Genetic counseling is often described as non-directive, meaning that clients are helped to make personal decisions without undue influence by the counselor. This practice principle emerged from reproductive genetic counseling where couples face decisions about having children or continuing an affected pregnancy. It remains an important ethical principle for guiding clients through their reproductive choices. Clients are helped to make personally relevant and informed choices for themselves. Nonetheless non-directiveness is difficult to achieve since counselors have personal and professional biases and experiences that may be inadvertently expressed in how information is presented or emphasized in genetic counseling. While counselors may not intend to guide client decisions, it is reasonable to assume that genetic counseling influences them. Yet the majority of clients are capable of making their own decisions and can benefit from prenatal counseling by exploring their own beliefs, attitudes, and values related to their ability to parent a child affected with a particular condition. Genetic counseling that is client-centered focuses on meeting the needs of clients by working within the context of their sociocultural beliefs and lived experience. Even if a genetic counselor explicitly expresses her own beliefs during reproductive counseling, it is unlikely that a client will simply adopt them. However there are situations where conflicts in promoting personal reproductive choice do exist.
When a prenatal genetic counselor is employed by a commercial laboratory or prenatal testing center, there is more likely to be a potential conflict of interest. If the testing center promotes prenatal tests rather than promoting the choice of testing, then the counseling may emphasize the benefits of testing over the risks. There might be more frequent assumptions on behalf of the counselor that if the client was referred for prenatal testing, that the client is going to undergo testing rather than insuring that each client makes an informed and personal decision whether or not to undergo optional prenatal tests. Further, if the counselor's salary depends upon a certain number of tests being conducted, there is likely to be an even greater chance for persuasive prenatal genetic counseling.
In genetic counseling settings other than reproductive, non-directiveness has little relevance. In the common disease setting, for instance, making screening recommendations to promote health intends to be directive. Applying the notion of non-directiveness to genetic counseling in general has lead to a great deal of confusion in the literature (Kessler). In addition to directive health-related recommendations, communication in genetic counseling is often directive. Offering advice or making referrals may be also be construed as directive. The adoption of non-directiveness as a central tenet of genetic counseling has limited the use of (directive) therapeutic interventions that may be helpful to clients. Genetic counseling may be practiced in a more hesitant manner if counselors fear directing their clients' decisions when fully engaging with them may be more productive. Issues related to non-directiveness continue to be actively debated in the professional literature.
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