Public Health Law Map - Beta 5 - Medical and Public Health Law Site

should be sure that she understands the risks. If she is the carrier, she must
understand that another father will not alter the risk. If the problem is a recessive
disease with a high gene prevalence, such as sickle cell disease or cystic fibrosis,
she may have the bad luck to pick a father who is also a carrier. On the other hand,
if her husband is the carrier and she is not, her idea is medically sound, if socially
questionable. Although it is reasonable to try to talk a woman out of seeking a
surrogate father without telling her husband, it would violate her privacy to tell her
husband. A physician who is uncomfortable with the situation should withdraw
from the case. He or she should not try to control the actions of an independent
adult.
c) Should We Get Married?
Although this is not a medical question, it is one that a physician doing genetic
counseling may be asked. The answer for a particular couple will depend on many
things: How much do they want children? How great is their risk of genetic
disease? How severe is the disease? What are their feelings about prenatal
diagnosis and abortion? The birth of a handicapped child is a strain on any
marriage and often contributes to divorce. If there are other potential problems,
such as family objections or teenage partners, then the risk of divorce is fairly high.
d) Should We Get Divorced?
The general understanding of genetic disease is not great. There are people who
believe that there is a moral duty to dissolve a marriage if the parties are even
distantly related or if there is genetic disease involved. One of the most widely
publicized cases involved a biologic brother and sister who were adopted by
different families as small children. They met in adulthood, married, and had three
healthy children. Another person who knew of their earlier relationship tried to
force them to divorce. They quite rightly refused.
Couples should understand the genetic problem they face and the likelihood that
children will be affected. Once they understand their options, the parties to the
marriage will have to make their own choices. Whatever a physician may advise,
strong marriages will tend to survive; weak ones may not, and genetic compatibility
is often only a small part of the equation.
e) What Should I Tell My Family?
The best answer to this one is “nothing.” If a couple is considering alternative
methods of conceiving a healthy child, such as artificial insemination, or if the
couple is going to have prenatal diagnosis and abortion of a defective fetus, they
are well advised to tell as few people as possible. If enough people are told, there is
certain to be someone who will disagree with the decision out of ignorance or
moral outrage. The child may also face ostracism in the family. A grandparent who
has a number of biologic grandchildren may not care about a child of artificial
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