Counterfactual Thinking and the Identity Problem: The Casus of Communication about Genetic Risks


 The subject of this article is counterfactual thinking as a tool in geneticist-patient communication under conditions of uncertainty. The article focuses on the use of the counterfactual narrative as one of the main components of doctor-patient communication in the framework of making decisions about future treatment. The conditions for the use of the counterfactual narrative are considered, taking into consideration two features: the logic of predetermination and the influence of overpersonal forces and notions of kinship that contribute to the deindividualization of the patient. Based on A.S. Karpenko's formulation of the concept of possibility, a heuristic approach to sketching possible scenarios for treatment during genetic counseling is outlined. The novelty of the study lies in the analysis of the problem of self-future identity, constructed by the patient in the counterfactual narrative. This problem is examined using two thought experiments. The first thought experiment (concerning the fate of the unborn child - D. Bunin) reveals the identity problem itself. The second (concerning non-derministic behavior of a flipped coin - C. Dorst) shows how this problem is disclosed under conditions of uncertainty. It is shown that in creating possible scenarios of disease and its treatment with counterfactuals it is important to take into account "necessary properties" (U. Eco) of the patient, focusing on qualitative, not numerical identity. In the last section of the article this conclusion is justified in the light of the concept of narrative identity, through which the counterfactual can be revealed.
