Guest post by Sandi Dheensa, Angela Fenwick and Anneke Lucassen
Imagine you’re a clinician in genetic medicine. For a while, you’ve been seeing Joe Bloggs, a patient with a mutation in a gene that’s caused a hereditary form of colon cancer. As is your standard practice, you help Joe identify who in his family is also at risk and spend some time talking about how he’ll tell them. The Bloggs’ are a large bunch: Joe has children, siblings, nieces, nephews, aunts, uncles, and cousins, all of whom might have the mutation. Anyone who tests positive would be eligible for regular bowel screening, which – while not pleasant – makes it much more likely that any cancer will be caught at a treatable stage. Unfortunately, despite all this, you’ve reason to believe that Joe hasn’t told his relatives anything and now you’re unsure what to do.
What are your options? You might say Joe’s confidentiality and autonomy are paramount: it’s up to him what he does, and, as his doctor, you’ve done your part by telling him the cancer is heritable. Or you might argue that Joe’s family needs to know – but how and when? The GMC says you can share a patient’s personal information without consent if the benefit of doing so outweighs the risk: does the situation meet this criterion? What if you share the information and Joe sues you for breaching his confidentiality? But what if you don’t say anything and a relative develops a cancer that could’ve been prevented? Won’t their trust in the health service be shaken if they knew you’d chosen not to share?
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.