Genetics and the interpersonal elaboration of ethics

Confidentiality in genetic testing poses important ethical challenges to th e current primacy of respect for autonomy and patient choice in health care . It also presents a challenge to approaches to decision-making emphasising the ethical importance of the consequences of health care decisions. In th is paper a case is described in which respect for confidentiality calls bot h for disclosure and non-disclosure, and in which respect for patient auton omy and the demand to avoid causing harm each appear to call both for testi ng without consent, and testing only with consent. This creates problems no t only for clinicians, families and patients, but also for those who propos e clinical bioethics as a tool for the resolution of such dilemmas. In this paper I propose some practical ways in which ethical issues in clinical ge netics and elsewhere, might be addressed. In particular I call for a closer relationship between ethics and communication in health care decision-maki ng and describe an approach to the ethics consultation that places particul ar emphasis on the value of interpersonal deliberation in the search for mo ral understanding. I reach these conclusions through an analysis of the con cept of `moral development' in which I argue that the achievement of moral understanding is a necessarily intersubjective project elaborated by moral persons.