Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Duty to Warn About Hereditary Disease Risks

Duty to Warn About Hereditary Disease Risks To the Editor: Dr Offit and colleagues1 conclude that, in general, physicians have a duty to advise patients with genetic disorders of an obligation to inform their relatives, but that physicians do not have a duty to breach patient confidentiality to warn patients’ relatives directly. This is consonant with the beliefs of the public.2 The authors argue cogently that the precedent of the Tarasoff case3 may not apply from a legal perspective because confidentiality still has an important role in medical practice (now strengthened by Health Insurance Portability and Accountability Act regulations), and genetic disorders may not have a high penetrance and may not be treatable. From an ethical perspective, this case diverges from the Tarasoff precedent in 2 other important ways.4 First, the lack of imminence of the harm from genetic disorders offers many other opportunities for affected relatives to learn of their diagnosis, so that all means of notification short of breaching confidentiality have not been exhausted. This includes the possibility that the health care professionals caring for the relative will make the diagnosis themselves, without any information from those treating the proband, since the relative will contain the necessary information in his or her own genome. Second, in genetic diseases the patient is not the agent of the harm to the innocent third party. Tatiana Tarasoff’s murderer was the agent of her harm. In extending the “duty to warn” to cases of infectious disease such as HIV, the infected patient is still the agent of harm to others. However, claims of wrongful birth notwithstanding, this is not true in cases of genetic disease, and it significantly diminishes the claim for any warrant to override the patient’s confidentiality. In the coming era of genetic medicine, it will be critically important not to overextend the Tarasoff precedent and to defend patient confidentiality in this circumstance. This letter was shown to Dr Offitt, who declined to reply.—ED. References 1. Offit K, Groeger E, Turner S, Wadsworth EA, Weiser MA. The “duty to warn” a patient's family members about hereditary disease risks. JAMA. 2004;292:1469-147315383518Google ScholarCrossref 2. Lehmann LS, Weeks JC, Klar N, Biener L, Garber JE. Disclosure of familial genetic information: perceptions of the duty to inform. Am J Med. 2000;109:705-71111137485Google ScholarCrossref 3. Tarasoff v the Regents of the University of California, 551 P 2d 334 (Cal 1976) 4. Sulmasy DP. On warning families about genetic risk: the ghost of Tarasoff. Am J Med. 2000;109:738-73911137492Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Duty to Warn About Hereditary Disease Risks

Sulmasy, Daniel P.
JAMA , Volume 293 (6) – Feb 9, 2005
Download PDF
1 page

Duty to Warn About Hereditary Disease Risks

Abstract

To the Editor: Dr Offit and colleagues1 conclude that, in general, physicians have a duty to advise patients with genetic disorders of an obligation to inform their relatives, but that physicians do not have a duty to breach patient confidentiality to warn patients’ relatives directly. This is consonant with the beliefs of the public.2 The authors argue cogently that the precedent of the Tarasoff case3 may not apply from a legal perspective because confidentiality still has an important...
Loading next page...
 
/lp/american-medical-association/duty-to-warn-about-hereditary-disease-risks-7kTN3yKbGm

References (4)

Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.293.6.676
Publisher site
See Article on Publisher Site

Abstract

To the Editor: Dr Offit and colleagues1 conclude that, in general, physicians have a duty to advise patients with genetic disorders of an obligation to inform their relatives, but that physicians do not have a duty to breach patient confidentiality to warn patients’ relatives directly. This is consonant with the beliefs of the public.2 The authors argue cogently that the precedent of the Tarasoff case3 may not apply from a legal perspective because confidentiality still has an important role in medical practice (now strengthened by Health Insurance Portability and Accountability Act regulations), and genetic disorders may not have a high penetrance and may not be treatable. From an ethical perspective, this case diverges from the Tarasoff precedent in 2 other important ways.4 First, the lack of imminence of the harm from genetic disorders offers many other opportunities for affected relatives to learn of their diagnosis, so that all means of notification short of breaching confidentiality have not been exhausted. This includes the possibility that the health care professionals caring for the relative will make the diagnosis themselves, without any information from those treating the proband, since the relative will contain the necessary information in his or her own genome. Second, in genetic diseases the patient is not the agent of the harm to the innocent third party. Tatiana Tarasoff’s murderer was the agent of her harm. In extending the “duty to warn” to cases of infectious disease such as HIV, the infected patient is still the agent of harm to others. However, claims of wrongful birth notwithstanding, this is not true in cases of genetic disease, and it significantly diminishes the claim for any warrant to override the patient’s confidentiality. In the coming era of genetic medicine, it will be critically important not to overextend the Tarasoff precedent and to defend patient confidentiality in this circumstance. This letter was shown to Dr Offitt, who declined to reply.—ED. References 1. Offit K, Groeger E, Turner S, Wadsworth EA, Weiser MA. The “duty to warn” a patient's family members about hereditary disease risks. JAMA. 2004;292:1469-147315383518Google ScholarCrossref 2. Lehmann LS, Weeks JC, Klar N, Biener L, Garber JE. Disclosure of familial genetic information: perceptions of the duty to inform. Am J Med. 2000;109:705-71111137485Google ScholarCrossref 3. Tarasoff v the Regents of the University of California, 551 P 2d 334 (Cal 1976) 4. Sulmasy DP. On warning families about genetic risk: the ghost of Tarasoff. Am J Med. 2000;109:738-73911137492Google ScholarCrossref

Journal

JAMA – American Medical Association

Published: Feb 9, 2005

There are no references for this article.