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The Ethic of Genetic Counseling and the Ethos of Managed Care
Author(s) -
PARENS ERIK
Publication year - 1997
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1997.tb48592.x
Subject(s) - genetic counseling , ethos , managed care , informed consent , psychology , genetic testing , business , medicine , health care , family medicine , political science , law , alternative medicine , genetics , pathology , biology
This essay explores how the values at the heart of the ethic of genetic counseling are and are not congenial with the institutional habits of managed care. As integrated delivery systems with the resources to look at the big picture of the patient's health, managed care organizations (MCOs) can be very good at helping patients to look at the genetic parts of that picture. Genetic counseling aimed at truly informed consent is a crucial feature of looking at the genetic part of the picture. As such, there is a fundamental respect in which the ethic of genetic counseling and the ethos of managed care are congenial. But nondirective genetic counseling, which aims at truly informed consent, takes time and thus costs money. It will be tempting for some MCOs to balk at reimbursing the time‐ and skill‐intensive counseling called for by the ethic of genetic counseling. More generally, MCOs are committed to aggregating risks and benefits for populations. But genetic counselors are concerned solely with the needs and decisions of individuals. And whereas one of the main missions of MCOs is disease prevention, it is not for genetic counselors. Moreover, whereas MCOs derive much of their efficacy from sharing information among the parts of the organization, genetic counselors are committed to ensuring clients that their genetic information will remain private unless written consent is given. In principle it is possible that MCOs will provide genetic counseling much like that called for by professional genetic counselors. But to do so, MCOs will have to recognize and directly address the tensions between the ethos of managed care and the ethic of genetic counseling.