Ethics, Legal, and Psychosocial Issues
Ethical principles in practice
Autonomy, beneficence, nonmaleficence, and justice frame genetic counselling dilemmas. Key concepts include informed consent, confidentiality, privacy, duty to warn versus confidentiality, genetic discrimination protections, and the right not to know. Minors raise special questions: predictive testing for adult-onset conditions is generally deferred until the person can decide, while diagnostic testing for childhood-onset conditions may be appropriate.
Legal and policy awareness
Know the broad shape of genetic nondiscrimination protections in your jurisdiction, including limits (for example, coverage that may not extend to all insurance types). Know that insurance and employment protections differ, and that legal details vary by country. Questions often test whether a counsellor may disclose results to relatives without consent, and the answer is generally no, though the counsellor can support the client in sharing information.
Psychosocial assessment
Screen for guilt, anxiety, family conflict, reproductive concerns, and impact on relationships. Refer to social work, psychology, or support groups when distress is significant. Consider cultural and religious values, and avoid imposing the counsellor's own preferences.
Traps
Common errors: prioritizing relatives' interests over the client's confidentiality without a legal basis; assuming adolescents lack capacity; disclosing to a partner without the client's permission; and treating a request for predictive testing as automatically appropriate.
Rule of thumb
When autonomy and family benefit conflict, default to the client's confidentiality and explore voluntary disclosure. Example: a client with a BRCA variant refuses to tell her sister. The counsellor respects the choice, offers to help with a family letter, and does not contact the sister.