How does a practitioner reconcile the obligation to respect the patient's right to privacy with a desire not to cause her relatives harm by failing to inform them of their risk? She is planning to discuss the results with her teenage daughter but insists that her younger adult half-siblings (from her father's second marriage after her mother's and father's divorce) not be told that they might be at risk for this disorder and that testing is available. The judges wrote that “there is no essential difference between the type of genetic threat at issue here and the menace of infection, contagion, or a threat of physical harm.” They added that the duty to warn relatives is not automatically fulfilled by telling the patient that the disease is hereditary and that relatives need to be informed.ĭuty to Warn Patient Autonomy and Privacy versus Preventing Harm to OthersĪ woman first presents with an autosomal dominant disorder at the age of 40 years, undergoes testing, and is found to carry a particular mutation in a gene known to be involved in this disorder.
In the realm of genetics, a duty to warn was mandated in a case in New Jersey, Safer v Estate of Pack (1996), in which a panel of three judges concluded that a physician had a duty to warn the daughter of a man with familial adenomatous polyposis of her risk for colon cancer. The judges declared that this situation is no different from one in which physicians have a duty to protect the contacts of a patient with a contagious disease by warning them that the patient has the disease, even against the express wishes of the patient. In the 1976 State Supreme Court case in California, Tarasoff v the Regents of the University of California, judges ruled that a psychiatrist who failed to warn law enforcement that his client had declared an intention to kill a young woman was liable in her death.
The precedent-setting case was not one involving genetics. Judges have ruled in a number of court cases in the United States on whether or not a health care practitioner is permitted or is even required to override a patient's wishes for confidentiality.
In this situation, is the genetics practitioner obligated to respect the patient's autonomy by keeping information confidential, or is the practitioner permitted or, more forcefully, does the practitioner have a duty to inform other family members and/or their providers? Is there a duty to warn? If so, is informing the patient that he or she should share the information with relatives sufficient to discharge the practitioner's duty? A serious ethical and legal dilemma can arise in the practice of genetic medicine when a patient's insistence that his or her medical information be kept strictly private restrains the geneticist from letting other family members know about their risk for a condition, even when such information could be beneficial to their own health and the health of their children (see Box ). Genetics, however, more than any other branch of medical practice, is concerned with both the patient and the family. Nussbaum MD, FACP, FACMG, in Thompson & Thompson Genetics in Medicine, 2016 Duty to Warn and Permission to WarnĪ patient's desire to have his or her medical information kept confidential is one facet of the concept of patient autonomy, in which patients have the right to make their own decisions about how their individual medical information is used and communicated to others.
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