Responsibility in the age of Developmental Origins of Health and Disease (DOHaD) and epigenetics

* Address for correspondence: H. Ismaili M’hamdi, Medical Ethics and Philosophy, Erasmus MC, Rotterdam, 3000 CA, The Netherlands. (Email [email protected])

Introduction

Insights from the Developmental Origins of Health and Disease (DOHaD) paradigm and epigenetics are elucidating the biological pathways through which social and environmental cues affect human health. These insights do not only advance biological and medical knowledge. They also lay bare the biological effects of social inequities on the health and well-being of individuals. The implications of these new insights raise ethical concerns that warrant discussion. These concerns are presented in this article.

Insights from DOHaD and epigenetics describe how social deprivation and poverty become biologically impinged. ¹ Adverse fetal and childhood exposures such as poor environmental quality, stress, smoking, drinking and poor nutrition all of which are typically associated with life in an underprivileged environment, leave developmental and epigenetic traces on the developing fetus. Together, these socio-biological traces not only maintain but also exacerbate the effects of social deprivation, thereby propagating the persistence of health disparities, from early life to adulthood. ² Moreover, ‘there is a strong rationale to consider developmental and epigenetic mechanisms as links between early life environmental factors like maternal stress during pregnancy and adult race-based health disparities in diseases like hypertension, diabetes, stroke, and coronary heart disease.’ ³ These factors have durable and even transgenerational adverse effects on health thereby propagating existing race-based health inequalities. ³

Despite this knowledge about the possible social and racial mechanisms underpinning health inequalities, health is increasingly being described and presented as a matter of individual responsibility; thereby suggesting that one’s health mirrors one’s efforts to be healthy. This view on health encourages a passive response from policymakers. In this article we argue that this oversimplified view on individual responsibility for health may be reinforced by an oversimplified interpretation of DOHaD and epigenetics. We will present an ethical framework to assist professionals and policymakers to determine the balance between individual and societal responsibility for health that takes into account the evolving insights of DOHaD and epigenetics.

We argue that the concepts avoidability and fairness are of critical importance for the proper assessment of responsibility. Building on the work of political philosopher John Rawls, we present a philosophical distinction between individual responsibility and social...