November 6, 2009
NURSING ETHICS – LECTURE 8
I – Introduction
• The last several weeks we have been using theoretical frameworks to
examine particular ethical principles and issues that arise in
• We have thus far looked at the concepts of veracity, informed consent,
confidentiality, and justice.
• We also looked at the issue of the just distribution of healthcare
• This week we will look at another important issue in healthcare ethics:
II – Genetic Testing and its Rationale
• Genetic testing involves the genetic diagnosis of vulnerabilities to
• It allows for the identification of changes in chromosomes, genes, or
• Every person carries two copies of every gene, one inherited from
their mother and one from their father.
• In addition to studying chromosomes at the level of individual genes,
genetic testing in a broader sense includes biochemical tests for the
presence or absence of key proteins that signal aberrant versions of
• In our assigned reading for this week, ‘Safeguarding Being: A
Bioethical Principle for Genetic Nursing Care’, Ellen Giarelli defines
genetic testing in a slightly more technical manner:
Genetic testing involves analysis performed on DNA,
RNA, genes, and/or chromosomes to detect heritable or
acquired genotypes, phenotypes, karyotypes that are
causing, or are likely to cause, a specific disease or
• What is the purpose of genetic testing?
• Its main purposes seem to be (1) diagnosis and prognosis of illnesses,
and most importantly (2) clinical management of illnesses.
(1) Genetic tests can be used to predict and detect illnesses and diseases.
-Most commonly, genetic tests are used to determine our genetic
predisposition for acquiring diseases.
-For example, they can be used for prenatal diagnosis or at any time
after birth to identify a genetic predisposition to common diseases.
-Of course, whether a person actually develops the disease depends on
the complex dynamics among genetic, behavioural and environmental
(2) Obviously the primary aim of genetic testing is the clinical
management of illnesses and diseases.
-Once an illness or a genetic predisposition to an illness has been
detected certain measures can be taken.
-Measures can be taken for the prevention, treatment, and/or
alleviation of genetically inheritable diseases.
-E.G.: A set of parents, through genetic testing, may be found to have
a high likelihood of producing offspring who will acquire cancer.
-What can be done?
-(i)They can choose not to have children.
-(ii)They can choose to have children, but to warn their children about
-The children can then take certain precautions, i.e., dietary, exercise,
medication, to try to decrease their chances of acquiring cancer.
• Notice that genetic testing, then, can potentially be justified using
some of the moral theoretical frameworks we have looked at.
• In particular, since the ultimate goal of genetic testing is illness
prevention, treatment, and alleviation, genetic testing is a technology
that is meant to serve a good: to improve the health of the general
• Thus, the use of genetic testing is intended to conform to the concepts
of beneficence (to promote well-being) and nonmalificence (to avoid
doing harm), that are generally thought to be utilitarian concepts.
III – Genetic Testing: Ethical Concerns
• Although genetic testing ultimately has a beneficent goal the
improvement of healthcare a number of ethical concerns emerge
regarding exactly how and to what extent it should be implemented.
• There are three main ethical concerns generated by the use genetic
testing: (1) veracity, (2) autonomy, and (3) privacy and
• We’ll look at each of these in turn.
(1) Veracity is an ethical principle that declares one should tell the truth
(or be honest) whenever possible.
• We have looked at this principle in application to healthcare ethics in
• Its application to the use of genetic testing technologies is particularly
-When a genetic test is performed, medical professionals acquire
information about a patient’s genetic predisposition to acquire certain
-In many cases, it will not be clear how much, if any, of this
information should be given to the patient.
E.G.: A patient asks for a genetic test for