Medicine Studies

, Volume 3, Issue 3, pp 171–183

Epigenetic Responsibility

Authors

    • Department of Political ScienceLund University
Article

DOI: 10.1007/s12376-011-0072-6

Cite this article as:
Hedlund, M. Medicine Studies (2012) 3: 171. doi:10.1007/s12376-011-0072-6

Abstract

The purpose of this article is to argue for a position holding that epigenetic responsibility primarily should be a political and not an individual responsibility. Epigenetic is a rapidly growing research field studying regulations of gene expression that do not change the DNA sequence. Knowledge about these mechanisms is still uncertain in many respects, but main presumptions are that they are triggered by environmental factors and life style and, to a certain extent, heritable to subsequent generations, thereby reminding of aspects of Lamarckism. Epigenetic research advances give rise to intriguing challenges for responsibility relations between the society and the individual. Responsibility is commonly understood in a backwards-looking manner, identifying causally responsible actors to blame for a bad outcome. If only a backwards-looking responsibility model is applied, epigenetics might give rise to arduous responsibility ascriptions to individuals for their health and the health of their future descendants. This would put heavy responsibility burdens on actors constrained by unequal social and economic structures. In contrast, a forward-looking responsibility notion takes account of structural conditions and pay attention to who is best placed to do something about conditions contributing to bad outcomes. A forward-looking responsibility notion would partly free disadvantaged individuals from responsibility, and identify actors with power and capacity to do something about structural factors constraining genuine choice.

Keywords

EpigeneticsResponsibilityStateIndividualHealth

Introduction

The purpose of this article is to argue for a position holding that epigenetic responsibility primarily should be a political and not an individual responsibility.

Epigenetics is a rapidly growing research field studying mechanisms regulating the function of genes. Although still afflicted with uncertainties, the main presumptions of epigenetic research are that these epigenetic mechanisms1 are triggered by environmental factors and life style (c.f. Sloboda et al. 2007) and, to a certain extent, are heritable to subsequent generations (Skinner et al. 2010), thereby rendering epigenetics a ‘Lamarckian flavour’ (Kaati 2009: 77).2 In these respects, epigenetics ‘blurs the conceptual boundaries between inheritance and development’ (Beck and Niewöhner 2006: 222) and potentially demonstrates how, biologically, individual behaviour via different epigenetic mechanisms influence phenotype later in life and, in some circumstances, future generations. Should these presumptions prove to hold, epigenetic research advancements give rise to intriguing challenges not only for common understandings of the gene–environment relation, but also, I argue, for questions of responsibility relations between the state and the individual. The main reason for this is how we normally understand responsibility.

The standard model of responsibility attributes responsibility to ‘a particular agent (or agents) whose actions can be shown to be causally connected to the circumstances for which responsibility is sought’, given that the agent(s) acted voluntary and with adequate knowledge (Young 2006: 116). Knowledge about causal relations contributes to control, which generally is considered a necessary factor for ascribing responsibility, at least to the extent that the actor can make an influence on the causal factors (Fischer 2006: 4; Fischer and Ravizza 1998: 14).

Epigenetic research opens up for increasing control, as it contributes to expanding knowledge about what happens biologically in gene–environment interactions, i.e., how, on the molecular level, for example, smoking constitutes a health risk (Fraga et al. 2005: 10609) or how stress in childhood affects adult health (Szyf et al. 2007). Adding to this is the trigging but yet uncertain question of inheritance of environmentally induced effects to future generations. By providing knowledge about causal relations—however, still in patches and mostly based on animal studies—epigenetic research advances might give rise to responsibility ascriptions that are quite arduous. If only the standard model of responsibility is applied, there is a risk that knowledge about epigenetic mechanisms—or how epigenetics will come to be perceived in society—will bring about heavy demands on individual responsibility in terms of risk avoiding behaviour and contribution to costs of health care. The crucial question here is whether it is justifiable to hold individuals responsible for effects of their lifestyles given the social, economic and political structures in which they make their lifestyle choices. To answer this question, we need an integrated model of responsibility taking account of structural factors.

The article proceeds with a short introduction of epigenetics, pointing at what makes this field of research challenging for questions of responsibility. In the next section, I discuss principal implications of epigenetics for state–individual responsibility relations and the political character of the state–individual boundary. This is followed by a theoretical discussion on responsibility, ending up with a responsibility notion that integrates structural causes in assigning responsibility. The section on epigenetic responsibility discusses responsibility questions derived from an epigenetic understanding of the gene–environment interaction, and I will argue that epigenetic responsibility primarily should be a political and not an individual responsibility.

