See "As his general practitioner, you referred Andrew, a 23-year-old man, to the local psychiatrist because of gradual onset of paranoid ideation. From the hospital correspondence, you gather that the psychiatrist detected dysarthria and abnormal involuntary movements and asked for a neurologist's opinion. The neurologist diagnosed Wilson's disease (hepatolenticular degeneration), and Andrew began chelation therapy under the care of a specialist.
You know Andrew's background reasonably well because you are the general practitioner for his 21-year-old brother, Martin, and his 20-year-old sister, Alison. Their father died many years ago in a traffic accident, and their mother died of breast cancer 2 years ago. Andrew lived with Martin and Alison until last year when he moved out to live with his girlfriend, in part because of his increasing mistrust of Martin and Alison.
Because the inheritance of Wilson's disease is autosomal recessive, both Martin and Alison have a 1-in-4 risk of having the disease. The disease is treatable in the presymptomatic stage, and you are anxious to ensure that Martin and Alison receive appropriate counseling and testing. You learn from Andrew, however, that Martin and Alison have not received such counseling. Indeed, when the staff at the specialty clinic asked Andrew whether he had any siblings, he replied that he had none. Although you explain to Andrew the importance of Martin and Alison receiving early counseling and testing, Andrew is clear that he does not want anyone to inform them about his diagnosis. He seems to understand the potential consequences of his refusal to inform Martin and Alison.
Under these circumstances, you have 3 options: to inform Martin and Alison about Andrew's recent diagnosis and refer them for appropriate counseling and testing; to take a blood specimen from Martin and Alison to test the serum ferroxidase activity (a screening test for Wilson's disease) without informing them of the reason; or to take no action.