In the coming years massively parallel DNA-sequencing technologies (MPS) will revolutionize health care, and become a factor in many important personal and business decisions.
These clinician fiduciary duties include the duty to: (1) provide material pretest information about secondary target genomic conditions that may be analyzed and reported when WGS/WES is ordered (2) give patients the opportunity to opt-out of the analysis and report of any secondary target genomic condition (3) offer WGS/WES and the examination of secondary target conditions, even if patients do not want all secondary target conditions examined (4) respect patients’ “right not to know” secondary target genomic information. In this context, the application of fiduciary principles (e.g., duty of loyalty, duty of care, duty to inform, and the duty act within the scope of authority), which have their origins in trust and agency law, gives rise to at least four specific clinician fiduciary duties. This article examines the concept of fiduciary relationships as a framework for defining clinicians’ duties and patients’ rights when ordering whole genome/exome sequencing (WGS/WES) in the clinic and managing potential genomic “incidental” 2 or secondary target findings. 1 However, in these reports the implications of applying fiduciary principles were often not made explicit, which can lead to uncertainty about how clinicians should act or some fiduciary principles were applied without considering others, which led to recommendations that are actually in conflict with the principles of fiduciary law. Recently, the American College of Medical Genetics and Genomics (ACMG) and the Presidential Commission for the Study of Bioethical Issues (PCSBI) released reports that refer to clinicians as fiduciaries when ordering genomic sequencing tests in clinical care. One promising alternative is to apply legal fiduciary principles to guide the generation, use, and handling of genomic information in the clinic.Ĭourts, legislatures, scholars, and medical organizations have applied fiduciary principles to define or describe different aspects of the physician-patient relationship. Therefore, it is important to identify frameworks that can guide the sustainable implementation of genomics in clinical care. The way the physician-patient relationship responds to the implementation of genomics is a crucial aspect of the success of these technologies as catalysts for the improvement of human health. The implementation of scientific innovations, such as genomic sequencing, forces the physician-patient relationship to continuously confront difficult ethical and legal dilemmas. The physician-patient relationship has a long history and is rich in deeply held traditions, yet it is one of the principal destinations for many of society’s most innovative technological advances.
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