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Wouters RHP, van der Horst MZ, Aalfs CM, Bralten J, Luykx JJ, Zinkstok JR. The ethics of polygenic scores in psychiatry: minefield or opportunity for patient-centered psychiatry? Psychiatr Genet 2024; 34:31-36. [PMID: 38441147 DOI: 10.1097/ypg.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Recent advancements in psychiatric genetics have sparked a lively debate on the opportunities and pitfalls of incorporating polygenic scores into clinical practice. Yet, several ethical concerns have been raised, casting doubt on whether further development and implementation of polygenic scores would be compatible with providing ethically responsible care. While these ethical issues warrant thoughtful consideration, it is equally important to recognize the unresolved need for guidance on heritability among patients and their families. Increasing the availability of genetic counseling services in psychiatry should be regarded as a first step toward meeting these needs. As a next step, future integration of novel genetic tools such as polygenic scores into genetic counseling may be a promising way to improve psychiatric counseling practice. By embedding the exploration of polygenic psychiatry into the supporting environment of genetic counseling, some of the previously identified ethical pitfalls may be prevented, and opportunities to bolster patient empowerment can be seized upon. To ensure an ethically responsible approach to psychiatric genetics, active collaboration with patients and their relatives is essential, accompanied by educational efforts to facilitate informed discussions between psychiatrists and patients.
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Affiliation(s)
- Roel H P Wouters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marte Z van der Horst
- GGNet Mental Health, Warnsveld, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
| | - Cora M Aalfs
- Department of Clinical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janita Bralten
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jurjen J Luykx
- GGNet Mental Health, Warnsveld, The Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
| | - Janneke R Zinkstok
- Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Brain Center, Utrecht, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry, University Centre Nijmegen, Nijmegen, The Netherlands
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Cruwys T, Brossard B, Zhou H, Helleren-Simpson G, Klik KA, Van Rooy D, Batterham PJ, Calear AL. Disciplinary differences in the study of the relationship between social variables and mental health: A systematic mapping review. Health (London) 2023; 27:810-828. [PMID: 34877893 DOI: 10.1177/13634593211063049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been sustained interest in the intersection between social constructs and mental health from diverse disciplines including psychiatry, sociology and public health. However, no systematic attempt has been made to catalogue what is meant by 'social' by different researchers, how variables deemed 'social' constructs are linked to mental health, nor whether these patterns differ by academic discipline. Understanding interdisciplinary differences and commonalities may reveal opportunities for interdisciplinary collaboration to enhance our understanding of how social factors relate to mental health. This article presents a prospectively registered systematic map of social approaches to mental health using an innovative synthesis methodology (coding all sentences from a random selection of N = 287 articles). Results indicated that although approaches are diverse, disciplinary overlap is substantial. Psychology and psychiatry led articles tend to focus on social skills or emotions as features of mental (ill-)health, while public health and social sciences led articles tend to focus on social relationships, status or context as determinants of mental (ill-)health. Medicine led articles were most likely to focus on social outcomes of mental (ill-)health. Potential growth areas are noted, particularly the relative dearth of intervention research drawing upon social approaches. The findings are discussed with a view towards enabling more effective interdisciplinary collaboration.
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Kong C, Campbell M, Kpobi L, Swartz L, Atuire C. The hermeneutics of recovery: Facilitating dialogue between African and Western mental health frameworks. Transcult Psychiatry 2023; 60:428-442. [PMID: 33761813 DOI: 10.1177/13634615211000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more 'local' perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more 'universalist' or 'relativist' approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health.
