Genetic Counselling and Potential Ethical Issues in Genetic Studies of Schizophrenia
If individual genes are identified, will presymptomatic screening for schizophrenia ever become available? This would perhaps be possible for a rare subset of individuals from families in which a major susceptibility gene has been identified. However, one must consider whether, how and at what age such testing would be appropriate.
There is a strong likelihood that any single genetic change would only lead to schizophrenia in a proportion of individuals who carried that genetic change. Also, as in many genetic illnesses it would be likely that the severity of the condition would not be predictable from the observed genetic change. Would testing in children be available? As for genetic disorders for which presymptomatic testing is available, one would only perform such testing if the clinical benefits in terms of disease prevention clearly outweighed compromising the child's autonomy and the risks of any interventions.
Testing children with syndromal features for 22qDS could be construed as a form of presymptomatic testing for schizophrenia since the risk of developing schizophrenia in 22qDS is about 25%. The risk for later-onset
treatable conditions such as schizophrenia and other psychiatric disorders
needs to become part of the standard information given to parents of infants or children diagnosed with 22qDS. We anticipate that this information will become incorporated into most genetic counselling sessions for this syndrome as practice using currently available data evolves.
In summary, the ethical issues surrounding molecular genetic testing of individuals for schizophrenia should be no different from those already encountered with several other genetic conditions. In all cases, individuals should be clearly informed of the benefits and disadvantages of testing and should be counselled regarding the potential insurance and employment discrimination issues.
To find out more, here's a publication from our research group related to genetic counselling:
- Hodgkinson KA, Murphy J, O'Neill S, Brzustowicz LM, Bassett AS: Genetic Counselling for Schizophrenia in the Era of Molecular Genetics. Canadian Journal of Psychiatry 46: 123-130, 2001.
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- Bassett AS: Genetic Counselling for Schizophrenia in the Era of Molecular Genetics. Canadian Journal of Psychiatry 46: 123-130, 2001.
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