1. The concerns Tonya and Lisa have regarding genetic testing raises several ethical questions that Dugas (2005) outlines. The right to self-determination is central in matters linked to genetic testing, and nurses do need to understand their role in providing informed consent when patients are faced with a decision similar to that of Tonya and Lisa (Dugas, 2005). In addition to providing patients with all the information they need to make informed decisions, nurses also have an ethical duty to strengthen relationships among all members of the healthcare team to promote patient advocacy during the decision-making process. As Dugas (2005) points out, “establishing the links among families, health-care systems, and community is an integral part of the nursing role in genetic health care,” (p. 106). As this case study also reveals, genetic testing is unique in that patients are “revealing information about their genetic makeup that typically remains unknown to themselves and others,” (Dugas, 2005, p. 106). The ethical conundrums the information can reveal challenge nurses to provide patients with the best possible care, while simultaneously keeping in mind the best interests of family members too. Based on her experience with her mom, Lisa desperately wants to receive the test as she believes it will help her make more informed choices about her future and will even impact her reproductive decisions. Tonya, on the other hand, warns her friend about the risks of revealing such sensitive information. Knowing also that genetic testing is elective and therefore paid for out of pocket, Tonya also raises critical ethical issues related to healthcare disparities. Finally, Tonya points out that insurance companies might turn down Lisa if her test results were positive. This latter point links with Dugas’s (2005) analysis of privacy and confidentiality issues.

2. There most certainly can be risks to genetic testing. A nurse...

For example, both Tonya and Lisa have a history of breast cancer in their immediate family and therefore suspect that they might be at a higher than average risk for developing breast cancer too. The risk of not getting genetic testingn also needs to be considered alongside the risks of getting tested. As Lisa so adamantly points out in the case, not getting tested can be dangerous because early detection is a crucial factor in prognosis (BreastCancer.org, 2017).
Moreover, preliminary research shows tentative support for Lisa’s position. Frank & Braverman (1999), for example, found that “evidence suggests that for individuals in high-risk families it is more beneficial to know than not to know one's genetic status,” (p. 139). The reasons why the test could be beneficial include the ability to empower the patient with knowledge and the ability to be proactive about her health. Because the test results are not necessarily definitive, the nurse needs to elucidate their implications and discuss what the results mean openly and honestly. As Dugas (2005) points out, informed consent and communicating with all members of the healthcare team throughout the decision making process will help the patients make the best decision for them.

Yet Tonya is also correct to point out the problems with genetic testing, such as being turned down by a health insurance company if the results were indeed positive. Her cost-related considerations raise critical issues in healthcare policy but may not be as relevant to Tonya and Lisa if both patients can afford the genetic testing. However, there are additional social and psychological concerns with breast cancer genetic testing. For example, organization Breast Cancer.org also elucidates the potential psychological effects of receiving an abnormal test result: “an abnormal…