In Correspondence in this week's Lancet, doctors discuss the ethical dilemma of what action to take when tests on a child reveal that they were likely conceived through incest. The Correspondence is by Dr Arthur L Beaudet, Baylor College of Medicine, Houston, TX, USA, and colleagues.
Use of DNA microarray analysis has led to a wide-range of useful genetic information in many conditions. Testing of children with developmental difficulties has led to discovery of a wide-range of previously unknown genetic disorders. However, these tests also reveal information about the child's parentage. A DNA microarray that compares single nucleotide polymorphisms (SNPs: variations in the individual building blocks of DNA) can reveal information about parentage without the parents undergoing tests. In cases where a quarter or more of the genome is the same, the likely cause is almost certainly that the child was conceived by first degree relatives, that is, through an incestuous relationship.
The proportion of such SNP comparison arrays is increasing, and thus many previously hidden cases of incest are likely to be revealed. The authors say: "Although such revelations might provide important diagnostic clues to the underlying disorders, they also raise important legal and ethical concerns." They add that where the child's mother is herself still legally a child, there would be an obligation to report the matter, but in cases where she is an adult, it is less clear cut, unless she was known to have been a child at the time of conception.
The authors conclude: "There clearly exist the possibility of harm in the form of stigmatisation, emotional distress, and criminal accusations… On the basis of these observations, we suggest that institutions establish a committee to discuss these and other legal and ethical issues with the purpose of drafting practice guidelines that deal with issues of consent, result disclosure, and reporting. Guidelines could be developed, for example, by existing ethics committees of the American College of Medical Genetics, American Society of Human Genetics, and European Society of Human Genetics."
Dr Arthur L Beaudet, Baylor College of Medicine, Houston, TX, USA. T) +1 713-798-4795 E) abeaudet@bcm.edu
For full Correspondence, see: http://press.thelancet.com/incest.pdf
Journal
The Lancet