Integrating Genomics into Psychiatric Practice: Ethical and Legal Challenges for Clinicians

Abstract

Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients’ symptoms. However, the field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions) needs to address numerous challenges to promote the responsible translation of psychiatric genomics technologies and knowledge. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize existing literature on how clinicians feel about the use of genomics in psychiatry, and analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels. Structural challenges are defined as aspects of the larger system of psychiatric practice that constitute potential barriers to the responsible integration of genomics for the purposes of psychiatric care and prevention. These structural challenges exist at a level where they can be intervened upon by professional groups that set standards and regulate the practice of psychiatry and genomics. Clinic-level challenges are day-to-day issues clinicians will face when managing genomic tests in the clinic. We discuss the need for action to mitigate these challenges and maximize the clinical and social utility of psychiatric genomics, including: expanding genomics training among mental health clinicians; establishing practice guidelines that consider potential clinical, psychological, and social implications of psychiatric genomics; promoting an integrated care model for managing genomics in psychiatry; emphasizing patient engagement and informed consent when managing genomic testing in psychiatric care.

Ethical challenges of cord blood banks: a scoping review

“…Addressing ethical issues related to these technologies seems to be one of the basic requirements that must be considered in the comprehensive health system [ 42 ]. One of these issues is respect for the autonomy and independence of individuals (sick or healthy) who are entitled to choose/reject a special treatment [ 43 ]. The maximum benefit for the recipients of health services should be considered by the service providers.…”

Pharmacogenomics: A road ahead for precision medicine in psychiatry

“…The application of these tests and the need for patient support in the form of counselling, as well as other resource implications, are yet to be fully assessed within psychiatry (Moldovan et al, 2019). Recent surveys show that psychiatrists are generally accepting of incorporating pharmacogenomic information in their routine clinical work, though they also recognise that their training is likely inadequate to take on the added responsibilities that this would entail (Ward et al, 2019). Public perceptions, on the other hand, seem to be more cautious and mostly interested in the effects test results could have on clinical decisions (Liko et al, 2020).…”

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