AMA Journal of Ethics^®

The Holocaust and the racial hygiene doctrine that helped rationalize it still overshadow contemporary debates about using gene editing for disease prevention.

Testing everyone for everything identifies more fetal conditions, but confusion persists about whether clinicians should leave screening decisions to patients.

Prognostic uncertainty about risk creates demand for ongoing communication and facilitated reflection about goals and values.

Rare genetic disease research has something to teach precision medicine about addressing some patients’ limited access to treatment. Health disparities exacerbated by high costs and limited availability of drugs can, perhaps, be mitigated when patient activism accelerates drug development.

Direct-to-consumer genetic testing requires that physicians share decision making with patients, not order unnecessary tests or interventions, and refer to genetic specialists when necessary.

Though the National Aeronautics and Space Administration’s collection of disaggregated genetic data for occupational surveillance and research raises numerous privacy concerns, the Genetic Information Nondiscrimination Act of 2008 allows genetic information to be used to develop personal pharmaceuticals.

Mandatory genetic testing of health care professionals could help structure health care organizations’ responses to a pandemic. Patients and more susceptible employees can benefit, and these benefits must be weighed against concerns about fairness, autonomy, genetic privacy, and potential loss of employment opportunities.

Pregnant women at high risk for heritable diseases need support and nondirective genetic counseling.

Protecting patients rather than informed consent should be the goal when the complexity of information overwhelms patients’ decision-making capacity.

Noninvasive prenatal testing arguably constitutes a form of eugenics in a social context in which certain reproductive outcomes are not valued.