Ethics in Medicine Genetic testing: a round table conversation. Part I.

This article presents a fictional round table conversation on genetic testing. The topic of breach of confidentiality between a patient and his doctor was discussed, with the view that doctors should not talk about their patients to anyone else, except to professional colleagues, when necessary for medical care. It has to be understood that with a condition like hereditary non-polyposis cancer of the colon-for which only a few of what is likely to be hundreds of mutations are known-all we can do is to look for those we already know about. The best way to do this is to examine DNA from a person with the disease. If one finds a mutation it is usually straightforward to test other family members. One problem is that even if one has a gene for a disease, it does not follow that the person will get the disease. With other conditions the risk can vary between about 20% and 100%. It is technically possible to take samples from the fetus during pregnancy but there are risks both to the mother and the baby. From a legal point of view, pathology specimens are the property of the laboratory, not the patient. Doctors always emphasize to medical students how important it is to ask about family history for genetic and for other reasons.