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Freeman L, Bristowe L, Kirk EP, Delatycki MB, Scully JL. Should genes for non-syndromic hearing loss be included in reproductive genetic carrier screening: Views of people with a personal or family experience of deafness. J Genet Couns 2024; 33:566-577. [PMID: 37533186 DOI: 10.1002/jgc4.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
Many commercial reproductive genetic carrier screening (RGCS) panels include genes associated with non-syndromic hearing loss (NSHL), however little is known about the general acceptability of their inclusion. Although some couples wish to avoid having a deaf child, there are effective interventions and supports available for deafness, and no consensus on whether it is appropriate to reproductively screen NSHL genes. This study explored views of people with personal experience of deafness regarding carrier screening for genes associated with NSHL. We interviewed 27 participants; 14 who identified as deaf and 13 hearing parents of a deaf child. Thematic analysis was undertaken on transcripts of interviews. The findings reveal the complexity of attitudes within these groups. Some vacillated between the wish to support prospective parents' reproductive autonomy and concerns about potential harms, especially the expression of negative messages about deafness and the potential loss of acceptance in society. While some participants felt carrier screening could help prospective parents to prepare for a deaf child, there was little support for reproductive screening and termination of pregnancy. Participants emphasized the need for accurate information about the lived experience of deafness. The majority felt deafness is not as severe as other conditions included in RGCS, and most do not consider deafness as a disability. People with personal experience of deafness have diverse attitudes towards RGCS for deafness informed by their own identify and experience, and many have concerns about how it should be discussed and implemented in a population wide RGCS program.
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Affiliation(s)
- Lucinda Freeman
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lisa Bristowe
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Edwin P Kirk
- School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
- NSW Health Pathology East Genomics Laboratory, Randwick, New South Wales, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Jackie Leach Scully
- Disability Innovation Institute, University of New South Wales, Randwick, New South Wales, Australia
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McGlynn J, DeCelie-Germana JK, Kier C, Langfelder-Schwind E. Reproductive Counseling and Care in Cystic Fibrosis: A Multidisciplinary Approach for a New Therapeutic Era. Life (Basel) 2023; 13:1545. [PMID: 37511919 PMCID: PMC10381247 DOI: 10.3390/life13071545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
With the advent of highly effective modulator therapies, many people with cystic fibrosis (CF) are living longer, healthier lives. Pregnancy rates for women with CF more than doubled between 2019 and 2021, reflecting increases in both planned and unplanned pregnancies. For men with CF, CF-associated infertility can be mitigated with assistive reproductive technology, yet patient knowledge of these challenges and options is variable. Preconception and prenatal counseling for individuals with CF and for parents of children with CF who wish to expand their families requires nuanced discussions to promote informed reproductive decisions, drawing from a combination of standard practice recommendations and CF-specific assessments. This review article synthesizes the current literature and practice recommendations regarding reproductive counseling and care in CF, outlining the role of genetic counseling, carrier screening, teratogen counseling, in vitro fertilization and pre-implantation genetic diagnosis, and careful assessment and management of cystic fibrosis-related diabetes when present. Via a multidisciplinary, patient-centered approach, clinicians can support adults with CF and parents of children with CF as they make informed reproductive decisions and embark on family planning.
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Affiliation(s)
- Julie McGlynn
- Gynecology and Reproductive Sciences, Department of Obstetrics, Yale School of Medicine, New Haven, CT 06510, USA
| | - Joan K DeCelie-Germana
- Zucker School of Medicine at Northwell Division of Pediatric Pulmonary, and Cystic Fibrosis Center, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA
| | - Catherine Kier
- Renaissance School of Medicine at Stony Brook, Department of Pediatrics, Stony Brook, NY 11794, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Department of Pulmonary Medicine, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA
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Sagaser KG, Malinowski J, Westerfield L, Proffitt J, Hicks MA, Toler TL, Blakemore KJ, Stevens BK, Oakes LM. Expanded carrier screening for reproductive risk assessment: An evidence-based practice guideline from the National Society of Genetic Counselors. J Genet Couns 2023. [PMID: 36756860 DOI: 10.1002/jgc4.1676] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 02/10/2023]
Abstract
Expanded carrier screening (ECS) intends to broadly screen healthy individuals to determine their reproductive chance for autosomal recessive (AR) and X-linked (XL) conditions with infantile or early-childhood onset, which may impact reproductive management (Committee Opinion 690, Obstetrics and Gynecology, 2017, 129, e35). Compared to ethnicity-based screening, which requires accurate knowledge of ancestry for optimal test selection and appropriate risk assessment, ECS panels consist of tens to hundreds of AR and XL conditions that may be individually rare in various ancestries but offer a comprehensive approach to inherited disease screening. As such, the term "equitable carrier screening" may be preferable. This practice guideline provides evidence-based recommendations for ECS using the GRADE Evidence to Decision framework (Guyatt et al., BMJ, 2008, 336, 995; Guyatt et al., BMJ, 2008, 336, 924). We used evidence from a recent systematic evidence review (Ramdaney et al., Genetics in Medicine, 2022, 20, 374) and compiled data from peer-reviewed literature, scientific meetings, and clinical experience. We defined and prioritized