Forzano eshg workshop2010

Genetic variants as extenuatingcircumstance: a controversiallegal proceeding in Italy

European Human Genetic Conference 2010WS10: Legal regulation for genetic testing

Francesca Forzano,

Pascal Borry, Anne Cambon-Thomsen, Shirley V Hodgson,

Aad Tibben, Petrus de Vries, Carla van El and Martina Cornel

THE CASE

� Crime: murder of Mr Novoa Perez Walter Felipe, stabbed to death

� Convicted man, Mr Bayout Abdelmalek : adult male affectedby schizophrenia, actively psychotic at the time of the crime, having discontinued his psychotropic medication againstmedical advice

� Facts: the two men taunted each other, wrangled over. Bayout went home, bought a knife, found Novoa Perez againand admitted to stabbing and killing him.

� First level of judgement: guilty, acted with premeditation, but reduced sentence (9 years) owing to his mental illness

F. Forzano, E.O. Ospedali Galliera, GenovaEuropean Human Genetic Conference 2010 - WS10: Legal regulation for genetic testing

APPEAL COURT

new expert assessment required, testing for the followinggenetic variants

� 5HTTLPR – allele Long/Short of the promoter of the gene coding for Serotonin Transporter (SCL6A4) (Heils et al, 1996)

� STin2 – VNTR in intron 2 of the gene coding for Serotonin Transporter (SCL6A4) (Ogilvie et al, 1996)

� Rs4680 – SNP change G/A in exon 4 of the gene coding for Catechol-O-Methyltransferase (COMT) (dbSNP database http://www.ncbi.nlm.nih.gov/SNP/snp_ref.cgi?rs=4680)

� MAOA-uVNTR – VNTR wthin the promoter of the gene coding for Monoamine Oxidase A (MAOA) (Sabol et al, 1998)

� DRD4-1/7 - VNTR in exon 3 of the gene coding for dopaminergicreceptor D4 (Lichter et al, 1993)


MAOA

� Han Brunner, 1993: inactive variant of MAOA associated with a Dutch family with antisocial behaviour

� Rod Lea, 2006: MAOA-L in 17/46 Maori men > MAOA-L as “the warrior gene”

� MAOA and MAOA-L activity greatly influencedby environment, habits (eg smoking), othergenes, different relevance in different ethnicgroup


Experts opinion

“…The points above-mentioned concern the late causal factors. There are also remote causal factors which, even if not decisive on the formulation of our opinion, since they are not neuralgic in the juridically relevant concept of material causality, might have a role in the comprehensive evaluation of the case. These remote causal factors (vulnerability factors) are of genetic and psychosocial nature. Considering the genetic factors, the analysis shows that Mr Bayout Abdelmalek carries, for each of the examined polymorphisms, one if not both the alleles which, accordingly to many international studies reported in literature, are linked with a significant increase of the risk of aggressive behaviour and impulsive behaviour (socially not acceptable) besides other forms of psychopathology…..”


APPEAL COURT

� Judgement: guilty, but reduced sentence owing to his mentalillness

� The judge based his sentence on the fact that the accusedwas affected by a mental disorder and that,because of the mental disorder, he was not fully capable of understandingthe seriousness of his actions

� The judge, however, further reduced the sentence from 9 to8 years, based on the fact that the accused had testedpositive for genetic variants that would make him particularlyprone to be aggressive under stressful circumstances and therefore he would be even more vulnerable because of that


This is the first time thatbehavioural genetics hasaffected a sentence in a

European court


susceptibility testing in the context of the legal proceedings…

a questionable issue

an individual should be judged on the basis of evidence-based informationand not on the basis of probability

interpretation


SCIENTIFIC EVIDENCEIS WEAK

The possibility of using genetic variants to evaluate the actual mentalcapacity of a person at a given time is far from being established

Genetic variants associated with schizophrenia do not add to the evaluation of the phenotype itself

The vast majority of these tests, if not all, are still purely research-basedand have not received any formal evaluation in terms of clinical validity and utility

In our opinion, no susceptibility test should as yet be used in forensic or other judicial settings

The use of genetic tests in forensic contexts should be restrictedto tests with proven clinical utility for the diagnosis of a disease relevant to the case judged


LEGAL RESPONSIBILITY

We conclude that, with regard to the sentencing of

convicted offenders, the criminal law should be receptive to

whatever valid psychiatric and behavioural evidence is

available. The taking into account of genetic factors would

depend on the degree to which such evidence is convincing

and relevant. Credible evidence of influence and a robust

test for the genetic factor in question would be essential:

the weight to be accorded to such information would be

determined by the judge.

Currently, environmental, social and psychiatric assessments may

be taken into account by judges in determining appropriate

sentences. These must also be supported by valid, accurate and

reliable evidence. It would be unwise to assume that genetics will

not be able to assist in determining degrees of blame, even if the

‘all-or-nothing’ question of responsibility is not affected by genetic

factors themselves. Such a role would not compromise basic

assumptions as to responsibility.


Chapter 14:


..remarks..

There is a danger in using words that attribute tobiology roles related to responsibility.

The case discussed above may also underline the importance of the words used by professionals to

designate the effects of genes.

When a judge is looking for responsibility and whengeneticists themselves express the effect of genes in

terms of responsibility, some confusion can beexpected.


The Italian Society of Human Genetics(SIGU) reaction

The Society discourages the use of suchtesting in legal proceedings

Currently trying to elicit collaborationfrom Superior Council of the Judiciary

(Consiglio Superiore della Magistratura, CSM)


Prof Steve Jones, University College Londonfrom Nature

“ does a genetic predisposition everdiminish an individual's responsibilityfor their behaviour? 90% of allmurders are committed by people with a Y chromosome - males. Should we always give males a shorter sentence? “


Francesca ForzanoPascal BorryAnne Cambon-ThomsenShirley V HodgsonAad TibbenPetrus de VriesCarla van ElMartina Cornel

Public and Professional Policy Committee (PPPC) of the ESHGMembers in 2009–2010 :

F. Forzano, E.O. Ospedali Galliera, Genova

Martina Cornel Chair, Amsterdam, The NetherlandsNurten Akarsu Ankara, TurkeyPascal Borry Leuven, BelgiumAnne Cambon-Thomsen Toulouse, FranceThoas Fioretos Lund, SwedenFrancesca Forzano Genoa, ItalyShirley Hodgson London, UKGyorgy Kosztolany Pe´cs, Hungary

Ulf Kristoffersson Lund, Sweden

Jan Lubinski Szczecin, PolandChristine Patch London, UKJorge Sequeiros Porto, PortugalAad Tibben Leiden, The NetherlandsLisbeth Tranebjaerg Copenhagen, DenmarkVeronica van Heyningen Edinburgh, UK

European Human Genetic Conference 2010 - WS10: Legal regulation for genetic testing

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Forzano eshg workshop2010