Medico-legal - Who's the daddy? Patient requests for paternity tests

GPs should bear in mind that paternity testing is not a routine investigation, says the MDU's Dr Jacqui Phillips.

GPs may be asked for information about paternity tests (Photograph: SPL)
GPs may be asked for information about paternity tests (Photograph: SPL)

Members of the public are now able to buy paternity testing kits OTC from a high street chemist. A helpline is available for discussion about suitability for testing, but the increased accessibility of testing may also lead to a corresponding rise in the number of patients seeking advice and counselling about paternity testing from their GP, or even requesting that the GP arrange the test.

We are occasionally contacted by GP members who have been approached by patients requesting paternity testing. Members are concerned whether those affected have really thought through the implications and impact of the test results. GPs also question whether performing such a test falls within their area of expertise.

GPs in this position should bear in mind that paternity testing is not a routine investigation and therefore the practice would not be compelled to carry out a test, particularly if none of the doctors has any previous experience of counselling, performing the test or interpreting the results.

In such circumstances it may be better to suggest that patients seek the test elsewhere, such as privately, unless the test is medically indicated, in which case it would ordinarily be performed by a clinical geneticist.

If you are approached by a patient for further information about paternity testing or have been asked to perform a test, you need to make a decision about whether you have the necessary competence to do so. Guidance is available from the Human Genetics Commission in its document A common framework of principles for direct-to-consumer genetic testing services. This provides helpful information about what should be considered and the importance of counselling before a paternity test is performed.

MDU advice
In deciding whether you are competent to offer paternity testing to patients, you may wish to bear in mind the following advice. Even though in most cases it may not be appropriate for you to carry out a paternity test, you may still be asked by patients for information about what a test involves and this advice may also help you in your discussion with the patient.

  • Counselling needs to include discussion about why the test has been requested and the implications of receiving the result for family relationships.

Information must be clear and unambiguous and should raise the possibility that the results may have a profound effect, with possible lifetime implications, for those involved.

  • Consent is required from the person concerned before a sample of blood, saliva or hair is taken for analysis for paternity testing. In England, Wales and Northern Ireland there is a statutory obligation to obtain consent under the Human Tissue Act 2004. The GMC also says patient consent should be obtained.
  • An adult with parental responsibility may authorise the test on behalf of their child. However, where a young person is capable of understanding the issues, their views should be taken into account when deciding whether testing would be in their best interests. A mature minor who is deemed to be competent may consent to testing in their own right.
  • If a court directs a paternity test, the clerk of the court will have a list of approved testers. The laboratories analysing the buccal swabs available OTC are accredited by the Ministry of Justice to carry out tests for England and Wales but where tests are obtained OTC, evidence from these tests cannot be used in a court of law.
  • It is important that the best interests of the child are considered at all times and that everyone involved understands what the test means. If after discussion, a mature minor withholds consent for paternity testing, it may not be in that person's best interests to proceed, regardless of the views of the adults involved.

References
1. McVeigh T. Unease at Boots decision to sell paternity test kits over the counter. The Guardian, 6 February 2011. www.guardian.co.uk/lifeandstyle/2011/feb/06/paternity-test-kit-boots

2. Human Genetics Commission. A common framework of principles for direct-to-consumer genetic testing services. Human Genetics Commission, August 2010. www.hgc.gov.uk/Client/Content.asp?ContentId=816

3. Human Tissue Act 2004. www.legislation.gov.uk/ukpga/2004/30/contents

4. GMC. Consent: patients and doctors making decisions together. GMC 2008.

5. GMC. 0-18 years: guidance for all doctors. GMC 2007, paragraph 24.

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