Confidentiality vs. Duty to Warn
Confidentiality vs. Duty to Warn
This report will examine the ethical conundrum of patient confidentiality vs. a doctor’s duty to warn a patient of a potential health risk (see Appendix one for scenario). Primarily, this report will argue that patient confidentiality cannot be overruled, as there is not adequate legal or ethical reasoning to do so and as such, Jane’s doctor should not inform her children of their potential mutated gene. A gene can be defined as ‘A sequence of DNA that carries the information required to make a molecule, usually a protein’ (Yourgenome.org: 2010). Deoxyribonucleic acid, or DNA, is made up of genes and is contained in the nucleus of cells in the human body and its purpose, simply put, is to instruct the body on how and when various proteins should be constructed (Geneticshomereference.gov: 2011). These instructions are constructed, and subsequently differ from organism to organism, by the pairing and subsequent alignment of four bases; adenine thymine, guanine and cytosine. This alignment is known as a double helix (See Appendix 2 for image).
Proteins, which are made up of amino acids, are an essential part of all living organisms and are necessary for growth and muscle development (Google Dictionary: 2010).
In humans, when a male sperm cell and a female egg cell combine to produce a zygote, specific genes from the two parents are combined. The genes that are selected for this new child are based on their dominant or recessive qualities.
Genetic mutation is defined by Wordnetweb.princeton (2010) as being ‘Any alteration in the inherited nucleic acid sequence of the genotype of an organism’. This mutation can occur for a variety of reasons; exposure to radiation, environmental factors (including ultra-violet light) or genetic construction errors.
Male sperm cells contain either an XY or XX pattern on their chromosome; an XY pattern eventuates in the creation of a male, while an XX pattern eventuates in a female. Females only receive X chromosomes and as such, they always contribute X chromosomes to a child, whereas a male can contribute either an X or a Y chromosome to the child, as he received both. In this scenario, Jane received a mutated BRCA1 gene from her father, as well as a normal BRCA1 gene from her mother. Subsequently, Jane had two children; a boy and a girl, with a husband who is not a carrier of the mutation. Jane’s children’s pattern of genealogical inheritance in relation to the BRCA1 gene is demonstrated in the table below: (Blue squares represent egg cells contributed by Jane, while red squares represent sperm cells contributed by Jane’s husband.) | N (representing a normal BRCA1 gene)| N (representing a normal BRCA1 gene)| M (representing a mutated BRCA1 gene)| MNThis would result in a child carrying the mutation.| NMThis would result in a child carrying the mutation.| N(representing a normal BRCA1 gene)| NNThis would result in a normal BRCA1 gene being inherited. | NNThis would result in a normal BRCA1 gene being inherited.|
The above table illustrates that there is only a 50% chance of either child inheriting a mutated BRCA1 gene. This means that there is no guarantee that Jane’s children will have contracted the gene. However, the BRCA1 gene is a gene which, after mutation, is linked with increased likelihood of contracting breast cancer. The BRCA1 gene belongs to a class of genes known as tumour suppressors. Hence, when the gene is mutated, and can no longer do the job it was intended for and the patient becomes far more prone to contracting cancer. According to Cancer.gov, a patient who has a mutated BRCA1 gene is up to 10 times more likely to contract breast cancer, and a mutation of the BRCA1 gene is related to 10% of all breast cancer cases in Australia. However, importantly, having a mutated gene...