Medical Surgical Nursing
Spacing: Double spaced
Topic: Medical Surgical Nursing (NSG 240)
Details: HW 2- due by the start of next class
there are many considerations to the patient and the nurse with genetic testing. below are some of the issues to think about. Please view/listen to the brief audio PPT on Genetics and Genomic testing, and then choose one of the issues below to discuss; what are your thoughts about ethics, societal impact, personal benefit or harm, etc? what are the practical issues? be sure to mention any cultural or religious influences that might influence your opinions.
post once with your thoughts (write directly into the discussion, don’t upload a document),
ETHICAL, LEGAL, AND SOCIAL ISSUES
Over the past decade, many ethical, legal, and social issues (ELSI) associated with genetic testing and research have been raised. For genetic testing to be used safely and appropriately, these issues should be discussed with patients so they are aware of risks and benefits. This chapter provides a brief overview of some of the major ELSI concerns related to genetic testing.
Concerns have arisen regarding the use and potential misuse of genetic information. The unease relates to a range of misuse: from the analytical and clinical validity of a genetic test to the possible stigma of carrying a genetic difference, to the duty of disclosing genetic information to potentially affected family members.
A number of companies (Ancestry.com, 23 and Me, e.g.) offer genetic tests directly to consumers without requiring physician involvement. Patients should be cautious when considering direct-to-consumer genetic testing and are encouraged to discuss this option with their healthcare professional. Some of these companies may play off consumer fears, offer tests with little clinical utility, or not be properly certified or licensed.
Duty to Disclose
The results of a genetic test may have implications for a patient’s family members. However, healthcare providers have an obligation to the person being tested not to inform other family members without the permission of the person tested, except in extreme circumstances. If a health professional believes family members may be at risk, the patient may be encouraged to discuss test results with other family members. The duty to inform varies by state, and courts have ruled differently in response to distinct cases.
The American Society of Human Genetics suggests that disclosure to at-risk individuals is permissible when the following criteria are met:
Attempts to encourage disclosure on the part of the patient have failed
Harm is highly likely, serious, imminent, and foreseeable
At-risk relatives are identifiable
Disease is preventable or medically accepted standards for treatment or screening are available
Harm from failing to disclose outweighs the harm from disclosure
When considering genetic testing, the potential for discrimination based on genetic information is a major concern often raised. Since genetic test results are typically included in an individual’s medical record, people should be aware that the results could be accessible to others.
On May 21, 2008, President Bush signed the Genetic Information Nondiscrimination Act (GINA) into law. As the first major new civil rights bill of the new century, GINA protects individuals from discrimination on the basis of genetic information in health insurance and employment.
In summary, GINA prevents health insurers from denying coverage or adjusting premiums on the basis of genetic information or requesting that an individual undergo a genetic test. Similarly, employers are prohibited from using genetic information to make hiring, firing, or promotion decisions. The law also limits an employer’s right to request, require, or purchase an employee’s genetic information. GINA does not apply to life, disability, or long-term care insurance.
Genetic information has enormous implications for the individual and the family. The privacy of that information is a major concern to patients—in particular, who should have or needs access to that information. To protect personal genetic information and avoid its inclusion in a patient’s medical record, some patients pay for genetic testing out-of-pocket.
Every individual will respond differently to news of his/her genetic test results, whether negative or positive. As there is no right or wrong response, healthcare professionals should refrain from judgment and help the patient understand the test results with respect to his/her own health, available interventions or follow-up, and risks to his/her family. An individual may respond to genetic information on several levels: individual, family, or community and society. Referrals to genetic counselors, psychologists, or social workers should be made as needed.
Genetic information is routinely used to inform reproductive decisions and medical care. Risk factors for genetic conditions for which preconception or prenatal genetic testing may be considered include advanced maternal age, family history, multiple miscarriages, and drug and alcohol exposure. As these procedures carry risks and benefits, parents should carefully consider and discuss these options with a physician or genetic counselor. Providers should take a nondirective stance and support the patients’ decisions.
Genetic information can raise questions about personal responsibility, personal choice versus genetic determinism/fate, and concepts of health and disease. Personal factors, family values, and community and cultural beliefs will influence responses to these issues. Genetic information may influence one individual to change his or her lifestyle or behavior to reduce risk or disease severity; whereas, others may choose to respond differently. Health professionals should be respectful and sensitive to cultural and societal values and work with the patient to define the appropriate course of action for him/her with respect to genetic testing and follow-up care.
The useful application of genetic tests will depend on the correct interpretation of test results and their utility in guiding medical care and treatment. However, for some genetic conditions, the utility of genetic test results may be limited if treatment is unavailable or the results are inconclusive. Even if a test is not considered to be medically useful, a patient or the family may still benefit from testing. Clinical guidelines should be consulted for recommended follow-up care and treatment.
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