DECISION-MAKING THROUGH DIALOGUE - RECONFIGURING AUTONOMY IN GENETIC-COUNSELING

Nondirective genetic counseling developed as a means of promoting info rmed and independent decision-making. To the extent that it minimizes risks of coercion, this counseling approach effectively respects clien t autonomy. However, it also permits clients to make partially informe d, poorly reasoned or ethically questionable choices, and denies couns elors a means of demonstrating accountability for the use of their ser vices. These practical and ethical tensions result from an excessive f ocus on noncoercion while neglecting the contribution of adequate info rmation and deliberative competence to autonomous decision-making. A c ounseling approach that emphasizes the role of deliberation may more r eliably produce thoroughly reasoned decisions. In such an approach, ch aracterized by dialogue, counselors are responsible for ensuring that decisions are fully informed and carefully deliberated. Counseling rem ains nonprescriptive, but in the course of discussion counselors may i ntroduce unsolicited information and/or challenge what they believe ar e questionable choices. By this means clients can be better assured th at the decisions they make are fully considered, while counselors demo nstrate a limited degree of professional accountability.