student research day - Case Western Reserve University School of ...

GEORGE L. ANESI
Autonomy and Beneficence in Conflict: Weighing Patient Confidentiality and a Duty to
Warn Relatives about an Inherited Cancer Risk
George L. Anesi, BS, MS-II and Georgia Wiesner, MD
Department of Bioethics and Department of Human Genetics
Case Western Reverse University School of Medicine and University Hospitals Case Medical Cener
The expectation of an agreement of confidentiality is central to the patient-physician relationship. Such an
agreement is based on practical, ethical, and legal principles. Confidentiality, however, is not by default
infinite. Challenges to patient confidentiality have arisen in the fields of infectious diseases and psychiatry
where the health status of patients—a dangerous and transmissible infection or a violent state of mental
instability, respectively—could potentially threaten the health or lives of third parties. In such cases, a
potential ―duty to warn‖ was seen in which physicians might seek or be required to breach confidentiality in
an effort to avert harm to a threatened third party. This dilemma has arisen anew in the field of genetics,
where the detection of a genetic abnormality in many situations immediately and automatically reveals
information about potential health risks faced by family members of the proband. Nowhere is this new
challenge to confidentially more important—and indeed becoming increasingly more so—than in the testing
for and treatment of inherited cancers. We now have the capacity to test for a number of cancer-associated
alleles and identify carriers who are at far higher risk of developing a given malignancy. The knowledge of
carrier status can allow for utilization of a number of extremely important prevention and treatment
strategies that may lead to significant improvements in morbidity and mortality. We have sought to
investigate the question of whether or not a physician has a duty to warn relatives about an inherited cancer
risk against a patient’s wishes and in doing so, breach patient confidentiality. The dilemma will be
investigated on legal, professional, practical, and ethical grounds, in effort to provide clinicians with guidance
in navigating this and related issues of confidentiality and third-party risk.
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