Advising on the management of genetic risk: Offering choice or prescribing action?

The aim of genetic counselling is to provide information about individuals' genetic risks, the available risk management options and the costs and benefits of genetic testing in both a neutral and non-directive manner. This paper reports the findings of a prospective study of genetic counselling for hereditary breast/ovarian cancer. It argues that genetic counselling for these types of cancer is not neutral, but can be seen as both overtly and covertly prescriptive. The analysis of genetic consultations indicates that the clinicians suggest that the risk of cancer is manageable, and that individuals have a responsibility to act to manage their risks in particular ways. It is observed that the selective presentation of the different risk management options potentially limits the risk management choices that are available to at-risk women. © 1999 Taylor & Francis Ltd.