Epigenetics

Epigenetics3 is a rapidly growing research field studying epigenetic mechanisms, i.e., links between environment and genes affecting the function of genes without changing the DNA (Szyf et al. 2007: 10). A popular way to explain what epigenetic mechanisms do is to say that they function as a conductor or as an on–off switch of genes, i.e., regulating whether a certain gene will be active or not, thereby affecting the phenotype (c.f. Butcher and Beck 2008: 293). Presumptions in the epigenetic research field are that epigenetic processes are triggered by environmental factors and individual lifestyle (c.f. Sloboda et al. 2007) and that they are reversible (Szyf 2009). The most intriguing presumption is the proposition that alterations of gene expression due to epigenetic mechanisms to a certain extent are inheritable and can affect subsequent generations (Skinner et al. 2010). This feature, however, still the weakest part in epigenetic research, reminds of aspects of Lamarckism (Hodges 2010: 9), which might be one reason why this idea has not been taken very seriously (Kaati 2009: 77).

Hitherto, studies of mice provides the strongest evidence of the occurrence of epigenetic inheritance from one to the next generation(s) (Skinner et al. 2010; Jablonka and Raz 2009), but this possibility in humans is more uncertain. Phenotypic differences between genetic identical twins could have epigenetical causes (c.f. Kato et al. 2005), but the existence of such epigenetic variance would not prove a trans-generational epigenetic inheritance. One problem with studies on humans is access to relevant information across generations. Another problem is the difficulty to identify effects of epigenetic processes on molecular level and rule out genetic, social, and other causes of observed effects (Morgan and Whitelaw 2008: 396). Possible experiment-like designs including humans are the use of historical records of time limited changes in food availability.4 Studies of the parish of Överkalix in Sweden during specific time periods of food abundance and food scarcity at the end of nineteenth and the beginning of twentieth century have demonstrated findings results about nutrition effects on subsequent generations (Kaati 2009; Pembrey et al. 2006). Researchers observed that food availability early in life was associated with survival of grandchildren (Pembrey et al. 2006), e.g., food abundance of paternal grandfathers was associated with a fourfold excess of mortality related to diabetes, which greatly shortened the life span of their grandsons (Kaati 2009: 71–72). Even though these studies ‘have not formally demonstrated epigenetic inheritance by molecular analysis’, the most likely explanation of these results is epigenetic inheritance (Kaati 2009: 76–77).

Although still afflicted with uncertainties, especially regarding effects on humans, epigenetics has been presented as a new paradigm, filling the gene-environment interaction gap (Vineis 2009: 3). The news is that epigenetics increasingly can explain biological mechanisms of how environmental factors and life style—in terms of smoking, nutrition, pharmaceuticals, toxics, physical activity, stress, caesarean reproduction—via epigenetic mechanisms influence gene expression (c.f. Szyf 2007; Fraga et al. 2005)5 and that the effects of these processes, under certain circumstances, are inheritable to succeeding generations (Skinner et al. 2010; Kaati 2009). A further intriguing challenge is that epigenetic changes appear to be reversible (Szyf 2009; Bracken and Helin 2009).6 The effects of the dialogue between the genome and its environment (Zhang and Meaney 2010: 458) seem to be most profound early in life. It is suggested that this have to do with an adaptation or matching of the offspring to the current environment, and if the conditions later in life would not correspond to the environment in early life, e.g., food scarcity in early life and food abundance in adult life, this preparation would turn out to be inaccurate and cause a mismatch between the epigenetic programming and the actual living conditions (Gluckman et al. 2007). This capacity of the cell to ‘memorise’ its early-life environment can have long-term health consequences (Jablonka and Raz 2009: 132).

Epigenetics inculcates the significance of the environment in a wide sense for behaviour and diseases and could, possibly, be described as heredity that is possible to influence. Epigenetics constitute a challenge not only for life science, but also for social science and policy makers on health care and environmental issues. How, then, does epigenetics affect society–individual responsibility relations?

Epigenetics and Responsibility Relations

The main reason why epigenetic research is of relevance for responsibility relations between society/the state and the individual is the expanding knowledge about biological mechanisms in the interaction between environmental factors and genes and that effects of these processes appear to be inheritable to subsequent generations (c.f. Rothstein et al. 2009). Epigenetic research advances have the potential to clarify causal relations between, on the one hand, life style and living conditions and, on the other hand, health and wellbeing, and make it possible for individuals and societal institutions to act accordingly—but also to decide not to act accordingly. Future generations might have to live with the consequences of actions that their predecessors, in the light of increasing knowledge, could have done otherwise (in principle).

