Ethics Opinions

Social networks, and other forms of communication online create new challenges to the patient-physician relationship. Physicians and trainees have an ethical responsibility to weigh a number of considerations when maintaining a presence online: abiding by standards of patient privacy and confidentiality, maintaining appropriate professional boundaries and recognizing that actions online and content posted may negatively affect their reputations.

Surgical co-management refers to the practice of allotting specific responsibilities of patient care to designated clinicians. Such arrangements should be made only to ensure the highest quality of care.

Information gathered and recorded in association with the care of a patient is confidential. Disclosing information to third parties for commercial purposes without consent undermines trust, violates principles of informed consent and confidentiality, and may harm the integrity of the patient-physician relationship.

Genetic testing is most appropriate when the results of testing will have meaningful impact on the patient’s care. It is important that patients always receive appropriate counseling. Physicians should not encourage testing unless there is effective therapy available to prevent or ameliorate the condition tested for.

Physicians may ethically provide genetic testing to inform reproductive decision making when the patient requests, but may also wish to offer broad screening to all persons who are considering having a child.

Patients who undergo genetic testing have a right to have their information kept in confidence, and a variety of state and federal laws prohibit discrimination by employers, insurers, and other third parties based on genetic information.

With the exception of genetic information (or material) collected under the jurisdiction of a coroner, medical examiner, or other medical legal officer, the release of genetic information from a physician’s records without the patient’s informed consent constitutes a breach of confidentiality. However, under limited circumstances, physicians may disclose such information to the criminal justice system.

Donating eggs or sperm for others to use in reproduction can enable individuals who would not otherwise be able to do so to have children. However, gamete donation also raises ethical concerns about the privacy of donors and the nature of relationships among donors and children born through use of their gametes by means of assisted reproductive technologies.

Therapeutic donor insemination using sperm from a woman’s partner or a third-party donor can enable a woman or couple who might not otherwise be able to do so to fulfill the important life choice of becoming a parent (or parents). However, the procedure also raises ethical considerations about safety for the woman and potential offspring, donor privacy, and the disposition of frozen semen, as well as the use of screening to select the sex of a resulting embryo.

In light of the physical risks of somatic cell nuclear transfer, ongoing moral debate about the status of the human embryos, and concerns about the impact of reproductive cloning on cloned children, families, and communities, reproductive cloning is not endorsed by the medical profession. Should reproductive cloning at some point be introduced into medical practice, however, any child produced by reproductive cloning would be entitled to the same rights, freedoms, and protections as every other individual in society.