Genetic counseling is fairly new. The fact that the field is an accepted professional enterprise in universities, clinics, and hospitals throughout the United States is remarkable. The contributors argue that genetics and medicine rest on beliefs widely held in American society. Scientific progress is good, and highly sophisticated technologies are appropriate means to solving medical problems. The better understanding they gain about the nature and evolution of disease, the more prepared clinicians will be to treat and prevent future occurrence of disease. A belief that medicine, including genetic medicine, is clear, factually based, and objective undergirds the strategies and norms of genetic counseling. This collection of original papers explores the history, values, and norms of that process, with focus on the value of non-directiveness in counseling practice. The contributors' examination of genetic counseling issues serves as a foundation from which to address the ethical, legal, and policy considerations of clinical genetics.

Dianne M. Bartels is associate director of the Center for Bioethics and assistant professor of medicine and bioethics at the University of Minnesota. She is the author or co-author of numerous books, including Beyond Baby M, Facilitating the Genetic Counseling Process, and Genetic Counseling Practice.

Bonnie S. LeRoy is director of the graduate program in genetic counseling and professor of genetics, cell biology, and development at the University of Minnesota. Her major area of research interest involves ethical and social challenges associated with genetic counseling.

Arthur L. Caplan is Emanuel and Robert Hart Professor of Bioethics at the University of Pennsylvania. His work has appeared in numerous publications, including Th e American Journal of Bioethics, Addiction, and Lancet.

Genetic counseling is fairly new. The fact that the field is an accepted professional enterprise in universities, clinics, and hospitals throughout the United States is remarkable. The contributors argue that genetics and medicine rest on beliefs widely held in American society. Scientific progress is good, and highly sophisticated technologies are appropriate means to solving medical problems. The better understanding they gain about the nature and evolution of disease, the more prepared clinicians will be to treat and prevent future occurrence of disease. A belief that medicine, including genetic medicine, is clear, factually based, and objective undergirds the strategies and norms of genetic counseling. This collection of original papers explores the history, values, and norms of that process, with focus on the value of non-directiveness in counseling practice. The contributors' examination of genetic counseling issues serves as a foundation from which to address the ethical, legal, and policy considerations of clinical genetics.

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ ation. Medical technology has not overwhelmed our moral ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil ization, embryo transfer, artificial insemination, or fertil ity drugs. Nor is it entirely accurate to describe assisted repro duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip ment. Yet, most of the methods used to assist reproduc tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin."

The first advanced-level genetics counseling skills resource

As genetic medicine and testing continue to expand, so the role of the genetic counselor is transforming and evolving. "Genetic Counseling Practice: Advanced Concepts and Skills" is the first text to address ways that genetic counselors can deepen their skills to meet expanding practice demands. This timely resource not only helps readers further develop their abilities to gather relevant data and interpret it for patients, it also aids them in surpassing their usual role by truly understanding patient situations, incorporating patient values into clinical practice, providing in-depth support, and facilitating thoroughly informed, autonomous decisions.

Edited by an expert cross-disciplinary team consisting of a genetic counseling program director, a licensed psychologist, and a nurse/bioethicist/family social scientist, this authoritative reference provides specific and detailed instruction in addressing psychosocial aspects of genetic counseling practice and professional development and training issues of genetic counselors.

Provides a "process" view of genetic counselor service provision; i.e., skills that promote desired genetic counseling outcomes are emphasized (such as relationship skills, patient characteristics, client behaviors, and extra-clinical skills)

Includes experiential activities in every chapter to help readers apply concepts and skills

Draws on the experience of widely recognized experts in genetic counseling theory, practice, and research, who serve as chapter authors

Features numerous specific, real-life examples from clinical practice

"Genetic Counseling Practice" addresses issues relevant to practicing genetic counselors as well as students of genetic counseling programs. In addition, oncology nurses, social workers, and psychologists working with genetic counseling patients and families; medical geneticists and physicians training in the field; and physician assistants will also benefit from this resource.