One way to structure different factors affecting epigenetic modifications that, in turn, affect the phenotype is to divide them according to level of influence or, differently expressed, in an actor–structure perspective. What constitutes an actor or a structure is contingent to the level of analysis (Lundquist 1987), but as a starting point, the environmental factors known to induce change in the epigenetic state can be divided into factors directly related to the individual (diet, life style etc.), to society or the state (living conditions, working environment, health care etc.), and to social structures (class, gender etc.). As we will see, it is not self-evident which entity is regarded an actor or a structure. Figure 1 will illustrate the point.
https://static-content.springer.com/image/art%3A10.1007%2Fs12376-011-0072-6/MediaObjects/12376_2011_72_Fig1_HTML.gif
Fig. 1

Actors and structures affecting and affected by epigenetic patterns

The structure-related factors in Fig. 1 could more or less be categorised as actor related, depending on perspective. From the point of view of the individual, factors that the individual herself definitely can affect,7 like diet, smoking or exercise habits, clearly are actor-related factors, while factors like living conditions, the availability of health care or gender relations are factors that the individual herself definitely cannot directly affect (although in some cases indirectly and in the long run) clearly are structure-related factors. Moreover, individuals are always embedded in social, cultural, and political structures that to a varying degree constrain the free choice. However, from the perspective of society or the state, factors here categorised as structural conditions more or less could be affected by state or other institutions, i.e., some kind of actors.

This occupation with the actor–structure categories and the attempt to illustrate causal links highlight the importance of responsibility. Responsibility has to do with the possibility to control the outcome of actions (Fischer and Ravizza 1998: 14), and thus presupposes knowledge about causal relations. Epigenetics achievements, would they turn out to be established as scientific truths, deepen the understanding of causalities in gene–environment interaction, and might give rise to burdensome responsibility ascriptions as compared to genetics.

Genetic responsibility is mainly discussed in relation to handling of genetic information—storing, screening, diagnosing—and the possibility of choosing healthy embryos in assisted reproduction. Having been marked by an ideology of genetic determinism, linking genetic risks to inevitability (d’Agincourt-Canning 2006),8 the debate about genetic responsibility has increasingly been dominated by a focus on individual rights to autonomy and privacy (Knoppers and Chadwick 2005; Nicholas 2001). Main concerns have been the weighing of risks and benefits with medical gene technology treatments for the individual (Hedlund 2007, 2010) and the rights of individuals to make their own choices about, e.g., genetic testing and communication of test results (Boddington 2010). Intensified attention on genetic information not being an individual but a familial matter has changed the debate also to be about individual responsibility to determine genetic risks and share the information with family members (Etchegary and Fowler 2008: 710), or about parents obligation to use genetic treatments to prevent serious disabilities in their children (Hammond 2010).

In contrast, epigenetic findings about the significance of the dynamics of the environmentally induced epigenetic mechanisms during the development put great emphasis on the living conditions and lifestyle, implying an extended range of crucial decisions and crossroads. This connects to the eternal debate about he boundary between state and individual responsibility (c.f. Mill 1859), in other words, what should be a political responsibility, i.e., common responsibility in society, and what should be the responsibility of the individual. The question of to what extent, if at all, society/the state should govern the behaviour of people, is a core issue area in political science, and bring to the fore not only ethical and existential questions about the human nature, but also the relation between integrity and autonomy of the individual and the capacity of the state to govern and implement political decisions. In the health care debate, scholars and other experts sometimes propose individual responsibility and risk behaviour as a basis for prioritisations of scarce medical resources (e.g. Dietrich 2002; Soini 2011; Swedish Priority Centre 2007), and in a recent volume on epigenetics and human health, expectations of individuals to take responsibility for epigenetic risks is sketched as a likely, but not very desirable, future scenario (Gesche 2009: 283–284). All this highlights the importance of discussing state–individual responsibility in relation to epigenetics.

Responsibility

The aim of this section is to delineate a notion of responsibility fruitful for an analysis of epigenetic responsibility. The point of departure is the standard model of ascribing responsibility by causation and cognizance to one or many actors, individually or collectively. The question of what is to be done with this responsibility calls attention to a future dimension and prospective responsibility, involving the notions of obligation and capacity. I will argue that a prospective responsibility concept is necessary when discussing issues involving complex causalities.

Causal and Moral Responsibility

Generally, holding someone responsible for an outcome is to deploy ‘reactive attitudes towards that person’ (Sneddon 2005: 241). Criteria for deploying those reactive attitudes is that the person has caused an outcome, and do not act in ignorance or under compulsion (Thompson 1987: 40). A distinction can be made between strict causal responsibility and moral responsibility, where the difference is to what extent the action in question ‘carries with it ascriptions of fault and blame’ (Miller 2001: 458) or not. Of interest here is mainly moral responsibility.

