Identification of Misattributed Paternity

 

Misattributed paternity refers to the situation where a test indicates that the assumed father of an individual is not in fact the biological father.⁶⁴

 

Case Study

 

Marlene and Steven have a child, Felicity, who is diagnosed with Friedreich ataxia.   Friedreich ataxia is an autosomal recessive neurodegenerative disorder that results in progressive disability and reduced life span.   Genetic testing reveals that Felicity has the common genetic change in both copies of the affected gene and this confirms the diagnosis.   DNA samples are obtained from Marlene and Steven for a research project.   Marlene is shown to be a carrier of the common gene fault but Steven is not.   This indicates with high likelihood that Steven is not Marlene’s biological father.

 

Ethical Implications

 

Much has been made of the fact that misattributed paternity (also called non-paternity) can be identified by genetic testing and the harm, in particular to family relationships, that could result from revelation of this.   The reported frequency of misattributed paternity in the general population varies from 2-10%.   Identification of misattributed paternity can occur when a child is diagnosed with an autosomal recessive condition and the father does not have one of the causative mutations found in the child.   It can also occur in research that is aimed at identifying genes.   Here a process called linkage is often employed.   In linkage, DNA from across the genome is examined in multiple family members.   DNA from area(s) of the genome that are shared by all in the family with the condition and not by those without it can help to isolate the part of the chromosome that holds the causative gene.   It is rapidly apparent when DNA is present from an individual who is not genetically related to the offspring they are said to be the father of.

 

There are four possible courses of action that can be taken when misattributed paternity is revealed.

 

1.   To not reveal it.

2.   To reveal it to the mother alone.

3.   To reveal it to the mother and “father”.

4.   To reveal it to the “father” alone.

 

Policies related to dealing with the identification of misattributed paternity are relatively old with none produced this decade.⁶⁵   The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982) recommended full disclosure to all parties.   By contrast, the Institute of Medicine Committee on Assessing Genetic Risks recommended withholding such information from the man.⁶⁴

 

An international survey of clinical geneticists asked how they would respond to a situation essentially identical to the case study of Marlene and Steven above.⁶⁶   The survey found that 81% of clinical geneticists indicated they would reveal the misattributed paternity to the mother in private, 13% said they would tell the couple they are both carriers (that is, they would lie about the test results and withhold information about misattributed-paternity) and 2% said they would tell them the father is not a carrier and that the child’s condition was due to a new mutation (which is possible but highly unlikely).   The reasons for their responses were preservation of the family unit (58%), the mother’s right to decide (30%) and the mother’s right to privacy (13%).

 

Ross argues that both parties should be informed because, to only inform the woman would mean unequal treatment of the two clients that seek genetic counselling and that this is unjust.⁶⁴   She argues that in the genetic counselling context, the counsellor cannot know if such disclosure will be good or bad for the couple.   In addition, a man may not have financial responsibility for a child that is not his genetic offspring and by not revealing this information, he may be denied the opportunity to end this financial commitment.   This argument is controversial with some ethicists arguing that a man who has brought up a child should not be eligible for financial compensation if it is found that the child is not his biological progeny.⁶⁷

 

It is argued that if knowledge of misattributed-paternity will change the future behaviour of the couple, then the father must be given the information.   For example if a child has a recessive condition and the “father” is not a carrier of one of the mutations, the couple may seek prenatal tests with future pregnancies unnecessarily.   If they were aware of the misattributed-paternity, and that the risk of having a child with that recessive condition would therefore be very low rather than 1:4, prenatal or preimplantation diagnosis would not be pursued.

 

Arguments in favour of withholding the information about misattributed-paternity or revealing it to the woman alone often relate to potential harm to family relationships.   It has been argued that women stand to lose more if misattributed paternity is revealed and thus that the couple are not in fact equal in terms of their right to such information.   It has also been argued that contributing to this inequality is the fact that men can hide infidelity whereas women cannot in such circumstances.⁶⁵

 

Another person that has an important potential stake in such a situation is the biological father.   He is a carrier of a recessive condition.   If it is a common condition, such as cystic fibrosis, he has a significant risk of having a child with the condition.   Should the discussion about revelation of genetic status extend to this man also?

 

It is worth noting that the potential to identify misattributed-paternity is not a new phenomenon restricted to DNA testing.   Blood typing can also result in identification of misattributed-paternity.   For example if a child has the blood group AB and the mother is group A and the assumed father is group O, that man cannot be the genetic father.