the outcomes of informed consent, change in reproductive plans, yield in identification of at-risk carrier pairs/pregnancies, perceived barriers to ECS, amount of provider time spent, healthcare costs, frequency of severely/profoundly affected offspring, incidental findings, uncertain findings, patient satisfaction, and provider attitudes. Despite the recognized barriers to implementation and change in management strategies, this analysis supported implementation of ECS for these outcomes. Based upon the current level of evidence, we recommend ECS be made available for all individuals considering reproduction and all pregnant reproductive pairs, as ECS presents an ethnicity-based carrier screening alternative which does not rely on race-based medicine. The final decision to pursue carrier screening should be directed by shared decision-making, which takes into account specific features of patients as well as their preferences and values. As a periconceptional reproductive risk assessment tool, ECS is superior compared to ethnicity-based carrier screening in that it both identifies more carriers of AR and XL conditions as well as eliminates a single race-based medical practice. ECS should be offered to all who are currently pregnant, considering pregnancy, or might otherwise biologically contribute to pregnancy. Barriers to the broad implementation of and access to ECS should be identified and addressed so that test performance for carrier screening will not depend on social constructs such as race.
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Affiliation(s)
- Katelynn G Sagaser
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Lauren Westerfield
- Department of Human and Molecular Genetics, Baylor College of Medicine, Texas Children's Pavilion for Women at Texas Children's Hospital, Houston, Texas, USA
| | | | | | - Tomi L Toler
- Division of Genetics & Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Karin J Blakemore
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Blair K Stevens
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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4
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Li J, Sun X. Correspondence on "The views of people with a lived experience of deafness and the general public regarding genetic testing for deafness in the reproductive setting: A systematic review" by Freeman et al. Genet Med 2023; 25:155-156. [PMID: 36378227 DOI: 10.1016/j.gim.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jie Li
- Medical Genetics Center, Lanzhou Maternal and Child Health Hospital, Gansu, China
| | - Xiaohong Sun
- Medical Genetics Center, Lanzhou Maternal and Child Health Hospital, Gansu, China.
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Dive L, Newson AJ. Reproductive carrier screening: responding to the eugenics critique. JOURNAL OF MEDICAL ETHICS 2022; 48:1060-1067. [PMID: 34244346 PMCID: PMC9726954 DOI: 10.1136/medethics-2021-107343] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 05/26/2023]
Abstract
Reproductive genetic carrier screening (RCS), when offered to anyone regardless of their family history or ancestry, has been subject to the critique that it is a form of eugenics. Eugenics describes a range of practices that seek to use the science of heredity to improve the genetic composition of a population group. The term is associated with a range of unethical programmes that were taken up in various countries during the 20th century. Contemporary practice in medical genetics has, understandably, distanced itself from such programmes. However, as RCS becomes more widespread, gains public funding and uses expanded gene panels, there are concerns that such programmes could be perceived as eugenic either in intent or outcome. The typical response to the eugenics critique of RCS is to emphasise the voluntary nature of both participating in screening and making subsequent reproductive choices. While safeguarding individuals' freedom to choose in relation to screening is essential, we consider this response inadequate. By examining the specific ethical wrongs committed by eugenics in the past, we argue that to avoid the perception of RCS being a form of eugenics it is essential to attend to the broader normative context in which reproductive decisions occur. Furthermore, ethical RCS programmes must recognise and respond to their potential to shift societal norms that shape individual reproductive choices.
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Affiliation(s)
- Lisa Dive
- Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
| | - Ainsley J Newson
- Sydney Health Ethics, The University of Sydney, Sydney, New South Wales, Australia
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Freeman L, Delatycki MB, Leach Scully J, Kirk EP. Views of reproductive genetic carrier screening participants regarding screening for genes associated with non-syndromic hearing loss. Prenat Diagn 2022; 42:1658-1666. [PMID: 36289583 PMCID: PMC10100309 DOI: 10.1002/pd.6253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Reproductive genetic carrier screening (RGCS) panels often include genes associated with non-syndromic hearing loss (NSHL) despite a lack of evidence of acceptability. Although some couples take steps to avoid having a child who is deaf, there are effective interventions for children who are deaf. There is no consensus whether deafness is considered a disabling condition. METHOD This study explored views of people who had RGCS, without genes for NSHL, about this topic. Online surveys were sent to 2186 people who had a low chance RGCS result and 655 completed the survey (participation rate 30%). RESULTS Sixty-three percent (N = 412) think deafness is a serious health condition. The majority agreed (60%, N = 391) that with support (i.e. hearing aids/cochlear implants) deafness is a minor condition in children. Most (84%, N = 545) agreed genes for NSHL should be included in RGCS. Thirty-five percent (N = 231) indicated they would make different reproductive decisions if they had an increased chance of having a child born deaf; 31% would not change their reproductive plans and 34% were unsure what they would do. CONCLUSION While the majority support inclusion of genes associated with NSHL in RGCS, there was uncertainty about the severity of deafness as a health condition and there was no consensus on whether it is a health condition that warrants changing reproductive decisions.
