Author Affiliations: Clinical Genetics Service, Department of Medicine (Dr Offit and Mss Groeger and Wadsworth), and Office of Legal Affairs (Ms Weiser), Memorial Sloan-Kettering Cancer Center, New York, NY; and Ropes and Gray LLP, Washington, DC (Mr Turner).
Health Law and Ethics Section Editors: Lawrence
O. Gostin, JD, Center for Law and the Public's Health at Georgetown University,
Washington, DC, and the Johns Hopkins University, Baltimore, Md; Helene M.
Cole, MD, Contributing Editor, JAMA.
Genetic tests for adult-onset disorders, including common forms of cancer,
are now commercially available, and tests for genetic polymorphisms that predict
drug effects or toxicity after treatment are under development. For each of
these circumstances, testing of 1 individual may imply an increased risk to
The obligation, if any, to warn family members of the identification
of a genetic mutation has generated concerns regarding the conflict between
the physician's ethical obligations to respect the privacy of genetic information
vs the potential liabilities resulting from the physician's failure to notify
at-risk relatives. A duty to warn relatives about risks due to some infectious
agents has been assumed by state and local health agencies, and the duty to
breach confidentiality to warn of imminent harm has been the subject of case
In general, the special nature of genetic tests has been viewed as a
barrier to physicians' breaching the confidentiality of personal genetic information.
However, the failure to warn family members about hereditary disease risks
has already resulted in 3 lawsuits against physicians in the United States.
While the findings of case law and the state and federal statutes that
bear on the issue of "duty to warn" of inherited health risk are still being
defined, we believe that health care professionals have a responsibility to
encourage but not to coerce the sharing of genetic information in families,
while respecting the boundaries imposed by the law and by the ethical practice
Offit K, Groeger E, Turner S, Wadsworth EA, Weiser MA. The "Duty to Warn" a Patient's Family Members About Hereditary Disease Risks. JAMA. 2004;292(12):1469-1473. doi:10.1001/jama.292.12.1469