![]() ![]() Threlkel, 13 the Supreme Court of Florida held in 1995 that a physician owed a duty of care to the children of a parent to warn the patient of the genetically transferable nature of the condition for which the physician treated the patient. Analogous reasoning has been used in cases involving genetic disorders and claims of medical malpractice for failing to warn potentially affected kin. The court held that under the circumstances of this case, the duty to warn outweighed the confidences of the relationship with the patient. After the patient killed the girlfriend, her family sued the psychiatrist and the court ruled in favor of the family, even though the psychiatrist/psychologist had no direct legal relationship with the girlfriend. Adhering to the doctrine of patient–physician confidentiality, the doctor did not warn the girlfriend. 12 In this often cited case, a patient confided to his psychiatrist/psychologist his wish to harm his girlfriend. Regents of the University of California decision. In 1976, the “old rule” was changed by the Tarasoff v. A relative of the patient was a third party who had no physician–patient relationship, and hence no duty was owed. 11 The old rule stated that there was no duty to warn relatives, who would be considered as “third party,” because the physician's relationship was directly with the patient. ![]() The second issue concerns the duty to warn relatives when a genetic condition is identified in a patient. Gary Birnbaum M.D., J.D., F.C.L.M., in The Medical Malpractice Survival Handbook, 2007 Duty to Warn Relatives In a pediatric cancer setting, this may mean the patient’s parents, siblings and/or future siblings, and extended relatives. At minimum, clinicians are obliged to inform patients about potential risks to family members. In summary, there is considerable uncertainty regarding the duty to warn from a legal precedence standpoint and in the opinions of medical societies. Therefore, although this is an important concept to acknowledge and understand, it is fortunately rarely encountered in clinical practice. In two survey-based studies, 6,7 it was found for both medical geneticists and genetic counselors that it is rare to be faced with the consideration of disclosure without consent, and in those cases, it was uncommon for the genetics professional to actually disclose. 5 The court upheld a duty to warn at-risk relatives of the avoidable harm from genetic disease. Safer sued her father’s physician for failing to warn her that her father died of colon cancer secondary to familial adenomatous polyposis, a condition causing severe polyposis and virtually 100% risk of colorectal cancer without intervention. There is a duty to disclose in these cases. Consider cases of suspected abuse, gunshot wounds, or times when a patient is deemed an immediate threat to him/herself or society. However, duty to maintain confidentiality is not absolute in medicine. The court found that the physician had a duty to warn his patient of the familial implications of the disease, but not a duty to breach confidentiality and warn at-risk relatives directly. She sued her mother’s physician, citing a duty to warn. Pate was diagnosed with medullary thyroid carcinoma 3 years after her mother was treated for the same disease. Although one may assume that such an important issue has been thoroughly reviewed at the legal level, there are in fact only two cases that represent legal precedent. If a clinician discloses a patient’s genetic information to an at-risk relative against his/her patient’s wishes, that action breaches confidentiality and therefore the implicit and explicit physician-patient contract. For a clinician deciding on whether to disclose genetic information to someone that is not his/her patient, the question of responsibility may also be a legal one. For a patient deciding whether to disclose genetic information to an at-risk relative, the question of responsibility is an ethical one. It is rooted in beneficence but may be at odds with autonomy and confidentiality in some scenarios. The duty to warn refers to the responsibility of a clinician and/or a patient to disclose genetic information to at-risk individuals. ![]() Farmer MS, CGC, in Pediatric Cancer Genetics, 2018 Duty to Warn
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