Prenatal Genetic Testing: Ethical Challenges, Essay Example

Genetic testing is a practice that has created much controversy since its inception. This practice is challenging because it possesses a number of components that may create ethical challenges for some patients, depending on a number of factors, such as religious preferences and the fear of learning if there is a potential genetic defect that may contribute to health concerns for patients. In the world of prenatal and obstetric care, these factors are particularly challenging because they lead to many questions regarding an unborn child and his or her chances for survival or a normal life. It is important to identify some of these challenges in an effort to determine how to approach genetic testing best at the prenatal stage and to identify some of the ethical issues that surround this practice. Ethical committees play a critical role in decision-making regarding the appropriateness of genetic testing and in other areas, such as those offered at the hospital level to address ethical dilemmas and to make decisions regarding these issues that will have a lasting impact on patients.

Prenatal genetic testing may determine if an unborn child has one or more birth defects or other issues that could complicate birth and quality of life, based upon family history, maternal age, and other factors (Benn & Chapman, 2010). In one scenario, a female patient with strong religious beliefs was hesitant to accept genetic testing as part of her prenatal care, in spite of a strong recommendation from her physician to have the test done, given her family history of Down’s Syndrome. The patient was hesitant to obtain testing because her husband was in disagreement with the physician’s decision, and he did not support her belief that in spite of their religious preferences, she should have the test done due to family history. In spite of his objections, the patient went ahead with the testing because she felt more comfortable knowing whether or not her child was at risk of Down’s Syndrome or other genetic conditions. This caused a rift between the two persons.  Also, the nurse on duty at the time was scolded by the husband, in spite of her following protocol and the patient’s wishes through informed consent. This is an important reminder to recognize how an ethical dilemma impacts decision-making and the steps that are required to ensure that patients receive the proper focus and treatment at all times, regardless of the circumstances. All dilemmas must be addressed with the appropriate tools in place to support favorable outcomes as best as possible.

In this example, the nurse followed protocol and adhered to the specific standards of the Code of Ethics for Nurses, including the following provisions: 1) The right to self-determination, as it is the patient’s decision whether or not to have the genetic testing procedure; 2) Privacy of the patient’s interests, whereby the patient’s decision in this case must remain her own decision and with her own consent; 3) Confidentiality, whereby the patient’s decision and information is kept confidential at all times; 4) Privacy, as the patient should have privacy when making the decision and in sharing her decision with the nurse; 5) Responsibilities to the public to ensure that genetic testing is explained in detail to make informed decisions; and 6) Interprofessional integrity across all clinical areas to ensure that patients are protected from unnecessary risk before, during, and after the testing (American Nurses Association). In this example, since the patient signed a consent form for the genetic testing, her husband’s objections did not carry any weight with the medical team. Therefore, although it was important to take the husband’s objections seriously, he was not the patient, and she was of sound mind and body to make this decision in her own right and properly approved of the testing.

Protecting patients from unnecessary risk and harm is a critical priority in making decisions regarding their care and treatment. It is known that “Depending on the population screened, and the test protocols, only a proportion of the affected pregnancies are identified as high risk” (Benn & Chapman, 2010, p. 128). Nurses play a primary role in this process and support the development of strategies to ensure that patients are protected through informed consent prior to procedures and testing. In this capacity, the patient in the example was protected by her informed consent authorization, giving her husband a lack of evidence to support his objections. Therefore, the Nursing Code of Ethics applies because it requires the need to obtain informed consent from patients before any procedures are conducted. Knowledge regarding the testing procedure and the steps of the process must also be provided while also using other resources to guide the patient through the decision-making process, such as family history and other variables. The patient’s decision to have the genetic testing without her husband’s approval was a point of contention between the two parties; furthermore, the patient’s spouse did not have a real argument because the patient was of sound mind and body when making her decision. The outcome demonstrated that it is important for patients to discuss testing decisions with family members in order to prevent arguments and other complications that could cause stress to the expectant mother. This case is an example to follow in that the spouse did cause undue stress to his wife and further complicated the decision by lashing out at the nurse.

With this case, the nursing leadership team is available to support the nurse in her time of need after the backlash received by the spouse, as she did nothing wrong and obtained the proper consent from the woman to proceed with the genetic test. Websites such as MedlinePlus (2014) and KidsHealth (2014) provide important information regarding genetic testing in a manner that is easy to understand and that may support the ability to make an informed decision regarding these practices so that expectant mothers are fully aware of their options in these cases. Ethics committees are typically present within healthcare organizations in order to address areas of need through consultation and problem-solving in order to address the potential outcomes of a dilemma in an effective manner (University of Washington School of Medicine, 2013). Ethics consultants are often available to address specific ethical dilemmas and to evaluate the facts and opposing views of each case in order to make an effective decision regarding the necessary outcome of the case.

Patients who have religious restrictions may find it difficult to agree to genetic testing, yet they provide a high level of support in determining whether or not a specific condition may be prevalent and whether or not it is likely to cause health concerns. Prenatal genetic testing is a complex argument in and of itself, but religious restrictions create additional risks and considerations for patients. In the example provided, the patient’s willingness to accept genetic testing in spite of her husband’s objections was supported by the nurse, as she obtained the appropriate informed consent for the testing and had provided knowledge and background information regarding the test and its potential outcomes.

References

American Nurses Association (2014). Code of Ethics for Nurses. Retrieved from http://www.nursingworld.org/codeofethics

Benn, B.A., & Chapman, A.R. (2010). Ethical challenges in providing noninvasive prenatal diagnosis. Current Opinion in Obstetrics & Gynecology, 22, 128-134.

KidsHealth (2014). FAQs: prenatal tests. Retrieved from http://kidshealth.org/parent/system/medical/prenatal_tests.html

MedlinePlus (2014). Prenatal testing. Retrieved from http://www.nlm.nih.gov/medlineplus/prenataltesting.html

University of Washington School of Medicine (2013). Ethics committees, programs and consultation. Retrieved from https://depts.washington.edu/bioethx/topics/ethics.html