Paternalism and Genetic Testing
In the best interest for all parties involved, I believe the physician has a moral obligation to divulge information that has been revealed by genetic testing. The conflicts that initially arise are serious enough to warrant discussion, but not enough to make an argument in favor of a right to ignorance.
A question of paternalism versus patient autonomy arises as perhaps the most crucial issue when confronting this ethical question. Paternalism can be observed in both the actions of physicians revealing all information (contrary to patient’s wishes) or withholding information from a patient that was made available through any particular test. While it may be paternalistic to override the wishes of the patient to remain ignorant, the doctor has a moral and societal obligation to inform the patient of any problems he may have.
The first argument for revealing all information rests on the fact that in any society much of what effects ourselves, often has consequences for others. For example, if a patient is discovered to be a carrier of the gene responsible for a disease such as Huntington’s, he has a moral obligation to consider whether o r not conceive a child, or take responsible measures to assure that the child is brought to term without any apparent risks or disabilities.
By not revealing information, we as a society run a terrible risk of allowing ourselves to act in ignorance, and furthermore act irresponsibly towards those whom rely on us or will be forced to suffer the consequences of our actions. However, there are potential downsides to this argument that must be recognized.
The Hubbard and Lewontin article stresses some of the problems associated with genetic testing. While the authors create a seemingly pointlessness to genetic screening, I feel their most pertinent assertion was regarding the implications regarding insurability, and some social stigmatization. In our severely flawed private healthcare situation, the risk of those rendered “uninsurable” due to genetic abnormalities runs extremely high. However, I do not see this as an inherent problem within divulging information; but rather something that could be solved with a socialist health care system. If we could guarantee medical coverall to all citizens, then the risk of an entire class of uninsured individuals due to their genes would simply not exist.
In regards to the social implication of revealing genetic information, I feel as if the populace has an obligation to know its genetic potential (or lack thereof) so it may make conscious, responsible decisions about its own health and that of future generations. I do not believe this would result in a social reaction of those with desirable genes persecuting those deemed “undesirable;” particularly when the other social ills of exploitation, monetary elitism, and alienation have ceased to exist.
The Hubbard and Lewontin article does bear significant weight however. It demonstrates the futility of certain aspects of genetic screening. It would pose an excessive burden on society to impose genetic screening on everyone. Also, we shouldn’t let genetic testing turn into a racialist policy of screening various racial or ethnic groups solely because they may be perceived as carrying a defective gene.
The Robert Washbroit article addresses the paternalism of physician not revealing information that may be potentially important. He addresses this problem by proposing an “opting out” type of scenario where it should be an initial duty to reveal results to a patient unless they explicitly state an objection to knowing. However, and this seems obvious, there are instances where the right to remain ignorant must be waived for crucial information that involves potential third parties.
The defense of requiring physicians to inform their patients about all genetic screening (or other) test results is on logical utilitarian grounds. By informing individuals of their genetic risks, we can help them deal with their situation and prevent further burdens on society. By identifying certain genetic problems, physician can assist potential parents if it would be wise to conceive a child, or if they need to utilize a form of artificial reproductive technology to ensure a child isn’t brought to term that is going to be an excessive burden on society or the parents. Encouraging and promoting the health of all individuals (both living and future, potential humans) yields the most social utility for society.
In conclusion, physicians have a moral obligation to both the patient and society to divulge information regarding genetic traits. The potential benefits override the risks of such a practice. It will mainly result in some infractions of patient autonomy; however, this doesn’t reveal a compelling reason to allow patients to remain ignorant. It is best for society and the patient to reveal the information, and allow and assist them in making conscious, beneficial decisions regarding their future and the future of any potential offspring.