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Docherty A, Kious B, Brown T, Francis L, Stark L, Keeshin B, Botkin J, DiBlasi E, Gray D, Coon H. Ethical concerns relating to genetic risk scores for suicide. Am J Med Genet B Neuropsychiatr Genet 2021; 186:433-444. [PMID: 34472199 PMCID: PMC8692426 DOI: 10.1002/ajmg.b.32871] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/20/2021] [Accepted: 07/23/2021] [Indexed: 01/02/2023]
Abstract
Genome-wide association studies (GWAS) provide valuable information in research contexts regarding genomic changes that contribute to risks for complex psychiatric conditions like major depressive disorder. GWAS results can be used to calculate polygenic risk scores (PRS) for psychiatric conditions, such as bipolar disorder or schizophrenia, as well as for other traits, such as obesity or hypertension. Private companies that provide direct-to-consumer (DTC) genetic testing sometimes report PRS for a variety of traits. Recently, the first well-powered GWAS study for suicide death was published. PRS reports that claim to assess suicide risk are therefore likely to appear soon in the DTC setting. We describe ethical concerns regarding the commercial use of GWAS results related to suicide. We identify several issues that must be addressed before PRS for suicide risk is made available to the public through DTC: (a) the potential for misinterpretation of results, (b) consumers' perceptions about determinism and behavior change, (c) potential contributions to stigma, discrimination, and health disparities; and (d) ethical problems regarding the testing of children and vulnerable adults. Tests for genetic prediction of suicidality may eventually have clinical significance, but until then, the potential for individual and public harm significantly outweighs any potential benefit. Even if genetic prediction of suicidality improves significantly, information about genetic risk scores must be distributed cautiously, with genetic counseling, and with adequate safeguards.
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Affiliation(s)
- Anna Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Brent Kious
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Teneille Brown
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Leslie Francis
- Department of Philosophy, University of Utah, Salt Lake City, UT USA
- Program in Medical Ethics and Humanities, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
| | - Louisa Stark
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Genetic Science Learning Center, University of Utah, Salt Lake City, UT USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Brooks Keeshin
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT USA
| | - Jeffrey Botkin
- S.J. Quinney College of Law, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Doug Gray
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT USA
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Bourdon JL, Dorsey A, Zalik M, Pietka A, Salyer P, Bray MJ, Bierut LJ, Ramsey AT. In-vivo design feedback and perceived utility of a genetically-informed smoking risk tool among current smokers in the community. BMC Med Genomics 2021; 14:139. [PMID: 34039360 PMCID: PMC8152342 DOI: 10.1186/s12920-021-00976-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The use of genetically-informed personalized risk information for behavioral disorders, namely smoking and smoking-related behaviors, is a promising yet understudied area. The Genetics and Smoking Risk Profile, or RiskProfile, leverages genetic and environmental information to communicate one’s risk for smoking-related diseases. Although prior studies have examined attitudes toward genetic results, little research has investigated these perceptions through a lens of in-vivo testing; that is, user-centered design feedback in response to personalized genetic results being returned contemporaneously. This qualitative study engaged current smokers in usability testing of the RiskProfile within the context of concurrently receiving this personalized, genetically-informed smoking cessation intervention. Methods Eighty-nine participants who were current smokers responded to open-ended interview questions on perceptions of smoking-related genetic information and the content and format of the RiskProfile intervention that they had received moments before. Data were analyzed via the conventional content analysis approach in which themes were allowed to emerge throughout the analysis. Results Participants were able to reference and offer design input on specific elements of the RiskProfile. Overall, current smokers perceived the RiskProfile to have high potential utility. Constructive feedback that current smokers offered about the tool centered around suggested improvements to optimize its usability and technical content. Conclusions The detailed and constructive feedback from participants highlights that in-vivo feedback offers a useful design approach that addresses concerns of rigor and relevance when returning genetic results. This unique method demonstrated perceived utility and constructive design feedback for the RiskProfile among current smokers and can play an important role in optimizing the design and implementation of personalized genetic risk interventions moving forward. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-00976-1.
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Affiliation(s)
- Jessica L Bourdon
- Wellbridge Center for Addiction Treatment and Research, Center for Addiction Science, 525 Jan Way, Room 1523, Calverton, NY, 11922, USA.
