Ethical Issues Related To BRCA Gene Testing in Orthodox Jewish Women

Abstract

Persons exhibiting mutations in two tumor suppressor genes, BRCA1 and BRCA2, have a greatly increased risk of developing breast and/or ovarian cancer. The incidence of BRCA gene mutation is very high in Ashkenazi Jewish women of European descent, and many issues can arise, particularly for observant Orthodox women, because of their genetic status. Their obligations under the Jewish code of ethics, referred to as Jewish law, with respect to the acceptability of various risk-reducing strategies, may be poorly understood. In this article the moral direction that Jewish law gives to women regarding testing, confidentiality, and other issues is explored. The intent is to broaden nurses' knowledge of how a particular religious tradition could impact on decision making around genetics testing, with the aim of enhancing their understanding of culturally sensitive ethical care.

Breast Cancer Incidence Rates Among Orthodox Jewish Women

“…The incongruent results of our analysis suggest the possibility that other factors, relevant to the Orthodox community could affect breast cancer risk. These factors could include poor health habits due to lack of health education, low screening rates, poor dietary habits and higher rates of obesity [6-8]. …”

“…Low cancer screening rates and poor health practices among Ultra-Orthodox Jews have been documented [6, 7]. This may be a result of their religious value system, which may include limited interactions with secular society and poor health education [8]. …”

Barriers to Cancer Screening Among Orthodox Jewish Women

“…In short, insularity and self-containment within the Orthodox community may create barriers that are especially challenging when attempting to conduct research and deliver health education programs. It is important to consider prevalent cultural factors and barriers when developing culturally relevant cancer education programs [17, 19–21]. This is particularly important in communities that emphasize their religious perspective in cancer-related health behaviors [19–22].…”

Caring for Familiar Strangers

“…Marcia encountered this among Ashkenazi Jews for whom the incidence of BRCA gene mutation is high (Mor & Oberle, 2008). There is a lifetime risk of breast cancer of 82% for both BRCA1 and BRCA2 carriers.…”

“…Should testing be presented as an ethical consideration for Jewish women and their children in this population? Although most rabbinical authorities advocate testing, Marcia discovered Jewish law obligates testing only if patients are mentally or psychologically capable of dealing with the results (Mor & Oberle, 2008). Jacobs and Giarelli (2001) Jewish law obligates believers to guard their health.…”