- Policy
- Published:
Genetic testing in asymptomatic minors
Background considerations towards ESHG Recommendations
- Pascal Borry1,
- Gerry Evers-Kiebooms2,
- Martina C Cornel3,
- Angus Clarke4 &
- Kris Dierickx1
- on behalf of the Public and Professional Policy Committee (PPPC) of the European Society of Human Genetics (ESHG)
European Journal of Human Geneticsvolume 17, pages711–719 (2009)Cite this article
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Abstract
Although various guidelines and position papers have discussed, in the past, the ethical aspects of genetic testing in asymptomatic minors, the European Society of Human Genetics had not earlier endorsed any set of guidelines exclusively focused on this issue. This paper has served as a background document in preparation of the development of the policy recommendations of the Public and Professional Committee of the European Society of Human Genetics. This background paper first discusses some general considerations with regard to the provision of genetic tests to minors. It discusses the concept of best interests, participation of minors in health-care decisions, parents’ responsibilities to share genetic information, the role of clinical genetics and the health-care system in communication within the family. Second, it discusses, respectively, the presymptomatic and predictive genetic testing for adult-onset disorders, childhood-onset disorders and carrier testing.
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References
Borry P, Stultiens L, Nys H, Cassiman JJ, Dierickx K : Presymptomatic and predictive genetic testing in minors: a systematic review of guidelines and position papers.Clin Genet 2006;70: 374–381.
Borry P, Schotsmans P, Fryns JP, Dierickx K : Carrier testing in minors: a systematic review of guidelines and positions statements.Eur J Hum Genet 2006;14: 133–138.
Hayhurst R, Cassiman JJ : EuroGentest standing up to scrutiny - first year demonstrates good progress harmonizing community approaches.J Appl Genet 2006;47: 5–7.
Cassiman JJ : EuroGentest - a European Network of Excellence aimed at harmonizing genetic testing services.Eur J Hum Genet 2005;13: 1103–1105.
Borry P, Fryns JP, Dierickx K : Predictive genetic testing in children. A clinical-ethical analysis; in de Bouvet A, Boitte P, Aiguier G (eds):Questions éthique en médicine predictive. Montrouge, Editions John Libbey Eurotext, 2006, pp 89–98.
Borry P, Dierickx K : Carrier testing for congenital adenal hyperplasia: ethical issues.Cares 2007;6: 16–18.
Borry P, Nys H, Dierickx K : Ethics watch – carrier testing in minors: conflicting views.Nat Rev Genet 2007;8: 828.
Stultiens L, Goffin T, Borry P, Dierickx K, Nys H : Minors and informed consent: a comparative approach.Eur J Health Law 2007;14: 21–46.
Nys H, Stultiens L, Borry P, Goffin T, Dierickx K : Patient rights in EU member states after the ratification of the convention on human rights and biomedicine.Health Policy 2007;83: 223–235.
Borry P, Stultiens L, Nys H, Dierickx K : Attitudes towards predictive genetic testing in minors for familial breast cancer: a systematic review.Crit Rev Oncol Hematol 2007;64: 173–181.
Borry P, Schotsmans P, Fryns JP, Dierickx K : Attitudes of minors, parents and health professionals towards carrier testing in minors: a systematic review.Genet Couns 2005;16: 341–352.
Borry P, Goffin T, Nys H, Dierickx K : Attitudes regarding carrier testing in incompetent children. A survey of European clinical geneticists.Eur J Hum Genet 2007;15: 1211–1217.
Borry P : Minors and informed consent in carrier testing. A survey of European clinical geneticists.J Med Ethics 2008;34: 370–374.
Borry P, Goffin T, Nys H, Dierickx K : Attitudes regarding predictive genetic testing in minors. A survey of European clinical geneticists.Am J Med Genet C Semin Med Genet 2008;148C: 78–83.
Andorno R : The Oviedo Convention: a European framework at the intersection of human rights and health law.J Int Biotechnol Law 2005;2: 133–143.
Buchanan AE, Brock DW :Deciding for Others. Cambridge: University Press, 1989.
Dawson A : The determination of the best interests in relation to childhood immunisation.Bioethics 2005;19: 72–89.
