Abstract
Professional guidelines and practice in clinical genetics generally counsel against predictive genetic testing in childhood. A genetic test should not be performed in a child who is too young to choose it for himself unless that test is diagnostic, will lead to an intervention to prevent illness, or enable screening. It is therefore generally considered unacceptable to test young children for adult-onset cancer syndromes. However, these guidelines are challenged when clinical genetics services receive requests from adoption agencies or pre-adoptive parents for predictive genetic tests in children being placed for adoption. Testing will foreclose a pre-adoptive child’s future autonomous right to choose, yet those commissioning these tests argue that adoption should form a special case. In this paper, we argue that predictive genetic testing as part of a pre-adoptive ‘work-up’ should be discouraged when the same test would not generally be carried out in a child who is not being adopted. We present an argument based on a principle of consistency and question those claims that privilege the adoptive process, whilst acknowledging the array of uncertainties faced by pre-adoptive parents. We suggest that if pre-adoptive testing is considered, this should only take place after prospective adoptive parents have had the opportunity to meet the clinical genetics team and fully understand the implications of the testing process.
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Abbreviations
- BAAF:
-
British Association for Adoption and Fostering
- BRCA1:
-
Breast cancer 1 gene
- FAP:
-
Familial adenomatous polyposis
References
Clarke A, Fielding D, Kerzin-Storrar L et al (1994) The genetic testing of children: report of a working party of the Clinical Genetics Society (UK). J Med Genet 31:785–797. doi:10.1136/jmg.31.10.785
Duncan RE (2004) Predictive genetic testing in young people: when is it appropriate? J Paediatr Child Health 40:593–595. doi:10.1111/j.1440-1754.2004.00481.x
Robertson S, Savulescu J (2001) Is there a case in favour of predictive genetic testing in young children? Bioethics 15:26–49. doi:10.1111/1467-8519.00210
Wertz DC, Fanos JH, Reilly PR (1994) Genetic testing for children and adolescents. Who decides? JAMA 272:875–881. doi:10.1001/jama.272.11.875
Clayton EW (1997) Genetic testing in children. J Med Philos 22:233–251
American Society of Human Genetics Social Issues Committee, The American College of Medical Genetics Social, Ethical, Legal Issues Committee (2000) ASHG/ACMG statement: genetic testing in adoption. Am J Hum Genet 66:761–767. doi:10.1086/302832
Barnes C, Mather M (2006) Genetic testing and adoption. Practice Note 50. London: British Association for Adoption and Fostering, p4, emphasis added
Jansen LA, Friedman Ross L (2001) The ethics of preadoption genetic testing. Am J Med Genet 104:214–220. doi:10.1002/ajmg.10057
Acknowledgments
The authors thank Dr. Havi Carel, Dr. Alan Donaldson, Professor Søren Holm, Dr. Peter Lunt, Dr. Ruth Newbury-Ecob, Dr. Ingrid Scurr and two anonymous referees for helpful discussions and feedback during the preparation of this paper.
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Newson, A.J., Leonard, S.J. Childhood genetic testing for familial cancer: should adoption make a difference?. Familial Cancer 9, 37–42 (2010). https://doi.org/10.1007/s10689-009-9262-8
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DOI: https://doi.org/10.1007/s10689-009-9262-8