
Ethical Obligations and Genetic Screening
This blog discusses how OB/GYNs need not only to understand the science behind genetic screening but also to counsel patients properly about the results.
ACOG’s recent
These tests are difficult to explain to patients and even more difficult to interpret. Practices who employ a genetic counselor obviously have a simple solution to this dilemma, but genetic counselors are in short supply, and few physicians in private practice have one available for consultation.
While this might appear to be more a practice management and communication issue than an ethical one, when we fail to properly educate and counsel our patients, and they make decisions based upon inadequate or inaccurate information, we actually failed to respect their autonomy. Our duty to patient autonomy includes providing them with the information necessary to make good choices predicated in their values. This requires us, in turn, to both give adequate information and to describe all the appropriate choices in a non-directive manner. It is simply ludicrous to believe we can do this in a 10-minute visit sandwiched between the other responsibilities of the follow-up appointment.
Time constraints are only one of the ethical challenges posed by these new genetic technologies. Equally important-and concerning-is our own need to remain abreast of these tests and what they can and cannot do. While Sequenom boasts sensitivity and specificity
Few of us remember statistics well enough to explain this clearly and accurately to a patient, and this explanation is crucial to ensuring that patients only terminate desired pregnancies when the fetus actually has the abnormality suggested by the screening test. One
I admit when I first saw the impressive accuracy of cell-free DNA screening I thought the amniocentesis had found its replacement, but when you do the math, you see this is not the case. As that
When training ethics consultants at our institution, I often belabor the point that they must understand the medicine in order to understand the ethics of a particular medical question. The corollary to this, and it is relevant to genetic testing in our obstetrical patients, is that we must understand the medicine in order to appropriately counsel our patients. Failing to counsel our patients properly is a breach of our duty to the patient. We must know the science to be ethical physicians. We must also find the time, or find someone who has the time. These twin responsibilities are crucial and admittedly difficult, but we owe it to our patients to provide them with the information and time to make these vital, life-altering choices.
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