Case X
The Case of My Daughter Should Be Tested
Assignment – Assume you are a judge that must decide the case below. Read the case carefully and write your decision based on the facts. It should be 1-2 pages, double-spaced and typed. It does not matter what you decide, rather, it is the arguments you make that support your opinion.
The Facts
Joe Smith is suing his ex-wife Jean Barnes-Smith for “failing to take adequate measures to protect their 13 year old daughter, Mary, from breast cancer.” Mrs. Barnes-Smith has decided not to have Mary tested for the mutant allele of the BRCA1 gene which is shown to have an 85% correlation with breast cancer in women who are homozygous for that allele. Mr. and Mrs. Barnes-Smith were divorced in 2017, and have shared custody of the child. Mary lives with her mother on a permanent basis, but Mr. Smith has rights to have Mary in his custody on the weekends. Two months after the divorce, Mrs. Barnes-Smith was diagnosed with breast cancer. Both of her grandmothers died of breast cancer, as did one of her sisters three years ago. Mr. Smith was tested for the presence of the mutant allele of the BRCA1 gene, and he was found to carry one copy of the mutant allele. Mrs. Barnes-Smith has not been tested, and chooses to subject neither herself nor her 13 year-old daughter to this knowledge when there is presently no known preventive measure other than a bilateral mastectomy.
The Argument in Favor of Mr. Smith
Mr. Smith strongly believes that Mary and her physician should have every bit of knowledge available at this stage in her physical and psychological development in order to educate her about the likelihood of contracting cancer and to be ready to make future decisions about screening and treatment options. Mr. Smith argues that Mrs. Barnes-Smith is projecting her own unresolved fear and guilt about the disease onto Mary’s situation, when there is a chance that neither of the women are homozygous for the mutant allele. The health and welfare of the child should not be hampered by the anger and fear of the mother, however painful it might be. Mary may be psychologically hampered during these critical years of emotional development by the ambiguity that would result by not testing. How would you like to grow up knowing that many women in your extended family have died from breast cancer, and knowing that there is a test that could help elucidate the situation? Mary should be tested now so that she can be properly educated during these instrumental years of her young adult life, and so that proper decisions can be made for her health as medical science progresses in the years ahead.
The Argument Against Mr. Smith
Mary is only thirteen years old. The test for the presence of two mutant alleles of the BRCA1 gene would not give absolutely conclusive evidence. Even if she was not homozygous for the mutant BRCA1 allele, Mary would still have the same chance of all US women (1 in 9, or 11%) of contracting breast cancer during her lifetime. If she was homozygous, she would indeed have an 85% chance of contracting breast cancer, but this means there is also a 15% chance that she would not. What are we going to do if she is homozygous for the mutant allele? The only known alternative for 100% prevention is a bilateral mastectomy. How do we explain all of this to a 13 year old girl? Knowledge is not always good if there is no plausible use for the information. Mary should be allowed to grow up like all of her friends, and not have to worry about this medical information right in the middle of puberty. Mary should be allowed to make her own decision about testing after she is 18 years old.
The Question
As the custodial judge hearing this case, you must decide whether the judge should order Mrs. Barnes-Smith to allow Mr. Smith to take Mary to a doctor to have her tested for the mutant BRCA1 alleles.