DNA testing challenges doctors, laboratories and courts

Medical laboratories, doctors and other healthcare professionals have begun struggling with gnarly ethical questions brought on by DNA testing. With the technology now widely available and its meanings fast evolving, medical professionals may see the legal risks only when a lawsuit is filed.

Experts in law, public policy, medicine and genetics are scrambling to think about these questions before they’re raised in court, not to mention the clinical setting.

The lawsuits have arrived

In a malpractice case, the court usually considers whether a physician failed to meet the standard of care, Professor Susan Wolf pointed out to Science magazine. But when it comes to genomics, “a real hinge point is, ‘What’s the standard of care?’”

Consider the real case of a man given an EKG as part of a medical checkup.

A lawsuit later contended that the results of the EKG should have prompted genetic testing of the man, which would have resulted in genetic testing of his 14-year-old son (who wasn’t the doctor’s patient), which might have kept the boy from dying of a heart condition (hypertrophic cardiomyopathy) two years after his father’s EKG. A judge ruled against the doctor.

Testing done long before the results can be understood

It’s one thing to develop technology to read out a patient’s sequence of base pairs making up their genome. It’s quite another to figure out what all that data might someday be able to mean to the patient and their clinicians. When new interpretations of DNA data appear in the medical literature, what are doctors supposed to do about it?

Should every patient’s genome be constantly revisited in response to every research paper? Labs have been known to tell a doctor that a former patient’s DNA contains a potentially harmful variant, but the patient’s current location is no longer on file. The American Society of Human Genetics released guidelines for such cases in the spring of 2019.

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