title: Ethical aspects of a predictive test for Huntington's Disease: A long term perspective.
abstract: BACKGROUND
  A predictive genetic test for Huntington's disease can be used before any symptoms are apparent, but there is only sparse knowledge about the long-term consequences of a positive test result. Such knowledge is important in order to gain a deeper understanding of families' experiences.
  
  
  OBJECTIVE
  The aim of the study was to describe a young couple's long-term experiences and the consequences of a predictive test for Huntington's disease.
  
  
  METHODS
  A descriptive case study design was used with a longitudinal narrative life history approach.
  
  
  METHODS
  The study was based on 18 interviews with a young couple, covering a period of 2.5 years; starting 6 months after the disclosure of the test results showing the woman to be a carrier of the gene causing Huntington's disease.
  
  
  METHODS
  Even though the study was extremely sensitive, where potential harm constantly had to be balanced against the benefits, the couple had a strong wish to contribute to increased knowledge about people in their situation. The study was approved by the ethics committee.
  
  
  RESULTS
  The results show that the long-term consequences were devastating for the family. This 3-year period was characterized by anxiety, repeated suicide attempts, financial difficulties and eventually divorce.
  
  
  CONCLUSIONS
  By offering a predictive test, the healthcare system has an ethical and moral responsibility. Once the test result is disclosed, the individual and the family cannot live without the knowledge it brings. Support is needed in a long-term perspective and should involve counselling concerning the families' everyday life involving important decision-making, reorientation towards a new outlook of the future and the meaning of life.
  
  
  CONCLUSIONS
  As health professionals, our ethical and moral responsibility thus embraces not only the phase in direct connection to the actual genetic test but also a commitment to provide support to help the family deal with the long-term consequences of the test.
authors.affiliation: Lund University, SwedenKarolinska Institute, SwedenKristianstad University, Sweden Petra.lilja_andersson@med.lu.se.
authors.forename: Petra Lilja
authors.initials: PL
authors.lastname: Andersson
authors.affiliation: Lund University, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Petersén
authors.affiliation: Karolinska Institute, Sweden.
authors.forename: Caroline
authors.initials: C
authors.lastname: Graff
authors.affiliation: Kristianstad University, Sweden.
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Edberg
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D005260:Female; D005817:Genetic Counseling / Q000592:standards; D005820:Genetic Testing / Q000941:ethics*; D006801:Humans; D006816:Huntington Disease / Q000175:diagnosis / Q000235:genetics / Q000523:psychology*; D008297:Male; D018454:Spouses / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology
keywords: Case study; Huntington’s disease; ethics; life history; predictive testing; support