Downie RS, Randall F : Parenting and the best interests of minors.J Med Philos 1997;22: 219–231.
Ross LF : Health care decision making by children. Is it in their best interest?Hastings Cent Rep 1997;27: 41–45.
Spence K : The best interest principle as a standard for decision making in the care of neonates.J Adv Nurs 2000;31: 1286–1292.
Trau JM, McCartney JJ : In the best interest of the patient. Applying this standard to healthcare decision making must be done in a community context.Health Prog 1993;74: 50–56.
Charter of Fundamental Rights of the European Union,http://www.europarl.europa.eu/charter/pdf/text_en.pdf, 2000.
Universal Declaration on the Human Genome and Human Rights; Unesco,http://portal.unesco.org/shs/en/ev.php-URL_ID=1881&URL_DO=DO_TOPIC&URL_SECTION=201.html, 1997.
Kopelman LM : The best-interests standard as threshold, ideal, and standard of reasonableness.J Med Philos 1997;22: 271–289.
Kopelman LM : Children and bioethics: uses and abuses of the best-interests standard.J Med Philos 1997;22: 213–217.
United Nations. Convention on the Rights of the Child,http://www.unhchr.ch/html/menu3/b/k2crc.htm, 1989.
Alderson P, Montgomery J :Health Care Choices: Making Decisions with Children. London: Institute for Public Policy Research, 1996.
Royal College of Psychiatrists Report:Appendix 2 – Children's Level of Understanding of Medical Decisions; Guidance for Researchers and for Ethics Committees on Psychiatric Research Involving Human Participants. London: The Royal College of Psychiatrists, 2001.
British Medical Association:Consent, Rights and Choices in Health Care for Children and Young People. London: BMJ Books, 2001.
Informed consent, parental permission, and assent in pediatric practice: Committee on Bioethics, American Academy of Pediatrics.Pediatrics 1995;95: 314–317.
Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the application of Biology and Medicine: Convention on Human Rights and Biomedicine. Oviedo, Council of Europe, 1997.
Clarke A, Richards M, Kerzin-Storrar Let al: Genetic professionals; reports of nondisclosure of genetic risk information within families.Eur J Hum Genet 2005;13: 556–562.
Loud JT, Weissman NE, Peters JAet al: Deliberate deceit of family members: a challenge to providers of clinical genetics services.J Clin Oncol 2006;24: 1643–1646.
Fanos JH : Developmental tasks of childhood and adolescence: implications for genetic testing.Am J Med Genet 1997;71 (1): 22–28.
Denayer L, Welkenhuysen M, Evers-Kiebooms G, Cassiman JJ, Van den BH : Risk perception after CF carrier testing and impact of the test result on reproductive decision making.Am J Med Genet 1997;69: 422–428.
Fanos JH, Johnson JP : Perception of carrier status by cystic fibrosis siblings.Am J Hum Genet 1995;57: 431–438.
Denayer L, De Boeck K, Evers-Kiebooms G, Van den BH : The transfer of information about genetic transmission to brothers and sisters of parents with a CF-child.Birth Defects Orig Artic Ser 1992;28: 149–158.
Axworthy D, Brock DJ, Bobrow M, Marteau TM : Psychological impact of population-based carrier testing for cystic fibrosis: 3-year follow-up. UK Cystic Fibrosis Follow-Up Study Group.Lancet 1996;347: 1443–1446.
Bekker H, Modell M, Denniss Get al: Uptake of cystic fibrosis testing in primary care: supply push or demand pull?BMJ 1993;306: 1584–1586.
Bekker H, Denniss G, Modell M, Bobrow M, Marteau T : The impact of population based screening for carriers of cystic fibrosis.J Med Genet 1994;31: 364–368.
Watson EK, Mayall E, Chapple Jet al: Screening for carriers of cystic fibrosis through primary health care services.BMJ 1991;303: 504–507.
Mennie ME, Gilfillan A, Compton Met al: Prenatal screening for cystic fibrosis.Lancet 1992;340: 214–216.
