Ethical issues associated with genetic counseling in the context of adolescent psychiatry

Abstract

Genetic counseling is a well-established healthcare discipline that provides individuals and families with health information about disorders that have a genetic component in a supportive counseling encounter. It has recently been applied in the context of psychiatric disorders (like schizophrenia, bipolar disorder, schizoaffective disorder, obsessive compulsive disorder, depression and anxiety) that typically appear sometime during later childhood through to early adulthood. Psychiatric genetic counseling is emerging as an important service that fills a growing need to reframe understandings of the causes of mental health disorders. In this review, we will define psychiatric genetic counseling, and address important ethical concerns (we will particularly give attention to the principles of autonomy, beneficence, non-maleficence and justice) that must be considered in the context of its application in adolescent psychiatry, whilst integrating evidence regarding patient outcomes from the literature. We discuss the developing capacity and autonomy of adolescents as an essential and dynamic component of genetic counseling provision in this population and discuss how traditional viewpoints regarding beneficence and non-maleficence should be considered in the unique situation of adolescents with, or at risk for, psychiatric conditions. We argue that thoughtful and tailored counseling in this setting can be done in a manner that addresses the important health needs of this population while respecting the core principles of biomedical ethics, including the ethic of care.

Receptiveness to participation in genetic research: A pilot study comparing views of people with depression, diabetes, or no illness

“…Psychiatric genetics research also has intrinsic challenges because of the many issues associated with human research involving ill and potentially vulnerable volunteers (Coors and Raymond, 2009; Ryan et al, 2015). While all genetic inquiry raises certain ethical, legal, and social issues, psychiatric genetic investigation presents additional concerns (Laegsgaard and Mors, 2008).…”

Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease

“…The findings from our interviews with PBD offer some support for the validity of our methodology as they reflect findings from qualitative and quantitative studies (Gershon, ; Hippman et al, ; Meiser et al, ; Meiser et al, ; Meiser et al, ; Peay et al, ; Quinn et al, ; Ratheesh et al, ; Shaw et al, ). A feature of the PBD interviews was ignorance of the role or accuracy of genetic testing in complex diseases or the psychological consequences of testing (Ryan et al, ; Salkovskis & Rimes, ). Clinical experts in BD are less enthusiastic about genetic testing than adults with BD (Jones, Scourfield, McCandless, & Craddock, ) and it is interesting that the OSBD seem to have a similar view.…”

Behavioral Genetics in Criminal and Civil Courts

“…Notwithstanding ongoing efforts—with some success—to identify genetic markers associated with psychiatric conditions such as depression, schizophrenia, bipolar disorder, autism, and attention-deficit hyperactivity disorder, 89–94 replicating findings has been a challenge. Furthermore, because existing genetic tests neither allow for a definitive diagnosis (except in the case of rare genetic syndromes), 95 nor provide an accurate estimate of when a disorder will occur, its severity, or how it will impact an individual’s functioning, behavioral genetic evidence may be too uncertain to have an impact in civil proceedings.…”