Genetic counseling is viewed as a therapeutic interrelationship between genetic counselors and their clients. In a previous relational ethics research project, various themes were identified as key components of relational ethics practice grounded in everyday health situations. In this article the relational ethics approach is further explored in the context of genetic counseling to enhance our understanding of how the counselor-client relationship is contextually developed and maintained. Qualitative interviews were conducted with six adult clients undergoing genetic counseling for predictive testing. Engagement, dialogue and presence were revealed as relevant to genetic counselor-client relationships. A relational ethics approach in genetic counseling challenges the concept of nondirectiveness and may enhance the outcome of counseling for both counselor and client.
Carper BA.Fundamental patterns of knowing in nursing . ANS Adv Nurs Sci1978; 1(1): 13-23 .
2.
Bergum V , Dossetor J.Relational ethics: the full meaning of respect. Hagerstown, MD: University Publishing , 2004 (in press).
3.
van Zuuren F , van Schie E , van Baaren N.Uncertainty in the information provided during genetic counseling . J Patient Educ Counsel1997; 32: 129-139 .
4.
Terrell-White M.Decision-making through dialogue: reconfiguring autonomy in genetic counseling . Theor Med Bioethics1998; 19: 5-19 .
5.
van Zuuren F.The standard of neutrality during genetic counseling: an empirical investigation . J Patient Educ Counsel1997; 32: 69-79 .
6.
Watson M , Duvivier V , Wade-Walsh Met al.Family history of breast cancer: what do women understand and recall about their genetic risk ? J Med Genet1998; 35: 731-738 .
7.
Rona RJ , Beech R , Mandalia Set al.The influence of genetic counseling in the era of DNA testing on knowledge, reproductive intentions and psychological well being . Clin Genet1994; 46: 198-204 .
8.
Bishop A , Scudder J.Nursing ethics: therapeutic caring presence. Boston, MA: Jones & Bartlett , 1996.
9.
Michie S , McDonald V , Marteau TM.Genetic counseling: information given, recall and satisfaction . Patient Educ Counsel1997; 32: 101-106 .
10.
Gadow S.Relational narrative: the postmodern turn in nursing ethics . Sch Inquiry Nurs Pract1999; 13: 57-70 .
11.
Gadow S.Relational ethics: mutual construction of practical knowledge between nurse and client . Proceedings of philosophy in the nurse’s world: practical knowledge for nursing; 1995 May 15; Banff, AB, Canada.
12.
van Hooft S.Kuhse on caring . Nurs Inquiry1999; 6: 112-122 .
13.
Gadow S.Basis for nursing ethics: paternalism, consumerism, or advocacy ? Hosp Prog1983; 64(10): 62-67, 78-78 .
14.
Brock S.Narrative and medical genetics: on ethics and therapeutics . Qualitat Health Res1995; 5: 150-168 .
15.
Wolff G , Jung C.Nondirectiveness and genetic counseling . J Genet Counsel1995; 4: 3-25 .
16.
Bowles-Biesecker B.Future directions in genetic counseling: practical and ethical considerations . Kennedy Inst Ethics J1998; 8: 145-160 .
17.
Bernhardt B.Empirical evidence that genetic counseling is directive: where do we go from here ? Am J Med Genet1997; 60: 17-20 .
18.
Murray TH.The worth of a child. Berkeley, CA: University of California Press , 1996.
19.
Burke M , Kolker A.Directiveness in prenatal genetic counseling . Women Health1994; 22(2): 31-53 .
20.
Suter S.Value neutrality and nondirectiveness: comments on future directions in genetic counseling . Kennedy Inst Ethics J1999; 8: 161-163 .
21.
Brunger F , Lippman A.Resistance and adherence to the norms of genetic counseling . J Genet Counsel1995; 4: 151-167 .
22.
Anderson G.Nondirectiveness in prenatal genetics: patients read between the lines . Nurs Ethics1999; 6: 126-136 .
23.
d’Agincourt-Canning L.Genetic testing for hereditary cancer: support for a relational view of autonomy . Proceedings of the 11th Annual Canadian Bioethics Society Conference; 1999 Oct 28-31; Edmonton, Alberta, Canada.
24.
Sherwin S.A relational approach to autonomy in health care. In: Sherwin S ed. The politics of women’s health: exploring agency and autonomy. Philadelphia, PA: Temple University Press , 1998: 19-47.
25.
Boykin A.Nursing as caring through the reflective lens. In: Johns C , Freshwater D eds. Transforming nursing through reflective practice. London: Blackwell Science , 1998: 43-50.
26.
Bergum V.Knowledge for ethical care . Nurs Ethics1994; 1: 71-79 .
27.
Niebuhr HR.The responsible self. San Francisco, CA: Harper San Francisco , 1963.
28.
Chadwick RF.What counts as success in genetic counselling ? J Med Ethics1993; 19: 43-46 .
29.
Brunger F , Lippmann A.Resistance and adherence to the norms of genetic counseling . J Genet Counsel1995; 4: 151-167 .
30.
Terrell-White M.Making responsible decisions: an interpretive ethic for genetic decision making . Hastings Cent Rep1999; 29(1): 14-21 .
31.
Pierson W.Considering the nature of intersubjectivity within professional nursing . J Adv Nurs1999; 30: 294-302 .
32.
Aranda S , Street A.Being authentic and being a chameleon: nurse-patient interaction revisited . Nurs Inquiry1999; 6(2): 75-82 .
33.
Bandman E , Bandman B.Nursing ethics through the life span. Stamford, CT: Appleton & Lange , 1995.
34.
Lebacqz K.Humility in health care . J Med Philos1992; 17: 291-307 .
35.
Keiser R.Roots of relational ethics: responsibility in origin and maturity. Atlanta, GA: Scholar’s Press , 1996.
Downie R , Jodalen H.I-Thou and doctor-patient relationship examined. In: Jodalen H , Vetlesen A eds. Closeness: an ethics. Oslo: Scandinavian University Press , 1977: 129-141.
38.
Fredriksson L.Modes of relating in a caring conversation: a research synthesis on presence, touch and listening . J Adv Nurs1999; 30: 1167-1176 .
