Ethical issues in genetic testing. The experiences of one family diagnosed with an inherited cancer syndrome

Drama as a Powerful Tool to Enrich Socio-scientific Argumentation

Socio-scientific argumentation (SSA) is increasingly being recognized as a key aspect of scientific literacy. Much of the reason for this is that this skill is crucial for helping students to become active participants in twenty-first-century democratic societies in which the construction of informed and critical views of socio-scientific issues (e.g. climate change, COVID-19 vaccination, genetic testing) plays a fundamental role. The problem is that instructors rarely give students explicit and research-based opportunities to enrich their SSA skills. Therefore, the aim of this study was to provide evidence that drama can be used as a platform to enrich argumentation in genetic testing. The data were derived from the written responses and the audio recordings of seventy-six university students (37 females and 39 males, 16-29 years old) in Colombia during a complete drama-based teaching-learning sequence (TLS) supervised by the same instructor. The outcomes suggest that the sequence can be used to enrich argumentation in genetic testing as it effectively provided participants with explicit opportunities to produce both arguments and counterarguments about the controversy whether the use of genetic tests among people should be encouraged. This study contributes to the literature on SSA in science education by demonstrating that drama is a promising tool to enhance argumentation about science-based social issues.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10763-022-10320-3.

Prenatal genetic testing for cystic fibrosis: a systematic review of clinical effectiveness and an ethics review

PURPOSE

We aimed to assess the clinical value of prenatal testing for cystic fibrosis (CF) and whether ethical considerations would affect endpoint selection.

METHODS

To determine effectiveness, we conducted a systematic literature review whose protocol outlined search strategies across eight databases, study inclusion criteria, and prespecified literature screening, data extraction, and synthesis processes. We conducted a scoping search on ethical considerations.

RESULTS

The genetic test showed good diagnostic performance. A change in clinical management was observed: termination of pregnancy (TOP) occurred in most cases where two pathogenic variants were identified in a fetus of carrier parents (158/167; 94.6%). The TOP rate was lower in pregnancies where CF was diagnosed after fetal echogenic bowel detection (~65%). TOP and caring for a child with CF were both associated with poor short-term parental psychological outcomes. Ethical analyses indicated that informed decisions should have been the main endpoint, rather than CF-affected births prevented.

CONCLUSION

CF testing leads to fewer CF-affected births. It is difficult to assess whether this means the test is valuable, since patients may not value TOP primarily in terms of maternal or fetal health outcomes, psychological or otherwise. The value of testing should arguably be measured in terms of improving patient autonomy rather than health.

A case of inappropriate apolipoprotein e testing in Alzheimer's disease due to lack of an informed consent discussion

BACKGROUND/OBJECTIVE

Apolipoprotein E (APOE) genetic testing is used to assist in the diagnosis of Alzheimer's Disease (AD). Whenever genetic testing is performed, an informed consent process should occur.

METHODS

In this case, a patient with memory loss presented to the neurologist. The neurologist ordered a lumbar puncture (LP). The LP was performed by a neuroradiologist who also ordered APOE genetic testing. The patient received no genetic counseling, nor was an informed consent document offered.

RESULTS

After the testing was completed, the neurologist faced an ethical dilemma. His solution was to offer the genetic testing to the patient in order to have an informed consent process. It was clear that the patient and her adult children did not want the genetic testing and that they would have been burdened with the results. The neurologist opted not to disclose the results.

CONCLUSION

Genetic counseling and a signed informed consent document are required prior to any genetic testing. In this case, neither occurred and it led to an ethical dilemma that was ultimately resolved by the neurologist. As the population ages and AD becomes more prevalent, there is a need to expand the workforce of genetic counselors and educate physicians who commonly treat AD about genetic testing.

Pediatric ethics guidelines for hereditary medullary thyroid cancer

Hereditary medullary thyroid cancer is an aggressive cancer for which there is no standard effective systemic therapy, but which can be prevented through genetic screening and prophylactic thyroidectomy. Although this cancer accounts for roughly 17% of all pediatric thyroid cancers, a significant percentage of affected families do not "accept" screening, while many gene carriers delay or refuse prophylactic thyroid surgery for their children. Current genetic screening practices in medullary thyroid cancer are inadequate; more than 50% of index patients with hereditary medullary thyroid cancer present with a thyroid mass; up to 75% have distant metastasis. These proposed pediatric ethics guidelines focus on two ethical issues that affect at-risk children: (1) how do we identify at-risk children whose RET-positive relative refuses to disclose that they carry the mutation? (2) How do we protect RET-positive children whose parents refuse prophylactic thyroidectomy?

Inherited cancer syndromes in children and young adults

Geneticists estimate that 5% to 10% of all cancers diagnosed in the pediatric age range occur in children born with a genetic mutation that directly increases their lifetime risk for neoplasia. However, despite the fact that only a fraction of cancers in children occur as a result of an identified inherited predisposition, characterizing genetic mutations responsible for increased cancer risk in such syndromes has resulted in a profound understanding of relevant molecular pathways involved in carcinogenesis and/or resistance to neoplasia. Importantly, because most cancer predisposition syndromes result in an increased risk of a small number of defined malignancies, personalized prophylactic surveillance and preventive measures can be implemented in affected patients. Lastly, many of the same genetic targets identified from cancer-prone families are mechanistically involved in the majority of sporadic cancers in adults and children, thereby underscoring the clinical relevance of knowledge gained from these defined syndromes and introducing novel therapeutic opportunities to the broader oncologic community. This review highlights the clinical and genetic features of many of the known constitutional genetic syndromes that predispose to malignancy in children and young adults.