Ethical considerations for modern molecular pathology.

Molecular pathology is becoming an increasingly important discipline in oncology as molecular tumor characteristics will increasingly determine targeted clinical cancer care. In recent years, many technological advances have taken place that contributed to the development of molecular pathology. However, attention to ethical aspects has been lagging behind as illustrated by the lack of publications or professional guidelines. Existing guidelines or publications on ethical aspects of DNA sequencing are mostly aimed at germline or tumor sequencing in clinical genetics or biomedical research settings. As a result, large differences have been demonstrated in the process of tumor sequencing analysis between laboratories. In this perspective we discuss the ethical issues to consider in molecular pathology by following the process of tumor DNA sequencing analysis from the preanalytical to postanalytical phase. For the successful and responsible use of DNA sequencing in clinical cancer care, several moral requirements must be met, for example, those related to the interpretation and returning of genetic results, informed consent, and the retrospective as well as future use of genetic data for biomedical research. Many ethical issues are new to pathology or more stringent than in current practice because DNA sequencing could yield sensitive and potentially relevant data, such as clinically significant unsolicited findings. The context of molecular pathology is unique and complex, but many issues are similar to those applicable to clinical genetics. As such, existing scholarship in this discipline may be translated to molecular pathology with some adaptations and could serve as a basis for guideline development. For responsible use and further development of clinical cancer care, we recommend that pathologists take responsibility for the adequate use of molecular analyses and be fully aware and capable of dealing with the diverse, complex, and challenging aspects of tumor DNA sequencing, including its ethical issues. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Use and disclosure of genetic information without consent: a decision-making tool for health practitioners--who, when, why and how?

BACKGROUND: As a result of legislative changes to the Privacy Act 1988 (Cth), Australian health practitioners in the private sector are now permitted to use or disclose patients' genetic information, without their consent, in circumstances where the health practitioner reasonably believes that doing so is necessary to lessen or prevent a serious threat to the life, health or safety of a genetic relative. AIM: This article aims to increase the reader's awareness of Guidelines developed by the National Health and Medical Research Council which are intended to assist health practitioners in making decisions about the use or disclosure of genetic information in certain circumstances. DISCUSSION: The Guidelines establish when, by whom and in what manner, use or disclosure of genetic information may take place. The Guidelines outline the factors that health practitioners should consider when determining whether use or disclosure is necessary to lessen or prevent a serious threat to an individual's life, health or safety.

Professional opportunities and responsibilities in the provision of genetic information to children relinquished for adoption.

We report a case involving the disclosure of BRCA1 mutation results to a woman who had placed a child for adoption 30 years prior to learning her mutation status. The disclosure of the mother's genetic test result to the son resulted in unexpected subsequent communications. This article briefly describes the experience and discusses the unique issues that arise in counseling a parent who has relinquished a child who is subsequently at risk to inherit a mutation for an adult onset genetic condition.