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Genetic Testing and Duty to Warn vs. Patient Confidentiality

Rachel comes from a family with a history of breast cancer on her mother’s side. Rachel’s mother died of breast cancer when she was very young. Rachel has two sisters, Lisa and Kristin. Rachel has remained close to Lisa, but she no longer has a relationship with Kristin. At a routine check-up, Rachel is told about the availability of genetic testing for identifying a predisposition to breast cancer. Her doctor recommends the test to Rachel, given her family history. Rachel has the genetic testing done and finds that she has a mutated BRCA1 gene. Her doctor tells her she is at high risk for developing breast and ovarian cancer. Rachel’s doctor suggests she ask her sisters to be tested also, so they can take the proper preventative measures. Rachel feels comfortable sharing this information with Lisa, but she has not spoken to Kristin in many years. Rachel tells her doctor that she is not in contact with Kristin and will not make an effort to tell her about BRCA1 and genetic testing. Rachel’s doctor feels confident that she can locate Kristin but worries about breaching patient confidentiality if she goes against Rachel’s wishes.

If you were Rachel’s doctor, what would you do?

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