Legal and ethical issues in genetic testing
and counselling for susceptibility to breast, ovarian and colon cancer
Bernard M. Dickens, PhD, LLD; Nancy Pei, BScPharm, LLB; Kathryn M. Taylor, PhD
Canadian Medical Association Journal 1996; 154: 813-818
Dr. Dickens is professor of law, Faculty of Law, Faculty of Medicine and Joint Centre for Bioethics, University of Toronto, Toronto, Ont. Ms. Pei is a graduate of the Faculty of Law, University of Toronto, Toronto, Ont. Dr. Taylor is associate professor, Department of Administrative Studies, York University, North York, Ont.
This is the third in a series on genetic screening for heritable breast, ovarian and colon cancer. The first two articles appeared in the Jan. 15 and Feb. 15, 1996, issues.
Paper reprints of the full text may be obtained from: Dr. Bernard M. Dickens, Faculty of Law, University of Toronto, 84 Queen's Park, Toronto ON M5S 2C5; fax 416 978-7899; bernard.dickens@utoronto.ca
Abstract
The prediction of susceptibility to heritable breast, ovarian and colon cancer raises important legal and ethical concerns. Health care professionals have a duty to disclose sufficient information to enable patients to make informed decisions. They must also safeguard the confidentiality of patient data. These duties may come into conflict if a positive finding in one patient implies that family members are also at risk. A legal distinction is made between a breach of confidentiality and the legitimate sharing of information in a patient's interest or to prevent harm to a third party. Physicians also have a fiduciary duty to warn. Other issues concern the legal liability assumed by genetic counsellors, whose disclosures may influence decisions about childbearing, for example, and the risk of socioeconomic discrimination faced by people with a known genetic susceptibility. Traditional ethical orientations and principles may be applied to these and other questions, but feminist ethics will likely have particular importance in the development of an ethical stance toward testing and counselling for heritable breast and ovarian cancer.
| CMAJ March 15, 1996 (vol 154, no 6) |