Do Physicians Have a Duty to Warn a Patient’s Family?
Exploring the ethical and legal issues around doctors sharing medical records and providing recommendations to the family members of the patients they treat.
Published June 1, 2002
By Fred Moreno, Dana Van Atta, Jill Stolarik, and Jennifer Tang
Academy Contributors
What guidelines should doctors follow regarding disclosure information to potentially affected family members and the genetic testing of children. In two widely discussed cases, Pate v. Threlkel and Safer v. Estate of Pack, judges grappled with whether physicians have a duty to warn family members of patients. Heidi Pate’s mother suffered from medullary thyroid carcinoma, an autosomal dominant disorder. Three years after Pate’s mother received treatment, Pate was diagnosed with the same disease. She sued, arguing that her mother’s doctors had a duty to warn her mother of the risk of genetic transmission and to recommend testing of any children.
The Florida Supreme Court ruled that if the standard of care were to warn a patient of the genetically transferable nature of a condition, as Pate alleged, then the intended beneficiaries of the standard would include the patient’s children. In other words, the patient’s children would be entitled to recover for a breach of the standard of care. However, in light of state laws protecting the confidentiality of medical information, the court found no requirement that a doctor warn a patient’s children directly. Rather, the court held that in any circumstances in which a doctor has a duty to warn of a risk of inherited disease, that duty is satisfied by warning the patient.
Donna Safer’s father was treated over an extended period of time for colon cancer associated with adenomatous polyposis coli, another autosomal dominant disorder. Almost two decades after his death, Safer was diagnosed with metastatic colon cancer associated with adenomatous polyposis coli. Safer also sued, arguing that her father’s doctor had a duty to warn her of the risk to her health.
Two Additional Significant Features
Two additional features of the case were significant. First, Safer’s mother testified that on at least one occasion she asked the doctor if what he referred to as an “infection” would affect her children and was told not to worry. Second, Safer contended that careful monitoring of her condition would have improved her medical outcome.
The New Jersey Superior Court found no essential difference between this case, with its “genetic threat,” and traditional duty-to-warn cases involving the menace of infection or threat of physical harm. The court concluded that a duty to warn in the genetics context would be manageable, commenting that those at risk are easily identified. The court failed to state how the duty to warn might be discharged, especially in cases involving small children.
This decision is of concern to many physicians who are worried about the scope and ramifications of a broad duty to warn. In 1996, following the Safer decision, the New Jersey legislature passed a law prohibiting disclosure of genetic information about an individual. The limited exceptions include disclosure to blood relatives for purposes of medical diagnosis, but only after the individual is dead.
It is important to remember that with predictive information, more is not necessarily better. In addition to possible psychological harms, family members may face discrimination if genetic information finds its way into their medical records or becomes part of their knowledge base and so must be disclosed on applications for insurance. An awareness of this problem may be behind a New York law that prohibits any person in possession of information derived from a genetic test from incorporating that information into the records of a non-consenting individual who may be genetically related to the tested individual.
Also read: Genetic Privacy: A War Fought on Many Fronts