To be responsible, actors must be able to control their actions.9 For that reason, central in any discussion on responsibility is the question of the free will, i.e., ‘whether humans are free in such a way that they appropriately be seen as responsible for their actions’ (Duus-Otterström 2007: 252). Determinism, i.e., the idea that everything in the world is determined to happen, would arguably erase responsibility completely by undermining control (Fischer 1982: 33).10 Without engaging in the philosophical debate about the free will problem (see Fischer 1999 for a review), my way of reasoning resembles but does not claim to be that of incompatibilism, i.e., responsibility not being compatible with determinism.11

Knowledge of causality is ‘necessary for any understanding of responsibility’ (Adam and Groves 2011: 18), and the logic of ascribing responsibility is that the agent can be tied to an action—or non-action12—that she is able to control.13 Consequences of an action can be intentional or not (c.f. Lanteri 2009). An actor unintentionally causing a bad situation can be assigned causal but not moral responsibility, as she has not done anything blameworthy or objectionable (c.f. Talbert 2008: 516). Analogous to the dimension of intentionality is the dimension of voluntariness. A voluntary action, i.e., an action performed without compulsion, is blameworthy in the similar manner as the deliberate action and thus ascribes moral responsibility to the causing actor (c.f. Thompson 1987: 40, 47). Compulsion refers to situations when an actor is forced to do something by law and other rules inflicted on her, or by mental illness (Talbert 2008: 517). Such involuntariness mitigates or eliminates responsibility of the actor, at least as far as the understanding of responsibility is limited to the backwards-looking dimension. Compulsion could also come about by real or perceived expectations from the social context (c.f. Thompson 1987: 61–64). In sum, agents ‘should be blamed only if they could have done otherwise’ (Thompson 1987: 41).

The cognizance aspect of responsibility has to do with the role of knowledge in ascribing responsibility. A prerequisite for being ascribed responsibility is adequate knowledge about the causal relations and consequences of an action (Thompson 1987: 47). The issue of relevance is to what extent the agent is able to realise the effects of an action, the effects of not to act, or the effects of acting differently. This also holds for knowledge about right and wrong. There are situations in which what is right or wrong is not contestable; legality might be an example. In many other situations, there are no definite rights or wrongs, but even without any clear-cut answer on the question of right and wrong, there are always context-dependent norms of what constitute a right or a good behaviour. Bad actions resulting from moral ignorance (real or alleged), i.e., ignorance of moral norms, are what we normally regard as ‘paradigm cases of moral responsibility’ (FitzPatrick 2008: 590). In the case of real ignorance, responsibility is mitigated unless it is reasonable to expect that the agent should have known (in a way similar to the obligation of all members in a society to know about the law in this society).

Collective Responsibility

The problem of many actors causing an outcome raises the question of who is to be held responsible for what. Collectives are a species of population differing from aggregates in that the members of a collective have some kind of ties to each other that the aggregate individuals do not (Gilbert 2006: 95, 102). The crucial question is whether a collective can be ascribed responsibility as a collective or, differently expressed, if the responsibility for outcomes caused by many actors constituting a collective is distributive or un-distributive.

There are two different ways to reason about ascribing responsibility to collectives. The first way states that each individual associated with the collective should be equally charged with moral responsibility for the outcomes generated by that collective (Thompson 1987: 44). However, every individual in the collective does not have to be involved in the blameworthy action or plays different roles within it, or they might not even know about what the collective has done (c.f. Feinberg 1970: 69–71). A way to handle this problem is to ascribe degrees of responsibility in relation to the actual contribution of each group member. However, it is hard to isolate the contribution of each individual in a collective, as ‘causes can combine in many various different ways to bring about an outcome’ (Gerstenberg and Lagnado 2010: 166). Furthermore, assigning responsibility to individuals in collectives by degree is in fact not collective responsibility, but a case of individual responsibility.

The second and probably most contested way to ascribe responsibility to collectives is to charge responsibility for the outcomes caused by a collective to the collective as a single body (Thompson 1987: 44). A key issue is whether a collective can be considered a moral agent, a prerequisite for moral responsibility. To be a moral agent, an actor must have awareness of the moral nature of an action. If a collective has such awareness, which according to Held (1970: 97) can be the case of organised groups, then the requirements to hold a collective morally responsible is the same as for holding individuals responsible (Held 1970: 90–91), i.e., causation, cognizance, and being able to control the outcome. According to this way of reasoning, a collective can be held responsible as a single body, which ‘does not entail anything about the personal moral responsibility of members of the blameworthy collective’ (Gilbert 2006: 114). Another position is that a collective cannot be considered a moral agent, as they ‘lack the kind of control over their actions that is required’ (Mäkelä 2007: 463). This is because it is the individuals of collectives that control the aim, values, preferences, and inputs of collectives and that these individuals, individually or jointly, actually make the moral decisions of the collective (Mäkelä 2007: 462). When this is the case, moral responsibility stems not from the collective but from the moral decisions of individuals ‘in terms of the moral responsibilities of individuals’ (Downie 1969: 50).

A further crucial question for the possibility of ascribing responsibility to collectives is whether, or on which conditions individuals could be blameworthy for the action of other individuals (McGary 1986: 79). One such condition is group solidarity, which could be a basis for vicarious collective moral responsibility even though not all members are at fault (Feinberg 1970: 61–62, 73) as we cannot ‘view ourselves as being detached from the actions of groups of which we are part’ (McGary 1986: 86).

