Howard: Paternity and Pandora's Box

Abstract

Howard, a young man named in a paternity suit, came to the Chief of the Genetics Clinic at a large teaching hospital to declare the charges against him false and ask for help in mounting evidence for his defense. Howard submitted to HLA testing, as did the mother and child; but in Howard's zeal to prove his innocence, he insisted that his siblings and parents also be tested to show conclusively there was no paternal link between himself and the child in question. The results of the tests solved one problem while creating another. Although the tests showed that Howard was not the father of the child as charged, the tests also indicated that the man Howard believed to be his own father could not, in fact, be his biological parent. The geneticist brought the case to the new ethics committee at a large teaching hospital to ask, "What, if anything, should be done with this information? Does a physician have the right to withhold information that, although acquired accidentally, would have great import for the patient?" In presenting his dilemma regarding Howard's situation, the geneticist also described a related and common problem of who owns the information. For example, a person comes in for genetic counseling about a particular family disorder. In the course of establishing a pedigree, it comes to light that there are relatives who are at high risk of developing a life-threatening disease that is preventable. What is the doctor's obligation to such a person who is not a patient and about whom crucial information has been learned through privileged communication?