Sir

Given the extent of current research into both genetics and mental disorders, the Nuffield Council on Bioethics has undertaken an inquiry into issues raised when these fields come together. The report, ‘Mental disorders and genetics: the ethical context’1, published on 23 September, is primarily concerned with whole persons and not simply with their genes. This broad and humanistic perspective may be contrasted with a reductionist approach which risks undermining both moral responsibility and social solidarity. Genetic information about mental disorders may alter the way those affected are viewed by others and in particular, the stigma they suffer.

The discovery of mutations associated with the ‘traditional’ Mendelian single gene disorders has had profound implications for clinical diagnosis and predictive testing. However, the Nuffield inquiry concluded that genetic tests for the diagnosis of the common mental disorders with more complex causes will not be particularly useful in the near future. Even if a number of susceptibility genes were identified for a particular disorder, the Nuffield Council takes the view that, without an understanding of their interaction, they would not be adequate for predicting individual risk in a clinical setting. It has therefore recommended that genetic testing for susceptibility genes which offer relatively low predictive or diagnostic certainty be discouraged unless and until there is clear medical benefit to the patient.

The Nuffield Council would construe as unethical the exclusion of people with a mental disorder from genetic research, as the identification of associated genes may lead to more effective drug treatments. The view is taken therefore that non-therapeutic research should be considered ethically acceptable even when it involves people lacking the capacity to consent to participation, subject to strict safeguards. While the best safeguard against new eugenic pressures is freely given, properly informed consent, guidelines for the establishment and maintenance of genetic registers are needed.