Crucial for the possibility of ascribing collective responsibility is what kind of collectives is the case in point. There are different varieties of collectives, having in common characteristics of being a body of many individuals, but varying in degree of joint commitment, organisation, decision-making procedures agreed on, and more (c.f. Held 1970: 89—90). In the case of hierarchical organisations, the dimension of authorisation is added to the collective (Gilbert 2006: 103). Formal positions in such organisations might decide who is responsible for the actions of the collective (c.f. May and Hoffman 1991: 1). This means that a superior can be charged responsibility for the action or non-action of a subordinate (May and Hoffman 1991: 11). In the case of professions, certain characteristics of such collectives make the issue of collective responsibility less problematic than in other collectives. First, in contrast to, e.g., families or states (c.f. Gilbert 2006: 112), a profession is chosen. With this choice, ‘one assumes the responsibility concomitant with being a professional’, and ‘chooses to adapt the values, methodology, rules, and customs of the profession’ (Muyskens 1982: 172). Second, there are certain collective power or rights given exclusively to every profession. This power or these rights are coupled with a collective responsibility to maintain acceptable professional standards (Muyskens 1982: 172–173). Third, professions are self-regulatory and monopolistic.14

Prospective Responsibility

So far, we have been mainly occupied with the backward-looking or retrospective question of whom to blame for a bad situation, but if responsibility should have any significance in real world situations, forward-looking or prospective responsibility must follow—or in some cases replace—the blaming. In other words, what does responsibility implicate prospectively for doing something about the bad situation?

Following the backwards-looking model of assigning responsibility to the causing actor only does not always convey a change of the bad situation. When talking about causal responsibility straightforward, it is easy to claim that the agent causing the harm has a responsibility to mitigate this harm (Miller 2001: 456), but in cases where the causing actor is no longer alive or in cases of complex causalities where the actions of many actors taken together contribute to a bad situation, ascribing backwards-looking responsibility to an actor, individually or collectively, would be restricted to just blaming, without any improvement of the bad situation. Furthermore, prospective responsibility not necessarily belongs to the agent causing the harm (Page 2008: 559). Other aspects than causality need also to be considered. Causal responsibility in itself is not sufficient to attribute responsibility to mitigate a bad situation (Miller 2001: 458). By virtue of power and resources, an agent can have a moral obligation to remedy a bad outcome irrespective of the agent’s direct role in generating that outcome (c.f. Nihlén Fahlquist 2009: 111). Obligations can also ‘arise between persons by virtue of the social processes that connect them’ (Young 2006: 102).

Generally, obligation means to have a reason to act that is not the creature of a person’s will (Gilbert 1993: 686–687). An obligation could be the result of a joint commitment, which is an interdependent agreement of two or more actors to act in a certain way (Gilbert 1993: 693–694). Another kind of obligation arises when an actor is in a position to act, notwithstanding her not being directly causally responsible for the situation at hand. Capacity to do something about a bad situation might, but need not, differ from the logic of ascribing responsibility on the basis of backwards-looking causation. The principle of capacity ‘holds that remedial responsibilities ought to be assigned according to the capacity of each agent to discharge them’ (Miller 2001: 460) or to agents in a position to act (Young 2006: 126). In this way, the capacity principle is separated from causal responsibility, which could constitute a legitimacy problem.

Apparently, the capacity principle needs somehow to be linked to the agent that is assigned responsibility. A fruitful way to handle this problem is the social connection model of responsibility proposed by Iris Marion Young (2006). By being part of social structures making certain kinds of outcomes possible, agents in society to varying extents contribute to those outcomes. Causality relations evidently are complex, but even though they would be difficult or in practice impossible to map, they do exist. Furthermore, as Young argues, the moral dimension of solidarity justifies why agents with capacity or in a position to act should be responsible in a forward-looking way.

To conclude, the standard model of responsibility has to do with identifying an actor to blame for causing a bad situation by an action that she controls, i.e., deliberately has caused to occur and could have avoided by not acting or by acting otherwise. Collectives can normally not be held responsible as a collective, but for certain kinds of collectives, like professions, it is often reasonable to ascribe responsibility collectively. Finally, and crucial for epigenetic responsibility, questions of moral responsibility do not only involve a backwards-looking dimension of attributing responsibility, but also a forward-looking dimension of decision-making and mitigating harm. The analysis of epigenetic responsibility will demonstrate how the backwards-looking and forward-looking dimensions lead to different responsibility outcomes.

Epigenetic Responsibility

The distinctive features of epigenetics are that epigenetic mechanisms governing gene expression can be modified by diet, pharmaceuticals, exercising habits, toxic exposures, and other lifestyle and environmental factors. Furthermore, the effects of these epigenetic mechanisms seem to be reversible and, in some cases, inheritable to succeeding generations. These characteristics give rise to responsibility concerns between individuals as well as between society and the individual, the latter being of primary concern here. The importance of life style and environment for health outcome is well established (c.f. Nathanson and Hopper 2010), and epigenetic research advances do not represent any changes in kind in this regard. However, they do make a change in degree. Responsibility matters would arguably be inculcated by more precise knowledge of causal processes, pointing at certain toxic substances or other environmental factors having specific molecular effects. In the following, I will point out responsibility issues concerning the state—individual relation brought to the fore by the special epigenetic features of reversibility and trans-generational inheritance of environmentally induced effects and demonstrate the consequences of ascribing responsibility according to the logics of different responsibility models. I will argue for a position holding that epigenetic responsibility should be primarily a political and not an individual responsibility.

