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

Abstract

Background: Increasing use of genetic technologies in clinical and research settings increases the potential for misattributed paternity to be identified. Yet existing guidance from the President's Commission for the Study of Ethical Problems in Biomedical and Behavioral Research and the Institute of Medicine (among others) offers contradictory advice. Genetic health professionals are thus likely to vary in their practice when misattributed paternity is identified, and empirical investigation into the disclosure of misattributed paternity is scarce. Given the relevance of this ethical dilemma and its significance to users of genetic services, this study aimed to investigate the attitudes of lay people with regard to the disclosure of misattributed paternity. Methods: An online questionnaire was hosted and advertised through Amazon's Mechanical Turk to 200 United States residents aged 18 years or older. Respondents were asked to rate (via a Likert scale) the ethical permissibility of possible actions a clinician may carry out when misattributed paternity is identified. Data analysis consisted of preliminary descriptive analysis, chi-squared analysis, and Wilcoxon signed-rank tests. Results: There was no clear majority support for many of the options surveyed across different contexts, with only six out of ten scenarios displaying some general consensus. Men were more likely to support scenarios where the father is informed of paternity. Importantly, participants' views varied according to whether the desires of the father were previously expressed, suggesting that perceptions of the permissibility of a clinician's action will depend on the interests of all parties affected. Conclusions: This sample of the general public showed attitudes that were, at least to some degree, at variance with some professional guidelines. We give arguments for why at least some of these attitudes might be justified. We argue that case-specific judgments should be made and outline some of the relevant ethical considerations. While general guidelines ought to be considered, context-specific moral judgments cannot be avoided.

Ethical issues when non-paternity is an incidental finding

“…When providers incidentally discover non-biological parenthood, this is a crisis. 12,19 The outcome of what they alone or with the parent or parents decide may profoundly affect children's and these families' lives. This may destroy their relationships with each other.…”

“…[16][17][18] Providers seeking uniformity may, for example, tell parents in advance that they will not give them incidental information unless it has medical relevance for their child. 19 The result will be more just. All parents and their children will be treated equally.…”

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“…20 If the mother suspects that her child's father may not be the biological father, she may choose to not ask this father to be tested. 19 This respects her autonomy and may be most beneficial to all. Providers may be willing to do this, however, only if there are no risks of adverse medical consequences to anyone.…”

Crowdsourcing in pediatric transplant studies—An opportunity for reflection on research ethics

“…The use of mTurk is increasingly popular in medical research, with the number of papers in PubMed referencing mTurk growing from 12 papers in 2008 to 157 in the first half of 2019. The technology has been used by prominent members of the medical ethics and health economics communities—Nobel laureate economist Alvin Roth published a paper on repugnance in transactions like paid kidney donation using the mTurk platform, and ethicists Savalescu and Wilkinson and have published papers using mTurk respondents to gauge public opinion on matters including parental demands for suboptimal treatment and misattributed paternity …”

“…to gauge public opinion on matters including parental demands for suboptimal treatment and misattributed paternity. 3,4 The mTurk platform works by having researchers act as "requestors" who design a survey which becomes a human intelligence task (HIT) to which "workers" can respond and sets a fee for successful completion of the task. The requestor may decide who is eligible to respond to the HIT based on demographics like country of residence, gender, race, parenthood, experience with previous tasks, and even whether they voted in the 2016 US presidential election.…”