this may be seen to violate existing ethical norms regarding the patient’s autonomy and “right not to know” genetic risk information. However, in selecting a minimal list that is weighted toward conditions where prevalence may be high and intervention may be possible, we felt that clinicians and laboratory personnel have a fiduciary duty to prevent harm by warning patients and their families about certain incidental findings and that this principle supersedes concerns about autonomy, just as it does in the reporting of incidental findings elsewhere in medical practice. The Working Group therefore recommended that whenever clinical sequencing is ordered, the ordering clinician should discuss with the patient the possibility of incidental findings, and that laboratories seek and report findings from the list described in the Table without reference to patient preferences. Patients have the right to decline clinical sequencing if they judge the risks of possible discovery of incidental findings to outweigh the benefits of testing.