The reversibility of epigenetic effects opens up for questions on drugs and other means to reverse disadvantageous epigenetic effects. Reversibility provides a promising market for the drug industry to develop epigenetic target drugs (c.f. Ptak and Petronis 2008: 265–267). As in drug development, generally, there is always the risk that common diseases or diseases requiring long-term—and for the drug companies profitable—medication will be privileged, at the expense of more rare diseases possible to treat by fairly limited measures (c.f. Trouiller et al. 2002). The risk would certainly occur that pharmaceutical manufacturers develop epigenetic target drugs primarily for potentially profitable diseases.15 The reversibility of epigenetic effects might also stimulate enhancements prospects (c.f. Buchanan 2011), which brings with it existential questions of responsibility to humanity and questions of which characteristics would be supported. However, for the state–individual responsibility relation, it is illustrative to consider reversibility of disadvantageous epigenetic effects in the lifestyle context.

Given that the individual has a genuine choice, it is reasonable to hold the individual causally responsible for the health effects of her lifestyle, but would the possibility to remedy those effects by drugs free the individual from moral responsibility? If the disadvantageous epigenetic effects have the cause of the lifestyle of an individual being ignorant about these causal effects, or if the actor lacks the economic or other capacities to change the bad situation, or if the suffering from these effects are so profound that not only the life quality of the individual herself, but also of her family and her relatives, is aggravating and causing big health care or social service costs—then the circumstances constitute morally justifiable reasons to exempt the individual from remedial responsibility. Basically this is the same type of problem as in relation to environmental factors. Added here is the possibility of a precise measure to remedy the epigenetic effects by directly affecting the epigenetic mechanisms. If simply taking a pill, available without prescription, could easily do this, it is, reasonably, entirely up to the individual. If, on the other hand, the reversing would be a complicated, costly, painful, and long-lasting procedure, unavailable without the involvement of medical professionals, the reversing not only concerns the individual, but the whole society in terms of resources. In the case of publicly financed health care for all, the responsibility burden of the individual herself to prevent bad epigenetic effects is particularly heavy if the reversing processes take a great amount of these resources.

The most intriguing aspect of epigenetics is the question of trans-generational inheritance, i.e., whether effects induced by environment can be transferred to subsequent generations. As referred above, there is some evidence of this in animal studies, while results on humans are rare, mainly due to research design difficulties. Nevertheless, ‘the idea that epigenetic changes might be linked to disease is well established’ (Kaati 2009: 81), and results of the Överkalix studies point in that direction. What implications would, then, trans-generational epigenetic inheritance have on responsibility for future generations? Crucial questions are what this responsibility would imply more specifically, and for whom.

If the possibility of trans-generational epigenetic inheritance could be established,16 causal responsibility between present and future generations in this respect clearly would exist, as life-style choices of now existing people affecting their epigenetic patterns would have health consequences for surviving relatives in the future. If exact inheritable patterns would be possible to map in detail—e.g., a certain diet would have a specific health effect on the grandchildren of our grandchildren—it would, possibly, be feasible to predict health effects on those individuals. However, social, economic, political, and other material and ideational structural conditions would also affect epigenetic processes, directly by contributing to physical and mental stress and wellbeing, indirectly by constraining and enabling individual choices. In short, many different factors contribute to the perpetual difficulty to establish complex causal relations. To those mentioned could also be added the dynamics of epigenetic mechanisms. All this highlights the difficulty to establish the causal links of importance for the causality responsibility model. However, as this backwards-looking responsibility model strives to isolate an actor—individual or in collective—to hold responsible, it will tend to disregard the structural factors that shape the norms of appropriate behaviour and that an integrated forward-looking responsibility model brings into question (Young 2006: 120). In this case, the structural factors of relevance are those circumstances that to varying extent constrain individual choice, i.e., social and economic factors that strike unevenly and thus contribute to unequal possibilities to actually behave causally responsible for the health of future generations.

To be able to take causal responsibility, actors must make informed decisions. This presupposes access to relevant information, in this case information and risk estimates of the epigenetic effects of nutrition, smoking habits, physical exercise, and other factors possible for the individual to decide upon herself. Furthermore, she needs capacity to act and to be able to influence the epigenetic regulatory mechanisms (c.f. Gesche 2009). Considering the complex causal relations contributing to actual possibilities to make free and voluntary choice, it would be a rather demanding task to behave in an epigenetically responsible way. Actors constrained by economic, social, and other inequalities, and who fails to act on informed decisions, run the risk of discrimination and stigmatisation if only a backwards-looking model of causal responsibility is applied.

