The Duty to Warn a Patient's Family Members About Hereditary Disease Risks

[Guest guest]

Abstract From Journal of American Medicine Vol. 292 No. 12, September

22/29, 2004

JAMA. 2004;292:1469-1473.

The " Duty to Warn " a Patient's Family Members About Hereditary Disease

Risks

Offit, MD, MPH; Groeger, BA; Sam , JD; Eve A.

Wadsworth, BA; A. Weiser, RN, JD

Genetic tests for adult-onset disorders, including common forms of

cancer, are now commercially available, and tests for genetic

polymorphisms that predict drug effects or toxicity after treatment are

under development. For each of these circumstances, testing of 1

individual may imply an increased risk to his/her relative.

The obligation, if any, to warn family members of the identification of

a genetic mutation has generated concerns regarding the conflict between

the physician's ethical obligations to respect the privacy of genetic

information vs the potential liabilities resulting from the physician's

failure to notify at-risk relatives. A duty to warn relatives about

risks due to some infectious agents has been assumed by state and local

health agencies, and the duty to breach confidentiality to warn of

imminent harm has been the subject of case law.

In general, the special nature of genetic tests has been viewed as a

barrier to physicians' breaching the confidentiality of personal genetic

information. However, the failure to warn family members about

hereditary disease risks has already resulted in 3 lawsuits against

physicians in the United States.

While the findings of case law and the state and federal statutes that

bear on the issue of " duty to warn " of inherited health risk are still

being defined, we believe that health care professionals have a

responsibility to encourage but not to coerce the sharing of genetic

information in families, while respecting the boundaries imposed by the

law and by the ethical practice of medicine.

Author Affiliations: Clinical Genetics Service, Department of Medicine

(Dr Offit and Mss Groeger and Wadsworth), and Office of Legal Affairs

(Ms Weiser), Memorial Sloan-Kettering Cancer Center, New York, NY; and

Ropes and Gray LLP, Washington, DC (Mr ).