| | - Amelia Dorsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Maia Zalik
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Pietka
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Patricia Salyer
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael J Bray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Laura J Bierut
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Alex T Ramsey
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
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Matshabane OP, Campbell MM, Faure MC, Appelbaum PS, Marshall PA, Stein DJ, de Vries J. The role of causal knowledge in stigma considerations in African genomics research: Views of South African Xhosa people. Soc Sci Med 2021; 277:113902. [PMID: 33865094 DOI: 10.1016/j.socscimed.2021.113902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 03/31/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Advances in genomics research have raised several ethical concerns. One concern is the potential impact of genomics research on stigma experienced by people affected by a disease. Studies have found that the type of illness as well as disease causal beliefs impact on the relation between genetic attribution and stigma. This study explored the potential impact of genetic attribution of disease on stigma among Xhosa people with Rheumatic Heart Disease (RHD). METHODS Study participants were 46 Xhosa people with RHD living in the Western Cape Province of South Africa. Using video vignettes in 7 focus group discussions we explored whether and how genetic attribution may impact on disease-stigma. Vignettes introduced participants to non-genetic and genetic causal explanations and were followed-up with a series of open-ended questions eliciting their perceptions of non-genetic disease causes as well as genetic causation and its impact on internalised stigma. RESULTS This study found that Xhosa people with RHD have a general understanding of genetics and genetic attribution for disease. Additionally, and not withstanding their genetic knowledge, these participants hold multiple disease causal beliefs including genetic, infectious disease, psychosocial, behavioural and cultural explanations. While there was evidence of internalised stigma experiences among participants, these appeared not to be related to a genetic attribution to the disease. DISCUSSION The findings of this study provide clues as to why it is unlikely that a genetic conceptualisation of disease impacts internalised stigma experiences of Xhosa people. The causal explanations provided by participants reflect their cultural understandings and their context, namely, living in low-income and poverty-stricken environments. Divergence in these findings from much of the evidence from high-income countries emphasises that context matters when considering the impact of genetic attribution on stigma and caution against generalising findings from one part of the globe to another.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Psychology, Rhodes University, Grahamstown, South Africa.
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, United States; New York State Psychiatric Institute, New York, United States.
| | - Patricia A Marshall
- Department of Anthropology, Case Western Reserve University, Cleveland, United States.
| | - Dan J Stein
- Department of Psychiatry & Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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The promise of public health ethics for precision medicine: the case of newborn preventive genomic sequencing. Hum Genet 2021; 141:1035-1043. [PMID: 33715055 DOI: 10.1007/s00439-021-02269-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
Precision medicine aims to tailor medical treatment to match individual characteristics and to stratify individuals to concentrate benefits and avoid harm. It has recently been joined by precision public health-the application of precision medicine at population scale to decrease morbidity and optimise population health. Newborn preventive genomic sequencing (NPGS) provides a helpful case study to consider how we should approach ethical questions in precision public health. In this paper, I use NPGS as a case in point to argue that both precision medicine and precision public health need public health ethics. I make this argument in two parts. First, I claim that discussions of ethics in precision medicine and NPGS tend to focus on predominantly individualistic concepts from medical ethics such as autonomy and empowerment. This highlights some deficiencies, including overlooking that choice is subject to constraints and that an individual's place in the world might impact their capacity to 'be responsible'. Second, I make the case for using a public health ethics approach when considering ethics and NPGS, and thus precision public health more broadly. I discuss how precision public health needs to be construed as a collective enterprise and not just as an aggregation of individual interests. I also show how analysing collective values and interests through concepts such as solidarity can enrich ethical discussion of NPGS and highlight previously overlooked issues. With this approach, bioethics can contribute to more just and more appropriate applications of precision medicine and precision public health, including NPGS.
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Corsico P. "It's all about delivery": researchers and health professionals' views on the moral challenges of accessing neurobiological information in the context of psychosis. BMC Med Ethics 2021; 22:11. [PMID: 33557813 PMCID: PMC7869514 DOI: 10.1186/s12910-020-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.
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Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Matshabane OP, Campbell MM, Faure MC, Marshall PA, Mayosi BM, Stein DJ, Appelbaum PS, de Vries J. Exploring how a genetic attribution to disease relates to stigma experiences of Xhosa patients with schizophrenia in South Africa. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1679-1686. [PMID: 32409883 DOI: 10.1007/s00127-020-01875-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/02/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation. METHOD In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all? RESULTS Most participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences. DISCUSSION For this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.