Callanan NP, Cheuvront BJ, Sorenson JR : CF carrier testing in a high risk population: anxiety, risk perceptions, and reproductive plans of carrier by ‘non-carrier’ couples.Genet Med 1999;1: 323–327.
Marteau TM, Michie S, Miedzybrodzka ZH, Allanson A : Incorrect recall of residual risk three years after carrier screening for cystic fibrosis: a comparison of two-step and couple screening.Am J Obstet Gynecol 1999;181: 165–169.
Fanos JH, Mackintosh MA : Never again joy without sorrow: the effect on parents of a child with ataxia-telangiectasia.Am J Med Genet 1999;87: 413–419.
Fanos JH, Nickerson BG : Long-term effects of sibling death during adolescence.J Adolesc Res 1991;6: 70–82.
Mischler EH, Wilfond BS, Fost Net al: Cystic fibrosis newborn screening: impact on reproductive behavior and implications for genetic counseling.Pediatrics 1998;102: 44–52.
Ciske DJ, Haavisto A, Laxova A, Rock LZ, Farrell PM : Genetic counseling and neonatal screening for cystic fibrosis: an assessment of the communication process.Pediatrics 2001;107: 699–705.
Forrest K, Simpson SA, Wilson BJet al: To tell or not to tell: barriers and facilitators in family communication about genetic risk.Clin Genet 2003;64: 317–326.
Varekamp I, Suurmeijer TP, Brocker-Vriends AHet al: Carrier testing and prenatal diagnosis for hemophilia: experiences and attitudes of 549 potential and obligate carriers.Am J Med Genet 1990;37: 147–154.
Varekamp I, Suurmeijer T, Brocker-Vriends A, Rosendaal FR : Hemophilia and the use of genetic counseling and carrier testing within family networks.Birth Defects Orig Artic Ser 1992;28: 139–148.
Varekamp I, Suurmeijer TP, Rosendaal FR, Brocker-Vriends AH : The use of preventive health care services: carrier testing for the genetic disorder haemophilia.Soc Sci Med 1993;37: 639–648.
Sorenson JR, Jennings-Grant T, Newman J : Communication about carrier testing within hemophilia A families.Am J Med Genet 2003;119C: 3–10.
Fanos JH, Johnson JP : Barriers to carrier testing for adult cystic fibrosis sibs: the importance of not knowing.Am J Med Genet 1995;59: 85–91.
Duster T : The social consequences of genetic disclosure; in: Carson RA, Rothstein MA (eds):Behavioral Genetics. The Clash of Culture and Biology. London: John Hopkins University Press, 1999, pp 172–188.
Sharpe NF : The duty to recontact: benefit and harm.Am J Hum Genet 1999;65: 1201–1204.
Borry P, Dierickx K : What are the limits of the duty of care? The case of clinical genetics.Per Med 2008;5: 101–104.
Biesecker BB : Future directions in genetic counseling: practical and ethical considerations.Kennedy Inst Ethics J 1998;8: 145–160.
Elwyn G, Gray J, Clarke A : Shared decision making and non-directiveness in genetic counselling.J Med Genet 2000;37: 135–138.
Oduncu FS : The role of non-directiveness in genetic counseling.Med Health Care Philos 2002;5: 53–63.
Metcalfe A : Consultation on testing in minors recommendations, personal communication, 2008.
Harper P, Clarke A :Genetics, Society and Clinical Practice. Oxford: Bios, 1997.
Codori AM, Zawacki KL, Petersen GMet al: Genetic testing for hereditary colorectal cancer in children: long-term psychological effects.Am J Med Genet A 2003;116A: 117–128.
Allan D : Ethical boundaries in genetic testing.CMAJ 1996;154: 241–244.
Godard B, Kaariainen H, Kristofferson Uet al: Provision of Genetic Services in Europe - current practices and issues.Eur J Hum Genet 2003;11 (Suppl 2): S13–S48.
European Society of Human Genetics: Provision of Genetic services in Europe - current practices and issues.Eur J Hum Genet 2003;11 (Suppl 2): S2–S4.
Clarke A :The Genetic Testing of Children. Oxford: Bios, 1998.
