Professional Documents
Culture Documents
Ethical Issues About Genetic Testing
Ethical Issues About Genetic Testing
Pamorca
Grade and Section: 8-Einstein
Before the appropriate process for obtaining consent for genetic tests is considered, it is necessary to confront the broader question of whether the consequences
of the results of those tests are substantively different from the consequences of other "medical" tests, for which specific consent is not always obtained. Some
ethicists argue against what has been called the "exceptionalism" of genetic tests . They maintain that many medical tests have consequences for patients that
are similar to those of genetic tests. For example, there can be discrimination by insurance companies against individuals either with a genetic disease or with a
disease that is not linked to any particular gene. Results of nongenetic tests, as well as genetic tests, can divulge information about family members (eg, tests for
sexually transmitted diseases). Additionally, both genetic and nongenetic tests can provide information about a person's medical future. As such, some authors
have concluded that many genetic test results "may cause stigmatization, family discord and psychological distress. Regardless of whether a test is genetic,
when this combination of characteristics is present…testing should be performed with particular caution and the highest standards of informed consent and
privacy protection should be applied".
Role of the Obstetrician–Gynecologist
In addition to needing to ensure proper consent, the obstetrician–gynecologist who orders genetic tests should be aware of when it is appropriate to test, which
particular test to order, and "what information the test can provide, the limitations of the test, how to interpret positive and negative results in light of the
patient's medical or family history, and the medical management options available" . The health care provider ordering tests has a responsibility to use and
interpret those tests correctly or to refer to someone with relevant expertise. Because completing all these tasks is particularly difficult when direct-to-consumer
marketing of genetic tests is used, that marketing approach has significant limitations . These enterprises receive compensation only if an individual, after
counseling, chooses to undergo a test, bringing the standard of neutral counseling into question and further rendering the use of a market-driven approach to
testing ethically problematic . In the end, the physician plays an important role in providing adequate, neutral counseling; ensuring informed consent; and
providing follow-up for genetic tests. Neutral counseling also may be compromised through the use of patient educational materials or counselors that are
provided by a company that might profit from a patient's decision to undergo testing.
Genetic Testing in Children and Adolescents
Testing of children presents unique issues in counseling and consent. Although it is most commonly pediatricians or geneticists who are called on to test
children for genetic diseases, obstetricians may be asked to test already born children of parents who, through the process of prenatal testing, have been found
to be carriers of genetic diseases. In such cases, the physician should balance the rights of the parents to have information that can optimize the ongoing health
care of their children against the rights of the children to have their best interests protected. There will be circumstances in which it can be determined that a
child is at risk for an untoward clinical event in the future, but there may be no information about interventions that have the potential to reduce the likelihood
of that event or the magnitude of its effect. In that circumstance, the benefits of testing a child are not always clear.