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Alerting relatives about heritable risks: the limits of confidentiality

BMJ 2018; 361 doi: (Published 05 April 2018) Cite this as: BMJ 2018;361:k1409

Re: Rapid response by Ali et al 15 th April 2018: Alerting relatives about heritable risks: Bolam Vs Montgomery

Ali et al appear to have misunderstood the main message of our paper. Contrary to what they say in their response, we do not advocate use of the Bolam test, nor do we "espouse" its use over the Montgomery ruling.

Instead we argue that in the clinical scenario we outline, consent for disclosure is not required if disclosing potentially familial information. For example, we suggest Clare in our scenario could have been told: " Your family history suggests there might be an inherited predisposition in your family" and that this is possible because John has refused disclosure of his (confidential) information, but he cannot refuse disclosure of information that is not unique to him.

We are proposing that familial and clinical information can often be separated to avoid a breach of confidentiality, allowing relatives to be alerted about their potential risks, and mitigating actions they might take, thus avoiding future cases like ABC. This approach does not favour Bolam over Montgomery.

Competing interests: No competing interests

23 April 2018
Anneke Lucassen
Roy Gilbar
Faculty of Medicine, University of Southampton
Wessex Clinical Genetics Service and Faculty of Medicine UoS