Counselling the genetically ‘at risk’: The poetics and politics of ‘non-directiveness’

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Abstract
According to the professional literature, genetic counselling should be value-neutral and 'non-directive'. Counsellors should impart genetic risk information without offering direct advice, enabling clients to reach informed, voluntary decisions. Although a growing number of genetic counsellors have questioned the desirability of adopting a non-directive stance and recognise the difficulty, if not impossibility, of realising this ideal in practice, non-directiveness continues to be promoted by the genetic counselling profession as a defining feature of genetic counselling. This article critically examines the use of the concept of non-directiveness in genetic counselling, making reference to a range of recent descriptions and critical appraisals of the genetic counselling process. It explores the context for the emergence of the ideal of non-directiveness and how this ideal is sustained through counsellors' self-descriptions of their profession and the routines of counselling practice. Finally, the article stresses the importance of critically assessing the aims and regulatory implications of genetic counselling in a context of proliferating new 'at risk' populations.