Skip to main content
Log in

Policy Recommendations for Carrier Testing and Predictive Testing in Childhood: A Distinction That Makes a Real Difference

  • Professional Issues
  • Published:
Journal of Genetic Counseling

Abstract

The genetic testing of children raises many ethical concerns. This paper examines how five position statements from Canada, UK and USA, which present guidelines for good practice in this area produce different recommendations for carrier testing and predictive testing. We find that the genetic information generated through carrier testing is routinely presented as less serious than that generated from predictive testing. Additionally, the reproductive implications of predictive testing are also routinely erased. Consequently, the papers argue strongly against predictive testing but advise caution against carrier testing in somewhat weaker terms. We argue that these differences rest on assumptions about the status of reproduction in people’s lives and on an ethical stance that foregrounds the self over others. We propose that questioning the crude and sharp distinction between carrier and predictive testing in principle may enable practitioners and parents/families to make more nuanced decisions in practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Academy of Pediatrics [AAP] (2001). Ethical issues with genetic testing in pediatrics (RE9924). Pediatrics, 107, 1451–1455.

    Google Scholar 

  • American Medical Association (1996) Genetic testing of children (Policy, E-2.138). Retrieved December 2002, from http://www.ama-assn.org

  • American Society of Human Genetics & The American College of Medical Genetics [ASHG/ACMG] (1995). Points to consider: Ethical, legal and psychosocial implications of genetic testing in children and adolescents. Am. J. Hum Genet, 57, 1233–1241.

    Google Scholar 

  • Baier, A. (1994). Moral prejudices: Essays on ethics. Harvard University Press: Cambridge, MA.

    Google Scholar 

  • Belgian Society of Human Genetics (2003) Guidelines for predictive genetic testing for late onset disorders. Retrieved November 2003, from http://www.beshg.be/Pages/guidelines.html

  • Boddington, P., & Hogben, S. (2004) Drawing on diseases: The use of specific exemplars in formulating and applying principles governing genetic testing. Poster presented at HUGO Human Genome Meeting Berlin, Germany, April, 2004.

  • Boszormenyi-Nagy, I., & Spark, G. (1973). Invisible loyalties: Reciprocity in intergenerational family therapy. New York: Harper & Row.

    Google Scholar 

  • Canadian Pediatric Society [CPS] (2003). Guidelines for genetic testing of health children, position statement (B 2003-01). Paediatric Child Health, 8(1), 42–45.

    Google Scholar 

  • Clarke, A. (1998). The genetic testing of children. Oxford: Bios Scientific.

    Google Scholar 

  • Clinical Genetics Society [CGS] (1994). The genetic testing of children: Report of a working party of the clinical genetics society (UK). Medical Genetics, 31, 785–797.

    Google Scholar 

  • Corea, G. (1985). The mother machine: Reproductive technologies from artificial insemination to artificial wombs. New York: Harper & Row.

    Google Scholar 

  • Dudgeon, M. R., & Inhorn, M. C. (2003). Gender, masculinity, and reproduction: anthropological perspectivas. International Journal of Men’s Health, 2, 31–57.

    Google Scholar 

  • Dworkin, R. (1977).Taking rights seriously. London: Duckworth.

    Google Scholar 

  • Edmondson, R. (1984). Rhetoric in sociology. London: Macmillan.

    Google Scholar 

  • Fairclough, N. (1989). Language and power. London: Longman.

    Google Scholar 

  • Fairclough, N. (1992). Discourse and social change. Cambridge, UK: Polity Press.

    Google Scholar 

  • Fischer, F., & Forester, J. (1993). Editor’s introduction. In F. Fischer & J. Forester (Eds.), The argumentative turn in policy analysis and planning (pp. 1–17). Durham, NC: Duke University Press.

    Google Scholar 

  • Franklin, S. (1998). Making miracles: Scientific progress and the facts of life. In S. Franklin & H. Ragone (Eds.), Reproducing reproduction: Kinship, power, and technological innovation (pp. 102–117). Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  • Genetic Interest Group [GIG] (1995). Genetics interest group response to the UK Clinical Genetics Society report “The genetic testing of children.” Journal of Medical Genetics, 32, 490–491.

    Google Scholar 

  • Gillligan, C. (1982). In a different voice. Cambridge: Harvard University Press.

    Google Scholar 

  • Gillott, G. (1998). Childhood testing for carrier status: The perspective of the Genetic Interest Group. In A. Clarke (Ed.), The genetic testing of children (pp. 97–102). Oxford: Bios Scientific.

    Google Scholar 

  • Glover, J. (Ed.). (1990).Utilitarianism and its critics. New York: MacMillan.

    Google Scholar 

  • Hajer, M. A. (1993). Discourse coalitions and the institutionalization of practice. In F. Fischer & J. Forester (Eds.), The argumentative turn in policy analysis and planning (pp. 43–71). Durham, NC: Duke University Press.

