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ACOG Issues Opinion on Ethics and Patient Testing

April 1, 2007

Washington, DC -- Rapid technological developments in medical testing have increased the complexity of the decision-making process for both physicians and patients. In response, The American College of Obstetricians and Gynecologists today issued a Committee Opinion, "Patient Testing: Ethical Issues in Selection and Counseling," that provides ethical guidance to obstetrician-gynecologists for decisions about ordering medical tests, counseling patients, and reporting test results. The document is published in the April issue of Obstetrics & Gynecology.

Ordering Tests

Physicians have a responsibility to communicate clearly with patients. Patients have a responsibility to give accurate information about their lifestyle, health habits, sexual practices, and religious and cultural beliefs when these factors may affect medical judgment.

Testing should be performed primarily for the benefit of the patient. Testing at the request of partners, family members, employers, or health insurers is justified only when the patient understands the risks and benefits and gives consent.

The decision to offer or to withhold a test should not be made solely on the basis of a physician's assumptions about the patient's expected response to test results. For example, prejudging a woman's wishes regarding fetal abnormalities should not preclude her being offered prenatal testing. Physicians are not, however, ethically obligated to perform every test a patient requests.

Counseling

Some tests may have medical and/or psychosocial ramifications that require comprehensive explanation about the test and its implications. For instance, genetic tests and toxicology tests to detect illicit drug use have the potential for psychological, social, and economic effects. In addition, certain tests, such as for HIV or for inherited breast cancer mutations, may limit future insurance coverage.

Physicians may need to refer some patients for comprehensive counseling if time constraints or lack of specialized expertise make it difficult to offer appropriate counseling in a particular practice. In these cases, physicians can refer patients to a specialized center for counseling only, or for both testing and counseling.

Confidentiality and Reporting

Information regarding the results of a patient's medical test is confidential and may not be revealed to a third party without the patient's express consent, except in certain circumstances. Patients must be told before being tested if their test results must be reported. Situations may arise in which a physician has competing obligations: protecting the patient's confidentiality or disclosing test results to prevent harm to a third party. Physicians should use every avenue of communication with the patient beforehand to discuss both the patient's and the physician's responsibility in these situations. A violation of confidentiality may be ethically justified as a last resort when all of the following conditions have been met: 1) there is a high probability of harm to a third party, 2) the potential harm is a serious one, 3) the information communicated can be used to prevent harm, and 4) greater good will result from breaking confidentiality than from maintaining it. Violating confidentiality also may be required by law in some cases.

Committee Opinion #363, "Patient Testing: Ethical Issues in Selection and Counseling," is published in the April 2007 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 51,000 members who provide health care for women.