The article reviews ethical and legal hurdles of integrating pharmacogenetic testing into personalized medicine. The aim of this publication was to systematize key ethical problems in clinical pharmacogenetics and find possible solutions in Russian legislation. It was an analytical review study that used a systematic analysis of scientific literature combined with comparative legal analysis of national/foreign regulations. The risks of confidentiality violations and unauthorized reuse of genetic data, difficulties in obtaining informed consent and interpreting incidental findings, and a threat of genetic discrimination from employers and insurance companies are reviewed. It has been shown that a high cost of genetic tests increases the inequality of access to medical technologies and highlights major social injustice issues. It is concluded that clarifying the legal status of genetic data, developing special mechanisms to protect patients from stigmatization and discrimination, and introducing educational programs on pharmacogenetics and genetic counseling for medical professionals are essential.