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Mayo Clin Proc Innov Qual Outcomes. 2018 May 8;2(2):81-90. doi: 10.1016/j.mayocpiqo.2018.03.005. eCollection 2018 Jun.

Ethical Issues in Contemporary Clinical Genetics.

Author information

1
Department of Internal Medicine, New York Presbyterian - Columbia University Medical Center, New York, NY.
2
The Hastings Center, Garrison, NY.
3
Department of Pediatrics, Division of Medical Genetics, Stanford Children's Health and Stanford University School of Medicine, Stanford, CA.

Abstract

As genetic sequencing capabilities become more powerful and costs decline, the reach of genomics is expanding beyond research laboratories to the wards, outpatient clinics, and, with the marketing of direct-to-consumer testing services, patients' homes. Increasingly, patients receiving various diagnoses-from cancer to cardiomyopathy-can reasonably expect to have conversations with their providers about indications for genetic testing. In this dynamic context, a grasp of the ethical principles and history underlying clinical genetics will provide clinicians with the tools to guide their practice and help patients navigate complex medical-psychosocial terrain. This article provides an overview of the salient ethical concerns pertaining to clinical genetics. The subject is approached with an emphasis on clinical practice, but consideration is also given to research. The review is organized around the temporal and informational sequence of issues commonly arising during the course of pretesting, testing, and posttesting phases of patient care. Drawing from medical, legal, and historical perspectives, this review covers the following topics: (1) informed consent, (2) return of results, and (3) privacy and confidentiality, and intends to equip readers with an appropriate foundation to apply ethical principles to genetic testing paradigms with an understanding of the contextual landscape against which these situations occur.

KEYWORDS:

ACMG, American College of Medical Genetics and Genomics; AMA, American Medical Association; CF, cystic fibrosis; CLIA, Clinical Laboratory Improvement Amendments; DTC, direct-to-consumer; FDA, Food and Drug Administration; GINA, Genetic Information Non-Discrimination Act

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