[Ethics and oncogenetics: how to resolve the contradictions?].
Ethical guidelines are necessary to help practitioners to deal with matters about which they are uncertainty and to solve problems where conflicting interests are at stake. To avoid doing harm is the first criterion to be adopted, in line with primum non nocere, as doing good is not enough (saving lives is not sufficient and one also has to consider whether a loss of dignity or suffering will not make the benefit worthless). Consultees must come to consultations freely and intentionally and must have control over the choices subsequently made. But others interests may be involved and ethical misconducts can arise in situations such as the following: family pressure about DNA testing, medical pressure to help other patients of for scientific purposes (sometimes merely to obtain data for publication). Geneticians must look at the reality underlying each situation, although complete autonomy and neutrality may be impossible to achieve. Individuals' rights are by now recognised, but the pursuit of autonomy at all costs has led to the development of a kind of self service medicine. One extreme situation of this kind was the request for prophylactic mastectomy made by a mutation free woman from a high risk family. Since this woman had seen her mothers and sister(s) die from breast cancer, her appraisal of her own risk may not fitted the neutrally calculated cumulative lifetime risk, which is about 9% (the so-called sporadic risk). Practitioners perceive contradictory elements during their consultations, and they ask for help. They cannot solve this kind of situation by themselves even by consulting the available medical, statistical and scientific knowledge. Other specialists (humanities) have to be consulted and asked to avoid wrong counselling.
Eisinger
F
F
Département de prévention et de dépistage, IPC Marseille.
D003219:Confidentiality; D004992:Ethics, Medical; D005260:Female; D005610:Freedom; D005820:Genetic Testing; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D009369:Neoplasms / Q000235:genetics*; D011287:Prejudice; D012962:Sociology, Medical