Clarke A, Flinter F : The genetic testing of children: a clinical perspective, in: Marteau T, Richards M (eds):The Troubled Helix: Social and Psychological Implications of the New Human Genetics. Cambridge: Cambridge University Press, 1996, pp 164–176.
Clarke A : The genetic testing of children.J Med Genet 1995;32: 492.
German Society of Human Genetics: Statement on genetic diagnosis in children and adolescents,http://www.gfhev.de/en/gfh/, 1995.
Danish Council of Ethics: Genetic Investigation of Healthy Subjects - Report on Presymptomatic Gene Diagnosis.http://www.etiskraad.dk/sw293.asp, 2001.
Borry P, Goffin T, Nys H, Dierickx K : Predictive genetic testing in minors for adult-onset genetic diseases.Mt Sinai J Med 2008;75: 287–296.
Rhodes R : Why test children for adult-onset genetic diseases?Mt Sinai J Med 2006;73: 609–616.
Hayes CV : Genetic testing for Huntington's disease–a family issue.N Engl J Med 1992;327: 1449–1451.
Grosfeld FJ, Beemer FA, Lips CJ, Hendriks KS, ten Kroode HF : Parents’ responses to disclosure of genetic test results of their children.Am J Med Genet 2000;94: 316–323.
Quaid KA, Morris M : Reluctance to undergo predictive testing: the case of Huntington disease.Am J Med Genet 1993;45: 41–45.
Malpas PJ : Why tell asymptomatic children of the risk of an adult-onset disease in the family but not test them for it?J Med Ethics 2006;32: 639–642.
Rhodes R : Why test children for adult-onset genetic diseases?Mt Sinai J Med 2006;73: 609–616.
Skirton H : Telling the children; in: Clarke A (eds):The Genetic Testing of Children. Oxford: Bios, 1998, pp 103–111.
Campbell E, Ross LF : Parental attitudes and beliefs regarding the genetic testing of children.Community Genet 2005;8: 94–102.
Hamann HA, Croyle RT, Venne VL, Baty BJ, Smith KR, Botkin JR : Attitudes toward the genetic testing of children among adults in a Utah-based kindred tested for a BRCA1 mutation.Am J Med Genet 2000;92: 25–32.
Benkendorf JL, Reutenauer JE, Hughes CAet al: Patients’ attitudes about autonomy and confidentiality in genetic testing for breast-ovarian cancer susceptibility.Am J Med Genet 1997;73: 296–303.
Evers-Kiebooms G : Predictief testen van minderjarigen voor aandoeningen die later in het leven tot uiting komen: psychologische aspecten en multidisciplinaire aanpak.Tijdschrift voor geneeskunde 2006;62: 463–471.
Swiss Academy of Medical Sciences: Genetic investigations in humans,http://www.samw.ch/, 1993.
Human Genetics Society of Australasia: DNA presymptomatic and predictive testing for genetic disorders,http://www.hgsa.com.au/policy/dnaptgd.html, 2002.
The American Society of Human Genetics Board of Directors and The American College of Medical Genetics Board of Directors: Points to consider: ethical, legal, and psychological impications of genetic testing in children and adolescents.Am J Hum Genet 1995;57: 1233–1241.
Task Force on Genetic Testing: Promoting safe and effective genetic testing in the United States,http://www.genome.gov/10001733, 1997.
Canadian College of Medical Geneticists: Genetic testing of children,http://ccmg.medical.org/, 2000.
Bioethics Committee Canadian Paediatric Society: Guidelines for genetic testing of healthy children.Paediatr Child Health 2003;8: 42–45.
Committee on Bioethics: Ethical issues with genetic testing in pediatrics.Pediatrics 2001;107: 1451.
Dalby S : GIG response to the UK Clinical Genetics Society report ‘The genetic testing of children’.J Med Genet 1995;32: 490–491.
Clarke A : The genetic testing of children. Working Party of the Clinical Genetics Society (UK).J Med Genet 1994;31: 785–797.
American Medical Association: Testing children for genetic status,http://www.ama-assn.org/, 1995.
Barnes C :Carrier testing in childhood: conflict or compromise.http://www.medacad.org/eshg/abstracts/eshgplenary.htm, 2002.