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Affiliation(s)
- Lucinda Freeman
- School of Women's and Children's HealthUNSWRandwickNew South WalesAustralia
- Graduate School of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Martin B. Delatycki
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
- Victorian Clinical Genetics ServicesParkvilleVictoriaAustralia
| | | | - Edwin P. Kirk
- School of Women's and Children's HealthUNSWRandwickNew South WalesAustralia
- Centre for Clinical GeneticsSydney Children's Hospitals NetworkRandwickNew South WalesAustralia
- NSW Health Pathology East GenomicsRandwickNew South WalesAustralia
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Zhang K, Lin G, Li J. Carrier screening: An update. Clin Chim Acta 2022; 535:92-98. [PMID: 35973610 DOI: 10.1016/j.cca.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
Genetic carrier screening (CS) for reproductive decision making was introduced 50 years ago. Technological advances and improvements in knowledge of the human genome makes multi-disease, pan-ethnic CS possible. Such screening will identify most individuals as carriers of at least one autosomal recessive or X-linked recessive disorder. Past experiences and best practices have provided a framework for CS. Although its clinical utilization is increasing, some challenges remain. In this study, several aspects of CS panel implementation have been addressed including how to evaluate the quantitative gene inclusion criteria, how to classify the severity of genetic conditions, how to understand clinical validity at the level of gene-disease association and variant classification, and how to minimize residual risks.
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Affiliation(s)
- Kuo Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, PR China
| | - Guigao Lin
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, PR China
| | - Jinming Li
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing, PR China.
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Freeman L, Righetti S, Delatycki MB, Scully JL, Kirk EP. The views of people with a lived experience of deafness and the general public regarding genetic testing for deafness in the reproductive setting: A systematic review. Genet Med 2022; 24:1803-1813. [PMID: 35659827 DOI: 10.1016/j.gim.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Genes associated with nonsyndromic hearing loss are commonly included in reproductive carrier screening panels, which are now routinely offered in preconception and prenatal care in many countries. However, there is debate whether hearing loss should be considered a medical condition appropriate for screening. This systematic review assessed research on opinions of those with a lived experience of deafness and the general public regarding genetic testing for deafness in the reproductive setting. METHODS Search of 5 online databases yielded 423 articles, 20 of which met inclusion criteria. We assessed the quality of each study, extracted data, and performed thematic analysis on qualitative studies. RESULTS Most studies indicated interest in the use of prenatal diagnosis for deafness. However, there were mixed views, and sometimes strongly held views, expressed regarding the reproductive options that should be available to those with an increased chance of having a child with deafness. Studies were small, from a limited number of countries, and most were too old to include views regarding preimplantation genetic testing. CONCLUSION There is a broad range of views regarding the use of reproductive options for deafness. Further research is essential to explore the benefits and harms of including nonsyndromic hearing loss genes in carrier screening.
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Affiliation(s)
- Lucinda Freeman
- School of Women's and Children's Health, Medicine, UNSW, Randwick, New South Wales, Australia; Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sarah Righetti
- School of Women's and Children's Health, Medicine, UNSW, Randwick, New South Wales, Australia
| | - Martin B Delatycki
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | | | - Edwin P Kirk
- School of Women's and Children's Health, Medicine, UNSW, Randwick, New South Wales, Australia; Centre for Clinical Genetics, Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia.
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9
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Woudstra AJ, van den Heuvel LM, van Vliet-Lachotzki EH, Dondorp W, Lakeman P, Haverman L, van Langen IM, Henneman L. Views of patients and parents of children with genetic disorders on population-based expanded carrier screening. Prenat Diagn 2022; 42:1201-1210. [PMID: 35734853 PMCID: PMC9543353 DOI: 10.1002/pd.6200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
Objective Faster and cheaper next generation sequencing technologies have enabled expansion of carrier screening for recessive disorders, potentially facilitating population‐based implementation regardless of ancestry or family history. Little is known, however, about the attitudes regarding population‐based carrier screening among families with genetic disorders. This study assessed views among parents and patients with a recessive disorder and parents of children with Down syndrome (DS) on expanded carrier screening (ECS). Method In total, 85 patients with various recessive disorders, 110 parents of a child with a recessive disorder and 89 parents of a child with DS participated in an online survey in the Netherlands. Severity of recessive disorders was classified as mild/moderate or severe/profound. Results The majority of the (parents of) patients with a recessive disorder had a positive attitude towards population‐based ECS, including screening for their own or their child's disorder. DS parents were significantly less positive towards ECS. Subgroup analyses showed that the severity of the disorder, rather than being a patient or parent, influences the attitudes, beliefs and intention to participate in ECS. Conclusion Our findings have important implications for future implementation initiatives as they demonstrate the different perspectives from people with experiential knowledge with genetic disorders.