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Affiliation(s)
- Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Megan M Campbell
- Department of Psychology, Rhodes University, Grahamstown, South Africa
| | - Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Palk A, Illes J, Thompson PM, Stein DJ. Ethical issues in global neuroimaging genetics collaborations. Neuroimage 2020; 221:117208. [PMID: 32736000 DOI: 10.1016/j.neuroimage.2020.117208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/09/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022] Open
Abstract
Neuroimaging genetics is a rapidly developing field that combines neuropsychiatric genetics studies with imaging modalities to investigate how genetic variation influences brain structure and function. As both genetic and imaging technologies improve further, their combined power may hold translational potential in terms of improving psychiatric nosology, diagnosis, and treatment. While neuroimaging genetics studies offer a number of scientific advantages, they also face challenges. In response to some of these challenges, global neuroimaging genetics collaborations have been created to pool and compare brain data and replicate study findings. Attention has been paid to ethical issues in genetics, neuroimaging, and multi-site collaborative research, respectively, but there have been few substantive discussions of the ethical issues generated by the confluence of these areas in global neuroimaging genetics collaborations. Our discussion focuses on two areas: benefits and risks of global neuroimaging genetics collaborations and the potential impact of neuroimaging genetics research findings in low- and middle-income countries. Global neuroimaging genetics collaborations have the potential to enhance relations between countries and address global mental health challenges, however there are risks regarding inequity, exploitation and data sharing. Moreover, neuroimaging genetics research in low- and middle-income countries must address the issue of feedback of findings and the risk of essentializing and stigmatizing interpretations of mental disorders. We conclude by examining how the notion of solidarity, informed by an African Ethics framework, may justify some of the suggestions made in our discussion.
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Affiliation(s)
- Andrea Palk
- Department of Philosophy, Stellenbosch University, Bag X1, Matieland, Stellenbosch, 7602, South Africa.
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Institute for Neuroimaging & Informatics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Groote Schuur Hospital, Cape Town 7925, South Africa
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Corsico P. Psychosis, vulnerability, and the moral significance of biomedical innovation in psychiatry. Why ethicists should join efforts. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:269-279. [PMID: 31773383 PMCID: PMC7260249 DOI: 10.1007/s11019-019-09932-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue that we should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we (i) integrate insights from several areas of ethics, (ii) translate bioethical principles into the mental health context, and (iii) proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna's notion of 'layers of vulnerability' to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis.
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Affiliation(s)
- Paolo Corsico
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
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Ward ET, Kostick KM, Lázaro-Muñoz G. Integrating Genomics into Psychiatric Practice: Ethical and Legal Challenges for Clinicians. Harv Rev Psychiatry 2020; 27:53-64. [PMID: 30614887 PMCID: PMC6326091 DOI: 10.1097/hrp.0000000000000203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psychiatric genomics is a rapidly growing field that holds much promise for improving risk prediction, prevention, diagnosis, treatment selection, and understanding of the pathogenesis of patients' symptoms. The field of psychiatry (i.e., professional organizations, mental health clinicians, educational institutions), however, needs to address numerous challenges to promote the responsible translation of genomic technologies and knowledge into psychiatric practice. The goal of this article is to review how clinicians currently encounter and use genomics in the clinic, to summarize the existing literature on how clinicians feel about the use of genomics in psychiatry, and to analyze foreseeable ethical and legal challenges for the responsible integration of genomics into psychiatric care at the structural and clinic levels. Structural challenges are defined as aspects of the larger system of psychiatric practice that constitute potential barriers to the responsible integration of genomics for the purposes of psychiatric care and prevention. These structural challenges exist at a level where professional groups can intervene to set standards and regulate the practice of psychiatry and genomics. Clinic-level challenges are day-to-day issues clinicians face when managing genomic tests in the clinic. We discuss the need for action to mitigate these challenges and maximize the clinical and social utility of psychiatric genomics, including the following: expanding genomics training among mental health clinicians; establishing practice guidelines that consider potential clinical, psychological, and social implications of psychiatric genomics; promoting an integrated care model for managing genomics in psychiatry; emphasizing patient engagement and informed consent when managing genomic testing in psychiatric care.
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Affiliation(s)
- Eric T Ward
- From the University of North Carolina School of Medicine (Dr. Ward); Center for Medical Ethics and Health Policy, Baylor College of Medicine (Drs. Kostick and Lázaro-Muñoz)
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Kong C, Singh I. The ethics of global psychiatric genomics: Multilayered challenges to integrating genomics in global mental health and disability-A position paper of the Oxford Global Initiative in Neuropsychiatric GenEthics (NeuroGenE). Am J Med Genet B Neuropsychiatr Genet 2019; 180:533-542. [PMID: 30523674 DOI: 10.1002/ajmg.b.32697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
Psychiatric genomics has the potential to radically improve the prevention and early intervention of serious mental and neurodevelopmental disorders worldwide. However, little work has been done on the ethics of psychiatric genomics-an oversight that could result in poor local uptake, reduced practical/clinical application, and ethical violations in this rapidly developing area of scientific research. As part of the Global Project of the Stanley Center for Psychiatric Research, the Global Initiative in Neuropsychiatric GenEthics (NeuroGenE) based at the University of Oxford aims to embed ethical inquiry within scientific investigation and engage with fundamental ethical questions around a psychiatric genomics approach to mental and neurodevelopmental disorder. This position paper sets out the core aims of the NeuroGenE research programme and explores the importance of a crosscutting research orientation in this field based on multidisciplinary methodologies which can ensure that efforts to translate and apply global psychiatric genomics in public policy and clinical practice are ethically grounded strategies, respectful of different cultures and contexts.
