The Promise and Peril of Precision Medicine : How Asian Perspectives on Naturalness Can Help to Reframe Disability Narratives.

The dominance of ableist assumptions in precision medicine has recently been challenged, notably by Mintz, Stramondo, and Tabor (2024). Yet a similarly radical critique exists in Daoist traditions, particularly in the philosophy of Zhuangzi. While Mintz, Stramondo, and Tabor call for greater disability inclusion in genetics and genomics, they do not fully engage with how cultural and philosophical worldviews shape responses to genetic intervention. Drawing on our research on preimplantation genetic testing for monogenic disorders (PGT-M), we argue that concepts like ziran (naturalness) and wuwei (non-action) can deepen our understanding of disability inclusion, particularly in Asian contexts. The comparatively restrictive approval of PGT-M in Asia reflects cultural discomfort with disrupting what is seen as nature's course. Zhuangzi's allegories-especially those illustrating "the usefulness of the useless"-challenge dominant hierarchies of ability and provide clinicians with tools to engage more sensitively with patients who may see genetic testing as ethically troubling. This paper integrates Daoist insights to propose a globally inclusive bioethics, one that affirms non-intervention as a legitimate stance and broadens how we conceive of naturalness, disability, and autonomy. By doing so, we aim to enrich debates around precision medicine and support ethically pluralistic genomic care.