This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (41)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Topic Collections  • Law and Medicine  • Medical Ethics  • Genetic Counseling/ Testing/ Therapy  • Alert me on articles by topic

Kenneth Offit, MD, MPH; Elizabeth Groeger, BA; Sam Turner, JD; Eve A. Wadsworth, BA; Mary A. Weiser, RN, JD

JAMA. 2004;292:1469-1473.

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 Turner).

RELATED LETTER

Duty to Warn About Hereditary Disease Risks
Daniel P. Sulmasy
JAMA. 2005;293(6):676.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ethical and Legal Implications of Cancer Genetic Testing: Do Physicians Have a Duty to Warn Patients' Relatives About Possible Genetic Risks?
Storm et al.
J Oncol Pract 2008;4:229-230.
FULL TEXT  

Medical Ethics for the Genome World: A Paper from the 2007 William Beaumont Hospital Symposium on Molecular Pathology
Ormond
J. Mol. Diagn. 2008;10:377-382.
ABSTRACT | FULL TEXT  

From Genetics to Genomics: Ethics, Policy, and Parental Decision-making
Wilfond and Ross
J Pediatr Psychol 2008;0:jsn075v1-jsn075.
ABSTRACT | FULL TEXT  

Genetic Testing for Cancer: Legal, Ethical, and Practical Issues for the Practicing Oncologist
Goss
J Oncol Pract 2008;4:64-65.
FULL TEXT  

Direct contact in inviting high-risk members of hereditary colon cancer families to genetic counselling and DNA testing
Aktan-Collan et al.
J. Med. Genet. 2007;44:732-738.
ABSTRACT | FULL TEXT  

Management of an Inherited Predisposition to Breast Cancer
Robson and Offit
NEJM 2007;357:154-162.
FULL TEXT  

Should healthcare providers have a duty to warn family members of individuals with an HNPCC-causing mutation? A survey of patients from the Ontario Familial Colon Cancer Registry
Kohut et al.
J. Med. Genet. 2007;44:404-407.
ABSTRACT | FULL TEXT  

Bibliography for Ethics, Professionalism, and End of Life Care
Focus 2007;5:417-419.
FULL TEXT  

Preimplantation Genetic Diagnosis for Cancer Syndromes: A New Challenge for Preventive Medicine
Offit et al.
JAMA 2006;296:2727-2730.
FULL TEXT  

Patient Confidentiality vs Disclosure of Inheritable Risk: A Survey-Based Study
Erde et al.
JAOA: Journal of the American Osteopathic Association 2006;106:615-620.
ABSTRACT | FULL TEXT  

Letting the family know: balancing ethics and effectiveness when notifying relatives about genetic testing for a familial disorder
Suthers et al.
J. Med. Genet. 2006;43:665-670.
ABSTRACT | FULL TEXT  

Do French lay people and health professionals find it acceptable to breach confidentiality to protect a patient's wife from a sexually transmitted disease?
Guedj et al.
J. Med. Ethics 2006;32:414-419.
ABSTRACT | FULL TEXT  

Deliberate Deceit of Family Members: A Challenge to Providers of Clinical Genetics Services
Loud et al.
JCO 2006;24:1643-1646.
FULL TEXT  

Sharing BRCA1/2 Test Results With First-Degree Relatives: Factors Predicting Who Women Tell
Patenaude et al.
JCO 2006;24:700-706.
ABSTRACT | FULL TEXT  

Research and Practice Opportunities at the Intersection of Health Education, Health Behavior, and Genomics
Wang et al.
Health Educ Behav 2005;32:686-701.
ABSTRACT  

Duty to Warn About Hereditary Disease Risks
Sulmasy
JAMA 2005;293:676-676.
FULL TEXT  

Family Privacy and Death -- Antigone, War, and Medical Research
Annas
NEJM 2005;352:501-505.
FULL TEXT  

Practical and Ethical Issues with Genetic Screening
Wagner
ASH Education Book 2005;2005:498-502.
ABSTRACT | FULL TEXT