Genetic counseling: Clinical and ethical challenges

After explaining the origin, nature, and goals of genetic counseling, we co nsider the impact of the Human Genome Project on its practice. In light of the availability of presymptomatic tests for late-onset disorders and the p ossibility of preventive behavior or treatment, we examine the apparent con flict between nondirectiveness and directiveness in genetic counseling. We discuss views of genetic counselors, medical geneticists, and counselees on specific issues, and document gender differences in attitudes toward genet ic ties to offspring. Because genetic discrimination and unequal access to genetic services are likely to increase with advances in genetics, we concl ude that efforts of genetic counselors to adhere to the principle of justic e or equity in their practice cannot be successful without governmental and public support, as well as support from researchers and colleagues in heal th care.