McConkie-Rosell A, Spiridigliozzi GA, Rounds Ket al: Parental attitudes regarding carrier testing in children at risk for fragile X syndrome.Am J Med Genet 1999;82: 206–211.
James CA, Holtzman NA, Hadley DW : Perceptions of reproductive risk and carrier testing among adolescent sisters of males with chronic granulomatous disease.Am J Med Genet 2003;119C: 60–69.
Green NS, Dolan SM, Murray TH : Newborn screening: complexities in universal genetic testing.Am J Public Health 2006;96: 1955–1959.
UK Newborn Screening Programme Centre: Newborn blood spot screening in the UK Policies and Standards.http://www.newbornbloodspot.screening.nhs.uk/download/policies_standards.pdf, 2005.
Health Resources and Services Administration: Newborn Screening: Toward a Uniform Screening Panel and System,ftp://ftp.hrsa.gov/mchb/genetics/screeningdraftforcomment.pdf, 2005.
Acknowledgements
Part of this contribution was supported by the Eurogentest Network of Excellence of the EU, FP6-512148.
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Authors and Affiliations
Research Fund Flanders, Centre for Biomedical Ethics and Law, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium
Pascal Borry & Kris Dierickx
Psychosocial Genetics Unit University Hospitals, Center for Human Genetics, Katholieke Universiteit Leuven, Belgium
Gerry Evers-Kiebooms
Department of Clinical Genetics/EMGO Institute, Community Genetics, VU University Medical Center, Amsterdam, The Netherlands
Martina C Cornel
Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, Wales, CF14 4XN, UK
Angus Clarke
- Pascal Borry
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- Gerry Evers-Kiebooms
Search author on:PubMed Google Scholar
- Martina C Cornel
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- Angus Clarke
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- Kris Dierickx
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Consortia
on behalf of the Public and Professional Policy Committee (PPPC) of the European Society of Human Genetics (ESHG)
Corresponding author
Correspondence toPascal Borry.
Additional information
Members of the PPPC in 2007–2008 were:
Martina Cornel, chair, MD, Epidemiologist, Professor of Community Genetics and Public Health Genomics, Department of Clinical Genetics/EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands; Gerry Evers-Kiebooms PhD, Psychologist, Psychosocial Genetics Unit University Hospitals, Katholieke Universiteit Leuven, Belgium; Ségolène Aymé MD, Medical Geneticist and Epidemiologist, Project Leader of ORPHANET, INSERM, Paris, France; Suzanne Braga MD, Medical Geneticist, Psychotherapist, Family therapist and counselor, SGMG/SSGM, Bern, Switzerland; Franca Dagna Bricarelli Professor, Human Genetics Laboratory, Galliera Hospital, Genoa, Italy; Shirley Hodgson Professor of Cancer Genetics, Honorary Consultant in Clinical Genetics, Department of Clinical Genetics, St George's Hospital, University of London, London, UK; Gyorgy Kosztolany Professor, Director of the Department of Medical Genetics, University of Pécs, Hungary; Jan Lubinski, MD, PhD, Professor, Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland; Meral Özgüc, Professor, Department of Medical Biology, Faculty of Medicine, Hacettepe University Ankara, Turkey; Christine Patch PhD, RN, Consultant Genetic Counsellor and Manager, Guys and St Thomas’ NHS Foundation Trust, London, UK; Jorge Sequeiros MD, Professor in Medical Genetics, Head of the Department of Human Genetics, University of Porto, Porto, Portugal; Lisbeth Tranebjaerg MD, PhD, Professor in Genetic Audiology, Department of Audiology, H:S Bispebjerg Hospital and Wilhelm Johannsen Centre of Functional Genomics, University of Copenhagen, Denmark; Veronica van Heyningen Dphil, FRS, FRSE, FMedSci, Honorary Professor of Edinburgh University, MRC Human Genetics Unit, Western General Hospital, Edinburgh, UK
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Borry, P., Evers-Kiebooms, G., Cornel, M.et al. Genetic testing in asymptomatic minors.Eur J Hum Genet17, 711–719 (2009). https://doi.org/10.1038/ejhg.2009.25
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