionnaire de Droit Canonique (3); others become evident when the language of the copyright.
As organ transplantation is physically possible within a tension between common biological properties and individual immunities, so it is ethically possible within a tension between individual personality in full integrity and the human community of which each member, social by nature, is an organic part. Ethical donation is by consent, explicit or presumed, spontaneously offered or procured by request. Altruism or commercial dealing is now a live issue in organ procurement, whether cadaveric or by live donation, related or unrelated. Attention is given to children in transplantation, and to new developments with fetal organs, neural tissue, bone marrow and xenografts. Given all that medical science and skill can now offer, patients are still free to decline.
In answer to questions raised by practitioners, an ethics of genetic screening is located in a tension between liberty and responsibility in three respects: (1) to nature and biological processes; (2) to the disposal of human life; and (3) to the relation of persons to society. Under (1), the obligation to pursue research, fundamental as well as applied, is affirmed, offering the benefit of economy with fetal life, but requiring discrimination between the beneficial, the trivial, and the bizarre. Under (2) the abortion question, when relevant to diagnosed abnormality, is discussed, not in the language of conflicting rights, but of the relation of duties to interests. Under (3) the familial and social dimensions of screening raise questions of the disclosure of information and the keeping or extending of confidences. Last comes the value placed on truth in two related areas of developing practice. In infertility treatment, the donors of gametes are required to remain anonymous. Gene tracing through families requires for its effectiveness some correspondence between assumed identity and genetic identity. This conflict of social policies should be resolved. Definitions and intent By 'screening' in the context of this discussion, I understand "any procedures undertaken in order to detect presymptomatic disease in a population".' Genetic screening I treat as a means to furthering "the main purpose of medical genetics (which) is to apply the principles of genetics to the practice of medicine so that the burden of genetic disorders can be reduced in the community".2 I observe the common agreement here to limit the discussion of screening to patients for whom there are already indications of risk. The relevant moral reasoning requires the holding in tension of a cluster of principles, each exerting moral claims. I reduce these to three. I shall then relate cases to them. A.1. The tension between human liberty and responsibility within nature and biological processes In the glib language of today's pseudo-piety, medical scientists are alleged to 'play God'. If this *Text of a paper presented at the King's Fund Forum 'Consensus and controversy in medicine: screening for fetal and genetic abnormality'. 30) November to
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