"Respect for autonomy" in genetic counseling: An analysis and a proposal

Abstract

Respect for autonomy in genetic counseling is generally understood as a negative right: as clients' right to noninterference in decision-making. In order to promote client autonomy, genetic counseling is nondirective, an approach that minimizes risks of counselor influence in the decision-making process. But by minimizing counselor involvement, nondirective counseling may permit clients to make decisions that are partially informed or poorly reasoned. Alternatively, clients may be better served if autonomy is construed as a positive right: as clients' right to a maximally enhanced decision-making process. This interpretation of autonomy suggests a counseling approach in which the deliberative process is central and takes place through dialogue. Dialogical counseling remains nonprescriptive but holds counselors responsible for ensuring that decisions are thoroughly and carefully considered. The goal is a good decision, defined as one in which clients' values and goals, identified through the deliberative approaches of authenticity, effective deliberation, and moral reflection, are in equilibrium. By this means, counselors may more reliably meet clients' needs while simultaneously demonstrating a limited degree of professional accountability. © 1997 National Society of Genetic Counselors, Inc.