Article

Ethicolegal aspects of cancer genetics.

Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Cancer treatment and research 01/2010; 155:1-14. DOI: 10.1007/978-1-4419-6033-7_1
Source: PubMed

ABSTRACT In the wake of efficacious preventive interventions based on hereditary cancer risk assessment, a number of ethical and legal challenges have emerged. These include issues such as appropriate testing of children and embryos, the "duty to warn" relatives about familial risk, reproductive genetic testing, the risk of genetic discrimination, and equitable access to testing. These and other issues will be discussed within the framework of a bioethical model, with reference to recent case law.

0 Followers
 · 
58 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oncologists are asked with increasing frequency to counsel their patients with respect to the medical, psychological and social repercussions of genetic testing for cancer susceptibility that may have been prescribed by physicians or carried out through direct-to-consumer tests. This article critically reviews the main ethical and social implications of BRCA testing, focusing on genetic responsibility and genetic discrimination. Genetic responsibility toward oneself and others is a highly debated implication of genetic testing for cancer predisposition that requires broad considerations of the boundaries between individual and community rights and a reappraisal of the notion of autonomy as relational. Physicians' duty to warn 'at risk' relatives can be an ethical quandary, yet confidentiality is key to the patient-doctor relationship. Mutation carriers may be subject to different forms and degrees of genetic discrimination and many individuals at risk have forgone BRCA testing to avoid potential discrimination. The scientific and medical community, together with patients and the public, has actively engaged against genetic discrimination. The legislation in many countries now protects against genetic discrimination by insurance companies and employers. Legal and regulatory issues are not the final answer to discrimination and profound cultural changes are required to create understanding and acceptance of all differences.
    Annals of Oncology 02/2011; 22 Suppl 1:i60-6. DOI:10.1093/annonc/mdq668 · 6.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Genetic counselors and surgeons both have important roles in the care of patients with hereditary cancer predisposition syndromes. Surgeons have the initial responsibility to identify and refer high-risk patients. Genetic counselors' specialized skill sets are then used in the risk assessment and genetic evaluation of such patients and their at-risk family members, and this may be performed in multiple settings. As discussed in this article, these roles and the processes of genetic counseling and genetic testing may be enhanced through multiple surgeon and genetic counselor collaborations. Continued medical management of patients and families with hereditary cancer predisposition syndromes becomes the responsibility of patients and their multiple health care providers. Box 7 provides a list of resources to assist in finding a local genetic counselor. Because there are various opportunities for surgeons and genetic counselors to collaborate, the authors urge surgeons to recognize the importance of, identify, and work in partnership with a local genetic counselor because that relationship sets the stage for optimal care of the cancer patient.
    Advances in Surgery 01/2012; 46:137-53. DOI:10.1016/j.yasu.2012.03.010
  • [Show abstract] [Hide abstract]
    ABSTRACT: The diagnosis of Lynch syndrome can lead to the prevention of colorectal cancer through periodic colonoscopies and removal of premalignant lesions in susceptible individuals. Therefore, predisposed individuals identified by mutation analysis are advised to inform their at-risk relatives about the options of predictive DNA testing and preventive measures. However, it has now been established that more than half of these relatives do not receive the necessary information. Barriers in conveying information include family communication problems and variable attitudes and practice among clinical geneticists. In this complex field, both medical, psychological, ethical and juridical aspects deserve consideration. Here we summarize the development of a revised guideline for clinical geneticists that allows a more active role of the geneticist, aimed at improving procedures to inform family members in Lynch syndrome and other hereditary and familial cancer syndromes.
    Familial Cancer 03/2013; 12(2). DOI:10.1007/s10689-013-9636-9 · 1.62 Impact Factor

Preview

Download
0 Downloads
Available from