Elsevier

The Lancet

Volume 357, Issue 9261, 31 March 2001, Pages 1033-1035
The Lancet

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Revealing false paternity: some ethical considerations

https://doi.org/10.1016/S0140-6736(00)04240-9Get rights and content

Introduction

Advances in genetic research are allowing increasing numbers of conditions to be diagnosed at the molecular level. Confirmation of a genetic condition in one person almost invariably has implications for others: tests reveal information not only about the person tested but also about their relatives and descendants, who may themselves be affected or be carriers of the condition. Clinicians handling such information may sometimes face the problem of to whom such information belongs and whether other family members should be informed.

The dilemma is perhaps brought most clearly to focus by situations where testing shows unexpected information not requested by the patient. One example of this is the discovery that paternity has been misattributed. When combined with a confirmed diagnosis of a genetic condition, such information can be of great importance to the making of informed reproductive choices for both partners. We discuss some of the ethical issues that surround such a finding using the following case.

John and Sarah attend the genetics clinic after the diagnosis of an autosomal-recessive condition in their newborn baby. The disorder is severe and debilitating and there is a high chance that the child will die in the first year. The gene for this disorder has just been mapped and there is a possibility that prenatal diagnosis would be possible in a future pregnancy. John and Sarah give their consent for a blood sample to be taken for DNA extraction, from themselves and their affected child. Molecular analyses of these samples shows that John is not the biological father of the child.

At their first consultation, when the condition was explained to them, they were told that there is a 25% chance that any future baby of theirs will be affected. The carrier frequency for this condition is about one in 1000 and thus the chance that John is also a carrier (since he is not the biological father) is in fact negligible.

Should the geneticist disclose the finding of nonpaternity to the parents when they come back to the clinic as part of their on-going counselling? Although they did not seek information about paternity, it is of direct relevance to their understanding of the probability of an affected child in future pregnancies. In this paper we explore the ethical arguments in favour of and against the disclosure of misattributed paternity in this type of case and make suggestions for future practice. We do not consider the disclosure of non-paternity in all situations. We limit our discussion to this type of case where both members of a couple are the geneticist's patients and where the information has reproductive implications for both partners. But what is current practice?

Section snippets

Current perspectives in clinical practice

The consensus emerging from the literature is not to tell the husband directly of the result. Only one report recommends disclosure to both partners (the 1983 President's Commission on the Ethical Issues of Genetic Testing1, 2). In 1994, the Committee on Assessing Genetics Risks of the Institute of Medicine in the USA recommended that in such cases only the woman should be informed as “genetic testing should not be used in ways that disrupt families”.3 Surveys of clinical geneticists and

Ethical arguments against disclosing paternity

Some clinicians would tell only Sarah, considering it her responsibility to decide whether or not to discuss this with her husband.4, 6 One argument in favour of this position is that to disclose such information to John would constitute a breach of the clinician's duty of confidentiality to Sarah. Consider a different situation: following a healthy pregnancy and birth Mary visits her general practitioner (GP) for her routine 6 week postnatal visit. Mary's husband, Peter, is registered with the

In favour of disclosing paternity

The question of what is best for the couple or best for the child raises the broader question of the responsibilities of the clinical geneticist to the patient. Should the clinical geneticist do what is best for patients, taking everything into account, for example, to protect the couple from splitting up? Is the geneticist ever in a position to be able to make an accurate assessment of this? Or is it their responsibility simply to provide patients with all the relevant information and to help

A way forward?

This example is an issue that is increasingly confronted in clinical genetics and these ethical arguments thus have implications for practice in the clinical setting. In our opinion the arguments in favour of disclosure are significantly stronger than those against.

In practice, this suggests that in situations where DNA testing could reveal non-paternity this should be raised at the outset. Raising the possibility before genetic testing minimises the ethical dilemmas encountered when such tests

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