Misattributed paternity refers to a situation in which a child's presumed father is not the biological father. There exists a persistent myth that in approximately 10 per cent of cases, the children of long-term relationships or marriages are not those of the putative father. This notion has taken on the status of what US sociologist Robert Merton terms a pseudofact, and continues to be quoted authoritatively, often by professionals who ought to know better (including, in the past, me).
The Australian sociologist Michael Gilding has undertaken intensive research to try to ascertain the origins of the myth and to gauge the actual incidence of misattributed paternity from the study of a range of sources of relevant information. With regard to the origins of high estimates (10 to 30 per cent), these appear to relate to discussions at a symposium and some unpublished data from many years back that were picked up by the media and essentially “took legs”.
Sources of information consulted by Gilding include medical records, surveys of sexual behaviour, DNA testing and genetic studies. Overall, the incidence of misattributed paternity varies between 1 and 3 per cent.
Gilding states that since the advent of DNA analysis, not one medical study in a Western country indicates a non-paternity rate of more than three per cent. In contrast to many earlier methods, DNA analysis is accurate to about 99.99 per cent.
Data from surveys of sexual behaviour that examined the number of sexual partners women had in the previous year, suggest that within marriage and among couples who are in long-term relationships, this number is low and well below 10 per cent (most were below 5 per cent).
Gilding argues that there are three groups who have contributed to the myth of rampant misattributed paternity. These are: fathers’ rights activists, who believe that paternity fraud is a major problem; DNA paternity testing labs, who have a vested interest in seeking clients; and sociobiologists and evolutionary psychologists who have provided “explanations” for inflated non-paternity rates.
For families who are faced with the issue of misattributed paternity, the consequences can be extremely serious and distressing. A paper published online in February in the Journal of Medical Ethics (JME) considers the challenges facing healthcare professionals in providing genetic counselling where misattributed paternity may arise as an incidental finding.
The article considers the law in relation to information provision to patients in Italy and Britain. Guidelines appear clearer in Italy, while in the UK there is greater uncertainty as healthcare workers are dependent on professional good standards of practice that are poorly defined. The pros and cons of the two systems are discussed.
Genetic counselling aims to promote client autonomy, help clients make informed decisions, and maintain client confidentiality. However, it is obvious that conflicts may arise with regard to the confidentiality issue if, for example, a woman who has been tested does not want the information given to her husband. Questions as to who the client is, what information to give and to whom are complex, and point to the need for all healthcare professionals involved in counselling to have training in bioethics.
The authors of the article in the JME suggest a number of guidelines that might be followed where there is the possibility of discovering misattributed paternity during genetic testing.
However, there are no easy answers in bioethics, and the principle of patient autonomy must remain a priority. Maximum information to competent clients prior to treatment will maximise control over decision making.
In cases of conflict, where information is wanted by one partner and not the other, discussion and negotiation with the concerned parties seems the only feasible route.
There is a desire among health care professionals for clearer guidelines in these kinds of areas, but it is difficult and probably inappropriate to be too prescriptive in this domain. A better route, which the above authors also suggest, would be to engage healthcare staff in appropriate training to help them develop skills in ethical thinking and decision making.
Paul O'Donoghue is a clinical psychologist and founder member of the Irish Skeptics Society