    Google Scholar 

  • Hajer, M. (2002). Discourse analysis and the study of policy making. European Political Science, 2(1), 61–65.

    Google Scholar 

  • Hastings, A. (1998). Connecting linguistic structures and social practices: A discursive approach to social policy analysis. Journal of Social Policy, 27, 191–211.

    Article  Google Scholar 

  • Jackson, J. (2001). Truth, trust and medicine. Routledge: London.

    Google Scholar 

  • Leehey, M. A., Munhoz, R. P., Lang, A. E., Brunberg, J. A., Grigsby, J., Greco, C., et al. (2003). The fragile X premutation presenting as essential tremor. Archives of Neurolology, 60, 117–121.

    Google Scholar 

  • McConkie-Rosell, A., & DeVellis, B. M. (2000). Threat to parental role: A possible mechanism of altered self-concept related to carrier knowledge, Journal of Genetic Counseling, 9, 285–302.

    Article  Google Scholar 

  • McConkie-Rosell, A., & Spiridigliozzi, G. A. (2004). “Family matters”: A conceptual framework for genetic testing in children. Journal of Genetic Counseling, 13, 9–29.

    PubMed  Google Scholar 

  • Maier, K. E. (1989) Pregnant women: Fetal containers or people with rights? Affilia: Journal of Women and Social Work, 4, 8–20.

    Google Scholar 

  • Majone, G. (1989). Evidence, argument, and persuasion in the policy process. New Haven, CT: Yale University Press.

    Google Scholar 

  • National Society of Genetic Counsellors (1995). Resolutions ballot: Prenatal and childhood testing for adult-onset disorders. Wallingford, PA: National Society of Genetic Counselors.

    Google Scholar 

  • NIH (2004) Genetics home reference. Retrieved April 2004, from http://ghr.nlm.nih.gov/ghr/glossary/

  • O’Neill, O. (2002). Autonomy and trust in bioethics. Cambridge University Press, Cambridge, UK.

    Google Scholar 

  • Parsons, E., & Atkinson, P. (1992). Lay constructions of genetic risk. Sociology of Health and Illness, 14, 437–455.

    Article  Google Scholar 

  • Pomerantz, A. (1980). Telling my side: ‘Limited access’ as a ‘fishing device.’ Sociological Inquiry, 50, 186–198.

    Google Scholar 

  • Procter, A. M., Clarke, A. J., & Harper, P. S. (1999). Survey of genetic testing in childhood. Poster presentation, British Human Genetics Conference, University of York, 27–29 September 1999.

  • Purkis, J. (2003). The quintessential female act?: Learning about birth. In S. Earle & G. Letherby (Eds.), Gender, identity and reproduction: Social perspectives (pp. 103–120). Palgrave Macmillan: Basingstoke.

    Google Scholar 

  • Rhodes, R. (1998). Genetic links, family ties, and social bonds: rights and responsibilities in the face of genetic knowledge. Journal of Medicine and Philosophy, 23, 10–30.

    CAS  PubMed  Google Scholar 

  • Schild, S. (1966).The challenging opportunity for social workers in genetics. Social Work, 11, 22.

    Google Scholar 

  • Sherwin, S. (1998). A relational approach to autonomy in health care. In S. Sherwin (Ed.), The politics of women’s health: Exploring agency and autonomy (pp. 19–47). Philadelphia, PA: Temple University Press.

    Google Scholar 

  • Takala, T., & Häyry, M. (2001) Genetic information, autonomy, and rights. Theoretical Medicine and Bioethics, 22, 403–414.

    Article  PubMed  Google Scholar 

  • Triandis, H. C. (1995). Individualism and collectivism. Boulder, CO: Westview Press.

    Google Scholar 

  • van Dijk, T. (1993). Principles of critical discourse analysis. Discourse and Society, 4, 249–283.

    Google Scholar 

  • Wexler, N. S. (1992). The Tiresias complex: Huntington’s disease as a paradigm of testing for late-onset disorders. The Federation of American Societies for Experimental Biology Journal, 6, 2820–2825.

    CAS  Google Scholar 

  • Woodward, K. (1997). Motherhood: Meanings and myths. In K. Woodward (Ed.), Identity and Difference (pp. 239–297). London: Sage.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susan Hogben.

Additional information

Parts of this work have been presented in the 1st International CESAGen Conference, London, 2004, and Genetics and Society Meetings, Wales.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hogben, S., Boddington, P. Policy Recommendations for Carrier Testing and Predictive Testing in Childhood: A Distinction That Makes a Real Difference. J Genet Counsel 14, 271–281 (2005). https://doi.org/10.1007/s10897-005-4840-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10897-005-4840-x

Keywords

Navigation