Incidental findings of nonparentage: a case for universal nondisclosure

Discovering your presumed father is not your biological father: Psychiatric ramifications of independently uncovered non-paternity events resulting from direct-to-consumer DNA testing

Direct-to-consumer DNA tests provide information on ancestry and family relations. Their increased use in recent years has led many to discover that their presumed father is not their biological father, a non-paternity event (NPE). We aimed to explore and quantify the psychiatric effects of discovering one's father's identity was misattributed. We distributed questionnaires in a private online community of individuals who learned they were NPEs. Questionnaires included clinical scales assessing depressive, anxiety, and panic symptomatology as well as background and personal details regarding participants' NPE discovery and demography. A total of 731 people participated. Results demonstrated increased levels of depression, anxiety, and panic symptoms relative to controls. Multiple factors influenced such effects, including demographics, background information, family members' reactions, and personal reactions. We identified a worsening relationship or attitude toward the mother as a risk factor for worse mental health. The ability to openly discuss the discovery and acceptance of it were identified as protective factors. This is the first paper to explore the psychiatric sequelae of discovering misattributed paternity in a large cohort. This unique psychosocial stressor is likely to become more common as direct-to-consumer DNA tests gain popularity, requiring the attention of mental health professionals.

The ethics and logistics of field-based genetic paternity studies

The rapidly decreasing costs of generating genetic data sequencing and the ease of new DNA collection technologies have opened up new opportunities for anthropologists to conduct field-based genetic studies. An exciting aspect of this work comes from linking genetic data with the kinds of individual-level traits evolutionary anthropologists often rely on, such as those collected in long-term demographic and ethnographic studies. However, combining these two types of data raises a host of ethical questions related to the collection, analysis and reporting of such data. Here we address this conundrum by examining one particular case, the collection and analysis of paternity data. We are particularly interested in the logistics and ethics involved in genetic paternity testing in the localized settings where anthropologists often work. We discuss the particular issues related to paternity testing in these settings, including consent and disclosure, consideration of local identity and beliefs and developing a process of continued community engagement. We then present a case study of our own research in Namibia, where we developed a multi-tiered strategy for consent and community engagement, built around a double-blind procedure for data collection, analysis and reporting.

Paternity testing in anthropology raises ethical and methodological issues. We summarize these and describe a novel double-blind method used in our work.

Considerations for whole exome sequencing unique to prenatal care

Whole exome sequencing (WES) is increasingly being used in the prenatal setting. The emerging data support the clinical utility of prenatal WES based on its diagnostic yield, which can be as high as 80% for certain ultrasound findings. However, detailed practice and laboratory guidelines, addressing the indications for prenatal WES and the surrounding technical, interpretation, ethical, and counseling issues, are still lacking. Herein, we review the literature and summarize the most recent findings and applications of prenatal WES. This review offers specialists and clinical genetic laboratorians a body of evidence and expert opinions that can serve as a resource to assist in their practice. Finally, we highlight the emerging technologies that promise a future of prenatal WES without the risks associated with invasive testing.

Disclosure of Misattributed Paternity

One of the most common dilemmas faced by physicians and genetic counselors is the discovery of misattributed paternity. In this article, we present a case in which misattributed paternity was discovered as an incidental finding. Experts analyze the competing moral obligations that might dictate disclosure or nondisclosure.

When genomic medicine reveals misattributed genetic relationships-the debate about disclosure revisited

PURPOSE

Accidental discovery of misattributed parentage is an age-old problem in clinical medicine, but the ability to detect it routinely has increased recently as a result of high-throughput DNA sequencing technologies coupled with family sequencing studies. Problems arise at the clinical-research boundary, where policies and consent forms guaranteeing nondisclosure may conflict with standard clinical care.

METHODS

To examine the challenges of managing misattributed parentage within hybrid translational research studies, we used a case study of a developmentally delayed child with a candidate variant found through a large-scale trio genome sequencing study in which data from unrelated samples were routinely excluded.

RESULTS

We discuss whether genetic parentage should be explicitly confirmed during clinical validation, thus giving greater weight to the diagnosis according to American College of Medical Genetics and Genomics variant interpretation guidelines, and what tensions this approach would create.

CONCLUSION

We recommend that the possibility of finding and disclosing misattributed parentage should be addressed during the consent or pretest counseling process, and that clinical relevance should determine whether or not to disclose results in the clinic. This proposition has implications for research governance, and implies that it may not always be possible to uphold nondisclosure commitments as investigations move from research to clinical care.

An old problem in a new age: Revisiting the clinical dilemma of misattributed paternity

Clinical genetics has wrestled with the problem of misattributed paternity for decades. While there are no clear directives on policy, surveys suggest that genetics professionals are inclined to avoid disclosure when possible. Changes associated with the increased use of genomic testing will alter the context and may limit the benefits of non-disclosure. Multi-site testing will preclude the uncertainty often associated with single-gene testing. Increased use of genetic testing in clinical and non-clinical settings will create new opportunities for the subsequent unmasking of misattributed relationships, as will the presence of test results in the electronic medical record. Family health history information will become more valuable as it is used more often and to better effect in risk assessment, diagnosis, treatment and reproductive decision-making. These changes associated with genomic testing increase the risks and decrease the benefits associated with the nondisclosure of misattributed paternity. For ethical and practical reasons, genetics professionals, and those who advise them, should consider a greater emphasis on the value of carefully planned disclosure.

Points to Consider: Ethical, Legal, and Psychosocial Implications of Genetic Testing in Children and Adolescents

In 1995, the American Society of Human Genetics (ASHG) and American College of Medical Genetics and Genomics (ACMG) jointly published a statement on genetic testing in children and adolescents. In the past 20 years, much has changed in the field of genetics, including the development of powerful new technologies, new data from genetic research on children and adolescents, and substantial clinical experience. This statement represents current opinion by the ASHG on the ethical, legal, and social issues concerning genetic testing in children. These recommendations are relevant to families, clinicians, and investigators. After a brief review of the 1995 statement and major changes in genetic technologies in recent years, this statement offers points to consider on a broad range of test technologies and their applications in clinical medicine and research. Recommendations are also made for record and communication issues in this domain and for professional education.

When Should Genome Researchers Disclose Misattributed Parentage?

Researchers need a decision-making framework about disclosing a finding of misattributed parentage that accounts for nonclinical factors like the effects of personal identity and familial relationships.