Under what circumstances is predictive genetic testing in children generally considered ethically appropriate?

• A. When results will influence medical management during childhood or there is a clear, actionable intervention during childhood.
• B. When there is a clear, actionable intervention during adulthood.
• C. When results will influence medical management during childhood or there is a clear, actionable intervention during childhood.
• D. When the patient or family requests testing regardless of impact.

Answer: (D)

Predictive genetic testing in children is typically acceptable only when the results will directly influence medical management during childhood or when there is a clear, actionable intervention available in childhood that can prevent or mitigate harm. This reflects a balance between beneficence and the child’s future autonomy: if knowing the result changes how a child is cared for now, it provides a real medical benefit. If there’s no childhood-based action or treatment, testing is generally deferred until the individual can decide for themselves as an adult, to preserve their future autonomy. A family request alone, without potential benefit to the child during childhood, does not by itself justify testing because it can add psychological burden and potential harms without immediate medical advantage.