Annie's Father and Genetics

Rosemary Flanigan

July 21, 2010

Remember the case I told you about that the Nurse Practitioners used last week in their Ethics Forum at their annual meeting?

Let me summarize it: a fourth pregnancy, two normal sons then an 8 year old girl with congenital adrenal hyperplasia. Genetic testing is proposed and the parents told that information gained from that could be used to test the fetus to determine if prenatal treatment is indicated.

Both girl and parents contribute blood, and the lab director calls the primary care physician (or it could be nurse practitioner) to say that DNA analysis identified both mutations in Annie and that Mrs. G was found to be a carrier for one of them but no mutation was found in Mr. G.

Hence, “he could not be Annie’s biological father.”

The NPs reportedly were more inclined to tell the husband she was not his child while some of them wanted to protect the wife’s privacy and have HER tell him. But interestingly a large portion of the Forum time was doing some basics in genetics.

YES!! In my one brown bag so far I have found that MY basic genetics needed a boost. I had originally seen the case as “Whom to tell?” or “Whom to tell first?” by the general practitioner or the nurse practitioner (which will increasingly be the case as the tests proliferate but numbers of genetic counselors don’t keep pace).

But it is so much more than that.

It is knowing enough that one can understand genetic principles, appreciate the benefits, limitations and risks of genetic knowledge and be able to explain them, be conversant on disease as a combination of genetic risk and environmental exposure which makes individual outcome a probability, not a certainty—and on and on.

Have any of you had a idea or two about this case? THANKS.