On the other hand, actors gaining from structural inequality have better chance to make informed choices and increase future health prospects for themselves and their descendants. This would not only give them moral responsibility for future generations, but also, as the forward-looking responsibility model points out, morally responsible to work for improving the present conditions that they are a part of and gain from. However, these responsibilities could not be handled individually. The causality behind constraining social structures is a complicated web of past and present social, economic, and political factors of which no isolated actor or collective of actors could be ascribed responsibility. Due to complex causality relations, of equality reasons and of solidarity towards those worse off, the responsibility ought to be common, or shared in the way Young (2006, 2011) discusses, i.e., a political responsibility. In the individual–state responsibility divide, the responsibility to make something about he detrimental situation falls heaviest, but not exclusively, on the state.

An additional question is whether individuals with knowledge and appropriate awareness should have a greater individual responsibility in terms of contribution to health care costs. Then it would be necessary to settle a boundary between voluntary and unvoluntary choice of lifestyle. Apart from the costs of administration this would imply, it is repugnant to create different groups as a basis for different treatment of people. Such differentiation might not only lead to attempts to exceed boundaries to get personal economic advantages and, with that, weakened legitimacy of the system, but also, and most important, the risk of stigmatisation and the risk that health care treatment would be different for different groups.

Ultimately settlements of responsibility in terms of the liability for payment of health care are political decisions. In democratic societies, public opinion is reflected in political decision-making. Therefore, public perceptions of epigenetic responsibility issues are of utmost importance, as these perceptions will inform the responsibility debate. A special responsibility could be ascribed to epigenetic researchers to communicate new knowledge extracted from the results of their research (c.f. Vieth 2010). However, this is no simple matter of transferring knowledge from science to society (c.f. Carlisle et al. 2010). How this knowledge is framed, and how it is received and interpreted by the public and political decision-makers are crucial factors not only for the effects on the behaviour of individuals, but also for ideas about responsibility. Regardless if the public and political decision-makers get a correct or an incorrect idea of what epigenetics is about, public discussions on epigenetics may give rise to certain perceptions of responsibility ascriptions (c.f. Gerstenberg and Lagnado 2010: 170). Such perceptions might bring with them, e.g., expectations on individuals to care for their own health to a greater extent, and, accordingly, to bear responsibility for their own health in terms of paying for their own costly health care. Moreover, such expectations would fall heaviest on those in most need of health care, as they tend to be the poorest and less privileged (c.f. Whitehead and Popay 2010). Furthermore, expectations of this kind run the risk of stigmatise individuals or groups of individuals not demonstrating awareness of the connection between their life style and their own wellbeing. Ultimately, justice might turn out to be the main concern for epigenetic responsibility (c.f. Rothstein et al. 2009). The integrated forward-looking notion of responsibility takes exactly this into account.

Conclusion

The appropriate relation between state and individual responsibility is an eternal ideological question that is given different answers in different contexts. At present, it is an open question whether epigenetic responsibility will be ascribed to individuals or to the society at large. Epigenetic research advancements pointing at the role of individual life style for the development of disease might contribute to an emphasis on individuals’ responsibility for their own health and the health of their future descendants, potentially leading to expectations that individuals who do not avoid injurious behaviour should pay for health care, and the risk of stigmatisation of those who do not take appropriate responsibility for their own health. Such a development is, however, not self-evident. The emerging knowledge about epigenetic mechanisms also calls attention to the role of structural conditions, which as well could give rise to a focus on the role of society and the state to protect and care for health and wellbeing of individuals, present and in the future. Most likely this will not become an either–or question, but rather a question of in which proportions responsibility will be distributed between individuals and society at large. But as Gesche (2009) points out, with growing awareness of epigenetics and at times of budget restraints, expectations on individuals to take personal responsibility for health outcomes is a likely scenario. Therefore, it is important to bring forward the arguments that defend another and, I claim, more fair position. To do this, it is necessary to use a responsibility concept beyond strict causality. Even if the logic of the strict causal responsibility model could be applied, there are reasons to defend a political responsibility model. In this article, I have argued that complex causality relations, structural conditions constraining individual choice, and solidarity are important reasons to ascribe epigenetic responsibility primarily to the state.

The epigenetic research field is in the making and many questions are still unanswered. Above all, the prevalence of the trigging and hitherto uncertain question of trans-generational epigenetic inheritance remains to be established. It is urgent to begin a normative discussion about responsibility relations and for political scientists to attend to how this is dealt with in decision-making bodies. The fundamental question about the responsibility relation between individuals and society is not exclusive for epigenetic implications or even for health issues more generally, but a profound dividing line in politics. The point here is that epigenetic research advancements put this basic and eternal political controversy on edge: where does societal (collective) responsibility cease and where does individual responsibility begin? By using an integrated forward-looking model of responsibility, taking account of the possibilities to improve structural conditions constraining individual choice, it has been demonstrated that epigenetic responsibility primarily should be a societal, collective responsibility. This is not to say that individuals ought not care for their own wellbeing, but that the responsibility not only for health care costs, but also to enable healthy working conditions, housing standards, decent schools, and other structural conditions contributing to real possibilities for all people to live a epigenetically responsible, healthy life, ultimately rests on the state.