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Affiliation(s)
- Camillia Kong
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Ilina Singh
- Department of Psychiatry and Oxford Uehiro Centre, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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Kong C. Ethical dangers of facial phenotyping through photography in psychiatric genomics studies. JOURNAL OF MEDICAL ETHICS 2019; 45:730-735. [PMID: 31363012 DOI: 10.1136/medethics-2019-105478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/29/2019] [Accepted: 07/14/2019] [Indexed: 06/10/2023]
Abstract
Psychiatric genomics research protocols are increasingly incorporating tools of deep phenotyping to observe and examine phenotypic abnormalities among individuals with neurodevelopmental disorders. In particular, photography and the use of two-dimensional and three-dimensional facial analysis is thought to shed further light on the phenotypic expression of the genes underlying neurodevelopmental disorders, as well as provide potential diagnostic tools for clinicians. In this paper, I argue that the research use of photography to aid facial phenotyping raises deeply fraught issues from an ethical point of view. First, the process of objectification through photographic imagery and facial analysis could potentially worsen the stigmatisation of persons with neurodevelopmental disorders. Second, the use of photography for facial phenotyping has worrying parallels with the historical misuse of photography to advance positive and negative eugenics around race, ethnicity and intellectual disability. The paper recommends ethical caution in the use of photography and facial phenotyping in psychiatric genomics studies exploring neurodevelopmental disorders, outlining certain necessary safeguards, such as a critical awareness of the history of anthropometric photography use among scientists, as well as the exploration of photographic methodologies that could potentially empower individuals with disabilities.
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Affiliation(s)
- Camillia Kong
- Birkbeck University of London Institute for Criminal Policy Research, London, UK
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Faure MC, Matshabane OP, Marshall P, Appelbaum PS, Stein DJ, Engel ME, de Vries J. Does genetics matter for disease-related stigma? The impact of genetic attribution on stigma associated with rheumatic heart disease in the Western Cape, South Africa. Soc Sci Med 2019; 243:112619. [PMID: 31715540 DOI: 10.1016/j.socscimed.2019.112619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A common concern in African genomic research is that such work may cause, or increase, stigma associated with particular diseases or population groups. While there is some evidence suggesting that genetic attribution of disease might impact stigma, there exists no evidence for the situation in African populations. With increasing genomic research in African populations, questions about the effect of genetic attribution on disease-related stigma are salient for stakeholders involved in implementation and regulation. To understand better the relationship between stigma and genetic attribution, we interviewed people with Rheumatic Heart Disease (RHD) in the Western Cape of South Africa. METHOD We conducted 11 focus group discussions with RHD patients of mixed-ancestry in the Western Cape, exploring the impact of genetic attribution on stigma. Participants had previously consented to participate in genomic research, attending information sessions on genetics. We explored the impact of genetic attribution by introducing both genetic and environmental causes to RHD and by specifically probing how these various causes would likely impact selected features of disease stigma. RESULTS Participants reported varying experiences of stigma relating to RHD, such as labelling, social exclusion and discrimination at the workplace. They had some understanding of genetics, either in general, or in relation to their illness. Participants' understanding depicted multiple causal models to explain RHD including genetic, environmental and bacterial causation. Overall, participants did not make a connection between genetics as a cause of RHD and their experiences of stigma. DISCUSSION In this study we found no support for the concern that genetic attribution of RHD, understood by participants in our study as a genetic predisposition to developing the disease, would impact stigma associated with it. Our findings provide some reassurance that genomic research may be unlikely to cause an increase in disease-related stigma in the South African context.
