Should doctors have a legal duty to warn relatives of their genetic risks?

• Published in: The Lancet (British edition) 2019-12, Vol.394 (10215), p.2133-2135
• Main Authors: Middleton, Anna, Milne, Richard, Robarts, Lauren, Roberts, Jonathan, Patch, Christine
• Format: Article
• Language: English
• Subjects: Confidentiality - legislation & jurisprudence; Domestic violence; Duty to warn; Duty to Warn - ethics; Duty to Warn - legislation & jurisprudence; England; Ethical standards; Ethics, Medical; Genetic Counseling - ethics; Genetic Counseling - legislation & jurisprudence; Genetic Diseases, Inborn - genetics; Genetic Predisposition to Disease - genetics; Genomics; Health care; Health risks; Humans; Huntingtons disease; Liability, Legal; Medical ethics; Medicine; Patients; Physician's Role; Physicians; Public concern; Public Opinion; Risk assessment; Risk communication; State Medicine - ethics; State Medicine - legislation & jurisprudence
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(19)32941-1

The JCGM also states that if a breach of patient confidentiality is necessary then the clinician should “attempt to obtain consent to disclosure from the patient” and if that is not possible they should: “(a) Discuss the case with experienced professional colleagues (eg, hospital clinical ethics committee, Genethics forum). (b) Tell the patient that you intend to breach this confidence and why. (c) Contact a relative where it is practical and reasonable to do so. (d) Keep any disclosure to the minimum that is strictly necessary for the communication of risk. (e) Record the balancing act undertaken and justification for breaching confidence.” [...]as prominent Australian Judge Sir Anthony Mason said: “because the courts are concerned with maintaining public confidence in the administration of justice, judges cannot dismiss public opinion as having no relevance at all to the work of the courts”.7 The outcome of this court case, which is expected in spring, 2020, will have important implications for how people experience health care and genetic medicine; specifically, it could make it more likely that clinicians would be sued if they do not inform (in exceptional circumstances) a relative of their genetic risks of disease. Genomic medicine is increasingly becoming part of routine health care and within the next 5 years genomic data will be gathered from an estimated 60 million people in clinical settings worldwide.8 Within genomic medicine services, there is a recognition that genetic information is family information—ie, genetic information belongs to, and is shared between, several people.9 Thus, as genomics is mainstreamed across health care in the coming years, clinicians need to appreciate that genetic information is not always treated the same as other health-care information.