Review of legal instruments and codes on medical experimentation with children

Ethical dimensions of genetics in pediatric neurology: a look into the future

Health care providers and families with children who participate in genetic research or who need specialized genetic services, including genetic testing, will encounter not only medical but difficult social, ethical, and legal questions surrounding pediatric genetic neurology. Children are often at the center of much of the genetic revolution and their unique needs raise special concerns about the risks and benefits associated with genetic research, particularly the issues of consent, the use of genetic databases, and gene therapy. Moreover, genetic research and testing raise important psychosocial risks. In this article we discuss some of the benefits and consequences of genetic technologies for children in relation to national and international guidelines. In particular, physicians, policy-makers, and families should be knowledgeable about the guidelines and have a good understanding of the psychosocial and ethical issues associated with genetics in pediatric neurology.

The law, adolescents, and the APOE epsilon 4 genotype: a view from Canada

The presence of an apolipoprotein E (APOE) epsilon 4 allele may be a risk factor for the severity of the consequences of head trauma, both short-term and long-term. If this proves to be true, genetic testing for APOE status might be encouraged, or required, to minimize the costs of participation in high-contact sports, such as ice hockey, soccer, rugby, and boxing, where head injury is likely to occur. Under some circumstances, testing minors for this purpose might be justifiable. This would raise complex ethical and legal questions about respective powers and rights of adolescents and parents. The wishes of the "nearly competent" adolescent not to be tested should override parental desires for testing, although such a conclusion has only limited warrant in Canadian law. If a mature adolescent wishes testing, but the parents do not, testing may be permissible--although Canadian law is again unclear. The physician should not be able to inform the parents of the test results without the adolescent's consent, nor should the adolescent be forced to disclose those results.