Ryan Jane, Virani Alice, Austin Jehannine C
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Department of Medical Genetics, University of British Columbia, Vancouver, Canada; Centre for Applied Ethics, University of British Columbia, Vancouver, Canada.
Appl Transl Genom. 2015 Jun 27;5:23-9. doi: 10.1016/j.atg.2015.06.001. eCollection 2015 Jun 1.
Genetic counseling is a well-established healthcare discipline that provides individuals and families with health information about disorders that have a genetic component in a supportive counseling encounter. It has recently been applied in the context of psychiatric disorders (like schizophrenia, bipolar disorder, schizoaffective disorder, obsessive compulsive disorder, depression and anxiety) that typically appear sometime during later childhood through to early adulthood. Psychiatric genetic counseling is emerging as an important service that fills a growing need to reframe understandings of the causes of mental health disorders. In this review, we will define psychiatric genetic counseling, and address important ethical concerns (we will particularly give attention to the principles of autonomy, beneficence, non-maleficence and justice) that must be considered in the context of its application in adolescent psychiatry, whilst integrating evidence regarding patient outcomes from the literature. We discuss the developing capacity and autonomy of adolescents as an essential and dynamic component of genetic counseling provision in this population and discuss how traditional viewpoints regarding beneficence and non-maleficence should be considered in the unique situation of adolescents with, or at risk for, psychiatric conditions. We argue that thoughtful and tailored counseling in this setting can be done in a manner that addresses the important health needs of this population while respecting the core principles of biomedical ethics, including the ethic of care.
遗传咨询是一门成熟的医疗保健学科，在支持性的咨询过程中，为个人和家庭提供有关具有遗传成分的疾病的健康信息。它最近已应用于精神疾病（如精神分裂症、双相情感障碍、分裂情感性障碍、强迫症、抑郁症和焦虑症）的背景中，这些疾病通常在童年后期到成年早期的某个时候出现。精神科遗传咨询正在成为一项重要服务，满足了人们日益增长的重新认识心理健康障碍病因的需求。在本综述中，我们将定义精神科遗传咨询，并探讨在青少年精神病学应用背景下必须考虑的重要伦理问题（我们将特别关注自主、行善、不伤害和公正原则），同时整合文献中有关患者预后的证据。我们讨论青少年不断发展的能力和自主性，这是为该人群提供遗传咨询的一个重要且动态的组成部分，并讨论在患有精神疾病或有精神疾病风险的青少年的独特情况下，应如何考虑关于行善和不伤害的传统观点。我们认为，在这种情况下，经过深思熟虑和量身定制的咨询可以在满足该人群重要健康需求的同时，尊重生物医学伦理的核心原则，包括关怀伦理。
