Discovering misattributed paternity in genetic counselling: different ethical perspectives in two countries

Abstract

Misattributed paternity or 'false' paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other biologically related members in the family. Disclosing or not a misattributed paternity has a number of different biological and social consequences for the people involved. Such an issue presents important ethical and deontological challenges. The debate centres on whether or not to inform the family and, particularly, whom in the family, about the possibility that misattributed paternity might be discovered incidentally, and whether or not it is the duty of the healthcare professional (HCP) to disclose the results and to whom. In this paper, we consider the different perspectives and reported problems, and analyse their cultural, ethical and legal dimensions. We compare the position of HCPs from an Italian and British point of view, particularly their role in genetic counselling. We discuss whether the Oviedo Convention of the Council of Europe (1997) can be seen as a basis for enriching the debate.

How should we deal with misattributed paternity? A survey of lay public attitudes

“…It is hypothesized that cultural and political contexts, along with access to affordable health care, may have significant influence upon the views regarding access to genetic and genomic information, and thus the views elicited in this study may not be representative of the views of lay people in other countries. For example, Tozzo and colleagues ( 2014 ) have illustrated that there are both differences and similarities in ethical arguments and practice in Italy compared to the United Kingdom with regard to misattributed paternity. However, in saying this, the study did raise the important point that people want health professionals to be sensitive to the needs of individuals involved, and not have a single, inflexible course of action for dealing with the incidental finding of misattributed paternity.…”

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“…In some cultures, for example, a woman convicted of consented infidelity may face most severe adverse consequences. [22][23][24][25] Providers should keep in mind, though, that even when parents share the same culture, as when they are next door neighbors, their views may wholly differ as much as they would if they were from different cultures. Providers must initially then explore both parents' views fully and separately so that they do not inadvertently favor one parent's views over the other's, by not exploring each to the degree that they could and should.…”

Is there a Role for Genetic Counselors in Prenatal Paternity Testing? – an Assessment Based on Audit of 13 years of Clinical Experience in South Australia

“…Identification of non-paternity within genetics clinics is most often an incidental outcome of genetic testing, in particular genomic testing, of children and their parents for another indication (Botkin et al 2015). There has been considerable debate about the most appropriate action to take in these circumstances, with views ranging from non-disclosure if there is no Bclear medical benefit that outweighs the potential harms^ (Botkin et al 2015;p.15), to informing the mother only, to informing both parents (Botkin et al 2015;Tozzo et al 2014). However, there is consensus that parents should be informed, prior to testing, that genetic testing has the potential to identify non-paternity (Botkin et al 2015;Tozzo et al 2014).…”

“…There has been considerable debate about the most appropriate action to take in these circumstances, with views ranging from non-disclosure if there is no Bclear medical benefit that outweighs the potential harms^ (Botkin et al 2015;p.15), to informing the mother only, to informing both parents (Botkin et al 2015;Tozzo et al 2014). However, there is consensus that parents should be informed, prior to testing, that genetic testing has the potential to identify non-paternity (Botkin et al 2015;Tozzo et al 2014). Post-natal testing of children, with the specific intention of determining paternity, is typically driven by social and legal issues and usually takes place in a non-medical setting; there appears to be general acceptance that it should be performed through a direct-to-consumer model, without involvement of genetics clinics or genetic counselors.…”