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Affiliation(s)
- Marlyn C Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Olivia P Matshabane
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | | | - Dan J Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Kostick K, Pereira S, Brannan C, Torgerson L, Lázaro-Muñoz G. Psychiatric genomics researchers' perspectives on best practices for returning results to individual participants. Genet Med 2019; 22:345-352. [PMID: 31477844 PMCID: PMC7000323 DOI: 10.1038/s41436-019-0642-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/13/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Large-scale array-based and sequencing studies have advanced our understanding of the genetic architecture of psychiatric disorders, but also increased the potential to generate an exponentially larger amount of clinically relevant findings. As genomic testing becomes more widespread in psychiatry research, urgency grows to establish best practices for offering return of results (RoR) to individuals at risk or diagnosed with a psychiatric disorder. Methods We interviewed an international sample (n = 39) of psychiatric genetics researchers to examine conceptualizations of “best practices” for RoR to individual research participants. Results While the vast majority of researchers do not offer RoR, most believed medically actionable findings (85%) and clinically valid but non–medically actionable findings (54%) should be offered. Researchers identified three main areas for improvement: interfacing with individual participants; interdisciplinary training, guidance, and integration; and quality planning and resource allocation for returning results. Conclusion There are significant gaps between researchers’ visions for “best” versus “actual” RoR practices. While researchers call for participant-centered practices, including consent practices that consider any special needs of participants with psychiatric disorders, return of individually meaningful results, and effective follow-up and provisions for treatment, the current reality is that consent and RoR practices lack standardized and evidence-based norms.
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Affiliation(s)
- Kristin Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Pereira
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Cody Brannan
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA.
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Brannan C, Foulkes AL, Lázaro-Muñoz G. Preventing discrimination based on psychiatric risk biomarkers. Am J Med Genet B Neuropsychiatr Genet 2019; 180:159-171. [PMID: 29633550 PMCID: PMC6173986 DOI: 10.1002/ajmg.b.32629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 02/17/2018] [Accepted: 03/01/2018] [Indexed: 01/09/2023]
Abstract
Recent studies have identified genomic and nongenomic psychiatric risk biomarkers (PRBs; e.g., genomic variants, blood analytes, gray matter volume). PRBs may soon become a powerful tool for improving psychiatric care and prevention. PRB research and its translation to clinical care, however, may prove to be a double-edged sword. Mental health stigma and discrimination are already widespread, and data caution that biological explanations of psychiatric disorders can exacerbate these stigmatizing attitudes, increasing the desire for social distance and heightening the perceived dangerousness of the patient. As a reaction to the Human Genome Project and historical concerns about eugenics, the international community mobilized to establish legislation to prevent genomic discrimination. But in most countries, these laws are limited to few contexts (e.g., employment, health insurance), and very few countries protect against discrimination based on nongenomic risk biomarkers. Like genomic PRBs, nongenomic PRBs provide information regarding risk for stigmatized psychiatric disorders and have similar-and in some cases greater-predictive value. Numerous large-scale neuroscience and neurogenomics projects are advancing the identification and translation of PRBs. The prospect of PRB-based stigma however, threatens to undermine the potential benefits of this research. Unbridaled by nonexistent or limited PRB anti-discrimination protections, the threat of PRB-based stigma and discrimination may lead many to forego PRB testing, even if shown to have clinical utility. To maximize the clinical and social benefits of PRB-based technologies, educational campaigns should address mental health and PRB stigma, and lawmakers should carefully consider expanding legislation that prohibits PRB-based discrimination.
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Affiliation(s)
- Cody Brannan
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
- Department of Biosciences, Rice University, Houston, TX, USA
| | - Alexandra L. Foulkes
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
- University of Houston Law Center, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Palk AC, Dalvie S, de Vries J, Martin AR, Stein DJ. Potential use of clinical polygenic risk scores in psychiatry - ethical implications and communicating high polygenic risk. Philos Ethics Humanit Med 2019; 14:4. [PMID: 30813945 PMCID: PMC6391805 DOI: 10.1186/s13010-019-0073-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/14/2019] [Indexed: 06/09/2023] Open
Abstract
Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations.