Footnotes
1

The most explored mechanisms are DNA methylation and histone modification. DNA methylation refers to processes of redirections of methyl groups to a gene, making it inactive. Histone modification refers to modifications of the proteins that package DNA. Other mechanisms include regulation by noncoding RNAs, and mechanisms controlling the organisation of chromatin (Jirtle and Skinner 2007: 253).

 
2

The evolutionist Jean-Baptiste Lamarck (1744–1829) suggested that acquired characteristics were passed on to next generation (Richards 2006: 399).

 
3

The term epigenetics (derived from Greek epi, meaning ‘upon’, and genetics) literally means ‘upon genetics’ (Zhang and Meaney 2010: 447) or ‘in addition to changes in genetic sequence’ (Weinhold 2006: 163).

 
4

One such study of the Dutch famine during the ‘hunger winter’ 1944–1945 (Lumey et al. 2007) reported that offspring born during this time were smaller than average and that this effect could persist for two generations, but these findings appeared to be difficult to reproduce (Morgan and Whitelaw 2008: 395).

 
5

For instance, different environmental toxins have been shown to affect epigenetic modifications being implicated in cancer and cardiovascular disease (Wrobel et al. 2009: 482); children born after in vitro fertilisation are more frequently seen with certain disorders (Kato et al. 2005: 624); rodent experiments have shown apparent stress reactions in the offspring deprived of maternal care in the form of pup licking long after the care giver was gone, a result pointing at possible long-term epigenetic effects (Szyf et al. 2007: 15).

 
6

Other novelties with epigenetics compared to the old paradigm of genetics: epigenetics refers to functional and not structural changes in DNA; e. indicates a gradual and not a leap wise development of nature; e. might come to overcome the genetics–nature divide. E. may also explain self-organisation of the living being. (Vineis 2009)

 
7

Although there is always the eternal question of the free will, here it will suffice to stipulate that certain factors are definitely out of control for the individual.

 
8

Our genes are given to us by heritage, so we are normally not viewed responsible for what these genes make us become. In contrast, we sometimes refer to our genes as an excuse for bad performance (Lewitt and Manson 2007). However, both in not a very distant history with compulsory sterilisation of individuals with ‘defective genes’ (c.f. Hansen and King 2001), and in recent debates about gene tests in reproduction matters, individuals have been ascribed responsibility for how they act on their gene set-up (c.f. Hammond 2010).

 
9

Different theories associate responsibility with control, or freedom to do otherwise; willing action or acting freely; or free or uncompelled action (Fischer 1982: 87). In this article control is the main guiding principle. Control here refers to ‘the power to determine whether or not’ something occurs (Kane 2002: 698).

 
10

Responsibility theorists disagree about the truth of determinism and about determinism being consistent with responsibility or not, the so called free will problem. Compatibilism, on the one hand, is the position that determinism is compatible with responsibility, while incompatibilism, on the other hand, is the position that determinism is not compatible with responsibility. Incompatibilists either deny the truth of determinism, or the possibility of responsibility if determinism is true (Duus-Otterström 2007: 248–254).

 
11

I do not, however, take a stand in the metaphysic question of the truth of determinism, but rather assume that people are able to make decisions for which they can be held responsible.

 
12

The same logic applies for action and non-action. For the sake of argument I will talk about actions only.

 
13

Although intuitively reasonable, this statement is in no way uncontroversial. There is a lively philosophical debate about e.g. the necessity of alternative possibilities for an actor to be able to act responsible or not (for a review, see Fischer 1999).

 
14

Political representatives are responsible in a similar manner as professions. However, the assigning of responsibility to political representatives is circumscribed with the rules and procedures that come with (democratic) accountability, which in some respects is analogous to the relation in hierarchical organisations between superior and subordinate (c.f. Lewin 2007: 3).

 
15

As the widespread illnesses of diabetes and cardiovascular disease have been associated with epigenetic effects (c.f. Jirtle and Skinner 2007: 253), it is likely that epigenetic factors involved in these diseases will be attractive targets for new drugs.

 
16

In this part of the analysis I will make the assumption that trans-generational inheritance does exist.

 

Acknowledgments

I would like to acknowledge the helpful comments received on earlier versions of this article from Ulf Mörkenstam, Magdalena Bexell, Göran Duus-Otterström, Annika Björkdahl, Dalia Mukhtar-Landgren, Johannes Lindvall, and the anonymous reviewers of this journal.

Copyright information

© Springer Science+Business Media B.V. 2011