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Do you have a duty to warn?
Your dealings with your patient are confidential, but you believe she should tell her children, both for her own care and for her children's ability to plan. It is not clear today that your patient has thought through the implications of her diagnosis, and she insists that she does not want to burden her sons.

You tell her that the gene for Huntington's disease has been identified and that a test is available. Though presumably healthy now, each of her sons has a 50% chance of carrying the mutated gene. If any one of them has inherited a copy of the mutated gene, he will face a long and debilitating illness before HD inevitably kills him. Knowledge about his genetic status may help him make important family and professional decisions. On the other hand, there are no treatments or cures available. If he does have the mutated gene, he may be discriminated against in employment or insurance settings or stigmatized in his personal life. Still, you believe all three sons should have the chance to know if they so choose.

How do you weigh your patient's confidentiality against the potential harms you believe her silence may cause for her family?
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Case

Whether a physician has a legal duty to warn family members or anyone else of a patient's genetic status is still uncertain, and two higher court rulings illustrate division in the courts. In both cases, children suffering from genetic diseases sued their parents' physicians for a failure to warn them of their risks. In Pate v. Threlkel (1995), the Florida Supreme Court ruled that a physician is only required to inform a patient that a disease she/he has is genetically transferable. While the court said that a patient's children do fall under a physician's duty to warn, that duty is satisfied by telling the patient alone. Conversely, in Safer v. Estate of Pack (1996), the Superior Court of New Jersey reversed a lower court decision, ruling that a physician has the duty to warn not only his patient of the genetic nature of a disease, but also members of that patient's immediate family who might be harmed by a failure to warn. Significantly, the court concluded that the threat of harm of not disclosing a genetic disease was not significantly different from the threat of infection from contagious disease.


Do you have a duty to warn?
Did you know?
Medical confidentiality is considered part of an individual's right to privacy, but it is not an absolute right, and the law has periodically waived confidentiality when it has perceived a weightier public policy issue. For instance, public health regulations related to infectious diseases sometimes allow—and at times require—a physician to alert someone who has come in contact with an infectious disease carrier. Every state recognizes a physician's duty to report evidence of child neglect or abuse, and it has been argued that a failure to warn when a physician knows a child may be genetically predisposed to disease represents neglect. Earlier this century, laws related to the outbreak of epidemics like smallpox allowed for the forced collection and quarantine of people suspected of carrying disease. Similarly, the Emergency Powers Acts passed by many states after the World Trade Center attack in 2001 expanded states' ability to intrude on an individual's privacy for purposes of public health and safety.