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Affiliation(s)
- A. C. Palk
- Department of Psychiatry, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
| | - S. Dalvie
- Department of Psychiatry and SA MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
| | - J. de Vries
- Department of Medicine, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
| | - A. R. Martin
- Analytic & Translational Genetics Unit, Massachusetts General Hospital, Boston, MA USA
- Stanley Center for Psychiatric Research & Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - D. J. Stein
- Department of Psychiatry and SA MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
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Lebowitz MS, Appelbaum PS. Biomedical Explanations of Psychopathology and Their Implications for Attitudes and Beliefs About Mental Disorders. Annu Rev Clin Psychol 2018; 15:555-577. [PMID: 30444641 DOI: 10.1146/annurev-clinpsy-050718-095416] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental disorders are increasingly conceptualized as biomedical diseases, explained as manifestations of genetic and neurobiological abnormalities. Here, we discuss changes in the dominant explanatory accounts of psychopathology that have occurred over time and the driving forces behind these shifts, lay out some real-world evidence for the increasing ascendancy of biomedical explanations, and provide an overview of the types of attitudes and beliefs that may be affected by them. We examine theoretical and conceptual models that are relevant to understanding how biomedical conceptualizations might affect attitudes and beliefs about mental disorders, and we review some empirical evidence that bears on this question. Finally, we examine possible strategies for combatting potential negative effects of biomedical explanations and discuss important conclusions and directions for future research.
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Affiliation(s)
- Matthew S Lebowitz
- Center for Research on Ethical, Legal, and Social Implications of Psychiatric, Neurologic, and Behavioral Genetics; Department of Psychiatry; Columbia University Medical Center; New York, NY 10032, USA;
| | - Paul S Appelbaum
- Center for Research on Ethical, Legal, and Social Implications of Psychiatric, Neurologic, and Behavioral Genetics; Department of Psychiatry; Columbia University Medical Center; New York, NY 10032, USA;
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Manzini A, Vears DF. Predictive Psychiatric Genetic Testing in Minors: An Exploration of the Non-Medical Benefits. JOURNAL OF BIOETHICAL INQUIRY 2018; 15:111-120. [PMID: 29230699 PMCID: PMC5897476 DOI: 10.1007/s11673-017-9828-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
Predictive genetic testing for susceptibility to psychiatric conditions is likely to become part of standard practice. Because the onset of most psychiatric diseases is in late adolescence or early adulthood, testing minors could lead to early identification that may prevent or delay the development of these disorders. However, due to their complex aetiology, psychiatric genetic testing does not provide the immediate medical benefits that current guidelines require for testing minors. While several authors have argued non-medical benefits may play a crucial role in favour of predictive testing for other conditions, little research has explored such a role in psychiatric disorders. This paper outlines the potential non-medical benefits and harms of psychiatric genetic testing in minors in order to consider whether the non-medical benefits could ever make such testing appropriate. Five non-medical themes arise in the literature: psychological impacts, autonomy/self-determination, implications of the biomedical approach, use of financial and intellectual resources, and discrimination. Non-medical benefits were prominent in all of them, suggesting that psychiatric genetic testing in minors may be appropriate in some circumstances. Further research needs to empirically assess these potential non-medical benefits, incorporate minors in the debate, and include normative reflection to evaluate the very purposes and motivations of psychiatric genetic testing in minors.
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Affiliation(s)
- Arianna Manzini
- Neuroscience, Ethics & Society Team, Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Ln, Oxford, OX3 7JX UK
| | - Danya F. Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium
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Halovic S. The Future Emerges from the Past : Comment on "Personal Genomic Testing, Genetic Inheritance, and Uncertainty". JOURNAL OF BIOETHICAL INQUIRY 2017; 14:591-592. [PMID: 29119461 DOI: 10.1007/s11673-017-9818-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
The case of Jordan (Mason 2017) highlights the gamble of connecting with the past through genomic testing. Unfortunately for Jordan, his genomic testing identified two variant genes which account for up to 75 per cent of early-onset Alzheimer's disease cases. Furthermore, his children were identified as having a 50 per cent risk of inheriting the gene which corresponds to the majority of early-onset Alzheimer's disease cases. Now Jordan is not only burdened with the foreknowledge that he will most likely develop Alzheimer's disease at a relatively young age but also burdened with the knowledge that his children may share his fate. Jordan was overwhelmed by his attempts to understand the genetic tests and experienced substantial distress. This response highlights the need for industry-wide regulations that adequately prepare individuals for the decision of whether to initiate genomic testing and require the results to be interpreted with genetic counsellors or other suitably skilled doctors. Furthermore, these industry-wide regulations need to be accountable to the same evidence-based standards that regulate the rest of the medical professions.
