Ethical, Legal, and Social Implications
Table 2. State Case Laws That Apply to Duty to Warn continued...
At the federal level, there are strict nondisclosure policies governing private health information. The Standards for Privacy of Individually Identifiable Health Information (Privacy Rule), which summarizes the Health Insurance Portability and Accountability Act (HIPAA) of 1996, finds it permissible to disclose health information without consent when the public interest is at risk;[15,16] therefore, under certain conditions, there are exceptions to the nondisclosure policy include the following:
- There is serious or imminent threat to the health or safety of a person or the public.
- The threat constitutes an imminent, serious threat to an identifiable third party.
- The physician has the capacity to avert significant harm.
Professional societies and government advisory agencies have published their different positions and recommendations on communication between a physician and a patient's relatives in regard to disclosure of genetic disease.[4,8,17]
The Council on Ethical and Judicial Affairs of the American Medical Association (AMA) and the American Society of Clinical Oncology (ASCO) [18,19] encourage discussing the importance of patients sharing genetic information with family members. Specifically, the Council on Ethical and Judicial Affairs of the American Medical Association states that "Physicians …should identify circumstances under which they would expect patients to notify biological relatives of the availability of information related to risk of disease…(and) physicians should make themselves available to assist patients in communicating with relatives to discuss opportunities for counseling and testing, as appropriate." ASCO's position is that providers "should remind patients of the importance of communicating test results to family members… ASCO believes that the cancer care provider's obligations (if any) to at-risk relatives are best fulfilled by communication of familial risk to the person undergoing testing, emphasizing the importance of sharing this information with family members so that they may also benefit."[18,19] These organizations recommend that family members disclose genetic information.
The National Society of Genetic Counselors and the International Society of Nurses in Genetics support the release of any genetic information upon request to third parties including relatives but only with the patient's consent. One of the tenets of genetic counseling is to maintain information received from clients as confidential, unless released by the client or consent for disclosure is provided as required by law.[4,20]