A case history from King Abdullah International Medical Research Centre, in Riyadh, Saudi Arabia, about telling the truth.

Should doctors always tell the truth? An article in the Journal of Bioethical Inquiry points out that there needs to be some wriggle room. The authors discuss a case history from King Abdullah International Medical Research Centre, in Riyadh, Saudi Arabia.

A husband and wife from a remote settlement brought their cherished but severely disabled daughter for genetic testing. The father was convinced that he had passed on a defective gene and wanted to know whether they could risk having another child.

In the course of testing, the researchers discovered that this was a case of misattributed paternity: the girl was not the daughter of the husband. Presumably she was the offspring of an extramarital affair.

The ethical dilemma facing the researchers was whether to inform the husband. The informed consent forms, strictly speaking, obliged the researchers to disclose all information to the parents.

However, the consequences of disclosure would be devastating. In Saudi society, adultery is a serious breach of honour. Inevitably there would be a divorce and the wife would be stigmatised and ostracised. In extreme cases the stain is expunged by the murder of the wife. And it is not only the woman who suffers. Unless the husband’s honour is avenged, he, all of his family and all of his wife’s family will be regarded with contempt.

Some (presumably Saudi) ethicists would nonetheless argue for disclosure. They believe that the husband has sacrificed himself unnecessarily and that withholding the information would be “rewarding the infidel.

However, the authors argue that in fact Islamic jurisprudence would favour non-disclosure. The unity of the family is paramount in Islam and disclosure would risk the life of mother and welfare of the child. The hospital ethics committee felt that:

“In this case the virtue of telling the truth may have the lowest priority due to the nature of the information, which may not only impact on a large number of people outside the case but also pose a threat to life… while the father’s autonomy had been compromised, the vulnerability and danger posed to both mother and child outweighed the father’s right to know.”

Michael Cook
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genetic testing
misattributed paternity
privacy
Saudi Arabia

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