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Affiliation(s)
- Shaun Halovic
- Westmead Psychotherapy Program and University of Sydney, Building 112, Cumberland Hospital, 5 Fleet St, North Parramatta, NSW, 2151, Australia.
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Abstract
BACKGROUND Addictions are highly stigmatized and increasingly construed as biomedical diseases caused by genes, partly to reduce stigma by deflecting blame. However, genetic explanations may have negative effects, which have been understudied in the context of addiction. How the effects of genetic explanations might differ for substance addictions versus behavioral addictions is also unknown. AIMS This study examined the impact of genetic explanations for addiction on measures of treatment expectancies, blame, and perceived agency and self-control, as well as whether these varied depending on whether the addiction was to a substance or a behavior. METHODS Participants read about a person ('Charlie') with either alcohol use disorder or gambling disorder, receiving either a genetic or nongenetic explanation of Charlie's problem. They rated how much they blamed Charlie for his disorder, his likelihood of benefitting from medication or psychotherapy, and how much agency and self-control they ascribed to him. RESULTS Compared to the nongenetic explanation, the genetic explanation reduced blame and increased confidence in the effectiveness of pharmacotherapy. However, it also decreased the expected effectiveness of psychotherapy and reduced ascriptions of agency and self-control. CONCLUSION Genetic explanations for addiction appear to be a 'double-edged sword', with beneficial effects that come at a cost.
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Affiliation(s)
- Matthew S Lebowitz
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, New York, NY, USA Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Paul S Appelbaum
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, New York, NY, USA Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
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Mozersky J, Stites SD, Sisti DA. Expanding Our Lens: Thinking Beyond Genomics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:29-31. [PMID: 28328357 DOI: 10.1080/15265161.2017.1284928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Sabatello M. Psychiatric Genomics and Public Mental Health in the Young Mind. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:27-29. [PMID: 28328362 PMCID: PMC5463093 DOI: 10.1080/15265161.2017.1284925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Hyman SE. A Valuable New Direction in Ethical Analysis of Psychiatric Genetics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:13-15. [PMID: 28328368 DOI: 10.1080/15265161.2017.1285145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Char D. Pediatric Acute Care Decision Implications of Genetically Discoverable Mental Disorders. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:32-33. [PMID: 28328359 DOI: 10.1080/15265161.2017.1284926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Lázaro-Muñoz G. Responsible Translation of Psychiatric Genetics and Other Neuroscience Developments: In Need of Empirical Bioethics Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:33-35. [PMID: 28328369 PMCID: PMC7133549 DOI: 10.1080/15265161.2017.1284917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Viaña JNM, Bueno RJ, Gilbert F. Beyond Genomic Association: Ethical Implications of Elucidating Disease Mechanisms and Genotype-Influenced Treatment Response. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:24-26. [PMID: 28328364 DOI: 10.1080/15265161.2017.1284931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Redinger MJ, Gibb TS, Westerman P. The Cautionary Tale of the Initial Widespread Foray Into Psychiatric Genetics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:22-24. [PMID: 28328358 DOI: 10.1080/15265161.2017.1284929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Tyler S Gibb
- a Western Michigan University, Homer Stryker M.D. School of Medicine
| | - Perry Westerman
- a Western Michigan University, Homer Stryker M.D. School of Medicine
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de Vries J, Stein DJ, Kamuya D, Singh I. Psychiatric Genomics: Ethical Implications for Public Health in Lower- and Middle-Income Countries. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:17-19. [PMID: 28328374 PMCID: PMC6995360 DOI: 10.1080/15265161.2017.1284938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Dan J Stein
- b University of Cape Town and South African Medical Research Council Unit on Anxiety & Stress Disorders
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Widdershoven G, Voskes Y, Meynen G. Psychiatric Genomics and the Role of the Family: Beyond the Doctor-Patient Relationship. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:20-22. [PMID: 28328366 DOI: 10.1080/15265161.2017.1284930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Martinez-Martin N. Psychiatric Genetics in a Risk Society. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2017; 17:1-2. [PMID: 28328381 PMCID: PMC6634988 DOI: 10.1080/15265161.2017.1300485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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