What's already known about this topic?
Carrier screening panels for recessive disorders are rapidly expanding. Concerns have been raised about the possible impact of expanded carrier screening (ECS) on people affected by genetic disorders.
What does this study add?
The majority of Dutch (parents of) patients with a recessive disorder had a positive attitude towards ECS. Parents of children with Down syndrome are less positive. Severity of the disorder, rather than being a patient or parent, influenced the attitudes, beliefs and intention to participate in ECS.
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Affiliation(s)
- Anke J Woudstra
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Lieke M van den Heuvel
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.,Department of Clinical Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Wybo Dondorp
- Department of Health, Maastricht University, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht, The Netherlands
| | - Phillis Lakeman
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.,Department of Human Genetics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Haverman
- Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.,Amsterdam UMC, location University of Amsterdam, Psychosocial Department, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Irene M van Langen
- Department of Clinical Genetics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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What is a 'serious' genetic condition? The perceptions of people living with genetic conditions. Eur J Hum Genet 2021; 30:160-169. [PMID: 34565797 PMCID: PMC8821585 DOI: 10.1038/s41431-021-00962-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
Despite no consensus on the definition of ‘seriousness’, the concept is regularly used in policy and practice contexts to categorise conditions, determine access to genetic technologies and uses of selective pregnancy termination. Whilst attempts have been made to create taxonomies of genetic condition seriousness to inform clinical and policy decision-making, these have often relied on condition appraisals made by health and genetics professionals. The views of people with genetic conditions have been largely under-represented. This study explores the concept of seriousness through the perspectives of people with a range of ‘clinically serious’ conditions (fragile X conditions, spinal muscular atrophy, cystic fibrosis, haemophilia, thalassaemia). Attitudes towards suffering, quality of life (QoL) and selective pregnancy termination were elucidated from 45 in-depth qualitative interviews and 469 postal/online surveys. The majority of participants reported good health/wellbeing, and the capacity for good QoL, despite experiencing suffering with their condition. Notably, participants with later-onset conditions held more negative views of their health and QoL, and were more likely to view their condition as an illness, than those with early-onset conditions. These participants were more likely to see their condition as part of their identity. Whilst most participants supported prenatal screening, there was little support for selective termination. Moreover, social environment emerged as a critical mediator of the experience of the condition. The complex and rich insights of people living with genetic conditions might usefully be incorporated into future genetic taxonomies of ‘seriousness’ to ensure they more accurately reflect the lived reality of those with genetic conditions.
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Dive L, Archibald AD, Newson AJ. Ethical considerations in gene selection for reproductive carrier screening. Hum Genet 2021; 141:1003-1012. [PMID: 34426854 PMCID: PMC9160090 DOI: 10.1007/s00439-021-02341-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/11/2021] [Indexed: 12/02/2022]
Abstract
Genetic carrier screening for reproductive purposes has existed for half a century. It was originally offered to particular ethnic groups with a higher prevalence of certain severe recessive or X-linked genetic conditions, or (as carrier testing) to those with a family history of a particular genetic condition. Commercial providers are increasingly offering carrier screening on a user-pays basis. Some countries are also trialing or offering public reproductive genetic carrier screening with whole populations, rather than only to those known to have a higher chance of having a child with an inherited genetic condition. Such programs broaden the ethical and practical challenges that arise in clinical carrier testing. In this paper we consider three aspects of selecting genes for population reproductive genetic carrier screening panels that give rise to important ethical considerations: severity, variable penetrance and expressivity, and scalability; we also draw on three exemplar genes to illustrate the ethical issues raised: CFTR, GALT and SERPINA1. We argue that such issues are important to attend to at the point of gene selection for RGCS. These factors warrant a cautious approach to screening panel design, one that takes into account the likely value of the information generated by screening and the feasibility of implementation in large and diverse populations. Given the highly complex and uncertain nature of some genetic variants, careful consideration needs to be given to the balance between delivering potentially burdensome or harmful information, and providing valuable information to inform reproductive decisions.
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Affiliation(s)
- Lisa Dive
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Level 1, Edward Ford Building A27, Sydney, NSW, 2006, Australia
| | - Alison Dalton Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Level 1, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
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