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2. Social Considerations
Some very tough questions arise in the process of genetic counseling or evaluation.
The following is an attempt to guide physicians in answering these questions in ways
that preserve the patients’ rights without embroiling the physician in too many legal
and social problems.
a) Am I the Baby’s Father?
Legally, a child’s father is the mother’s husband or a man who has been assigned
paternity in a court proceeding. Biologic paternity is virtually irrelevant without
legal recognition. Courts may choose to transfer legal paternity from one man to
another, but they endeavor not to disturb paternity when it will render an otherwise
legitimate child a bastard. Physicians should also avoid casting doubts on paternity
when a family is already in crisis. Although physicians should not lie to patients,
there is enough uncertainty about paternity determinations to allow room for
differing interpretations. Even tissue typing can be confused by mutation, the
presence of related males among the candidates, or laboratory error.
It is best to avoid questions of paternity unless they are directly relevant to the
patient’s medical condition or care. If the father is concerned about possible genetic
disease in his child, the information gathering should be directed to the disease, not
the paternity. Physicians should decline to test a child to determine paternity unless
it is a medical necessity. (This is usually an issue only for certain rare genetic
diseases and as a side issue in tissue typing for organ transplantation.) If a court
orders paternity testing, the physician must honor the order. But the physician
acting as an expert witness in such a case should inform the court of the limitations
of the tests and avoid making any unequivocal pronouncements of paternity.
While modern DNA testing techniques make paternity testing much more certain,
they do little for the social consequences flowing from such tests. DNA testing is
now available and marketed directly to the public. If the reasons for testing are
social, not medical, physicians should advise patients to seek this information
outside the medical setting. If the issue is legal paternity or child support, the state
child welfare agency should be involved.
b) Can I Have a Healthy Baby with Someone Else?
This is a very difficult question because the answer is so often yes. A woman who
asks this question should be warned that choosing a father at random may be as
risky as conceiving with her husband. Artificial insemination is a standard option
that allows the woman to avoid genetic disease. But most programs will not
inseminate a woman unless she is married and her husband consents. If the woman
does not want her husband to know that he is not the genetic father, then she will
have to seek help outside the traditional medical care system.
A physician who suspects that a patient is considering such private selection
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