Rethinking the "open future" argument against predictive genetic testing of children.
DOI: 10.1038/s41436-019-0483-4; PMCID: PMC6754817
Professional consensus has traditionally discouraged predictive genetic testing when no childhood interventions can reduce future morbidity or mortality. However, advances in genome sequencing and accumulating evidence that children and families cope adequately with predictive genetic information have weakened this consensus. The primary argument remaining against testing appeals to children's "right to an open future." It claims that the autonomy of the future adult is violated when others make an irreversible choice to obtain or disclose predictive genetic information during childhood. We evaluate this argument and conclude that children's interest in an open future should not be understood as a right. Rather an open future is one significant interest to weigh against other important interests when evaluating decisions. Thus, predictive genetic testing is ethically permissible in principle, as long as the interests promoted outweigh potential harms. We conclude by offering an expanded model of children's interests that might be considered in such circumstances, and present two case analyses to illustrate how this framework better guides decisions about predictive genetic testing in pediatrics.
Genetics in medicine : official journal of the American College of Medical Genetics
Child; Child, Preschool; Decision Making; Disclosure; Forecasting; Genetic Predisposition to Disease; Genetic Testing; Human Rights; Humans; Parents
adult-onset conditions; children’s interests; pediatric genetic testing; right to an open future; secondary findings
Garrett, J. R., Lantos, J. D., Biesecker, L. G., Childerhose, J. E., Chung, W. K., Holm, I. A., Koenig, B. A., McEwen, J., Wilfond, B. S., Brothers, K., . Rethinking the "open future" argument against predictive genetic testing of children. Genetics in medicine : official journal of the American College of Medical Genetics 21, 2190-2198 (2019).