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Do you have a duty to warn?
A doctor taking blood pressure.You are a family doctor in a suburban town. Today you are seeing a 55-year-old woman, the mother of three grown boys. She works in the bookkeeping department at a nearby airport where many local residents work. For the past year she has not been herself, and today she comes in lurching and slurring her words. Six months ago, you ran a number of inconclusive tests. Today you are alarmed and, after probing, you learn that before her father died an early death, he exhibited "strange and spastic" behavior. With further investigation, you diagnose your patient with Huntington's disease (HD), a devastating, degenerative brain disorder for which there is no effective treatment or cure. Over time, HD undermines the ability to walk, talk, think and reason. Unlike most genetic diseases, HD invariably sickens and kills anyone who carries the gene, and anyone with a parent with HD has a 50% chance of inheriting the gene.
Do you have a duty to warn anyone of risks stemming from your patient's disease, even if it means compromising confidentiality?
Clicking on "yes" or "no" will move you to the next page. You will have a chance to reconsider your answer when you get to the end of the case and have explored some of the ramifications of your decision, but you cannot click back!
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Context

When physicians enter medical practice, many take the Hippocratic Oath, which includes a promise that they will keep communications with their patients confidential. The oath says: "Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."


Do you have a duty to warn?
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Did you know?
There are about 10,000 diseases caused by mutations in a single gene, but there is huge variability in the range and severity of symptoms in individuals with these diseases. The overwhelming majority of diseases are a complicated mix of genetic and environmental factors, and relatively few follow the Huntington's disease model of a single gene leading to a single, relatively predictable disorder.