We think that thus advising the couple may in fact be understood as taking them seriously as autonomous and therefore responsible agents in the parental role they want to assume.

When taking a directive stance in such situations, counselors should of course limit their efforts to rational (non-coercive) persuasion. Another situation where directivity may be appropriate emerges when due to a fertility problem, a couple at a high risk of transmitting a serious disease (such as DMD) can only reproduce through medically assisted reproduction. Given their direct and causal www.selleckchem.com/products/cbl0137-cbl-0137.html involvement in the realization of the parental project, fertility doctors have the professional responsibility to refrain from medically assisted reproduction in case of a high risk of serious harm to the child

(ESHRE 2007). It may therefore be morally appropriate to offer genetic testing to applicants at risk of having an affected child as a condition for access to medically assisted reproduction (ESHRE 2011). Here, appropriate directivity may even go beyond persuasive advice and take the form of a ‘coercive offer’. We have suggested that directivity may be appropriate in cases where reproduction would entail a high risk of serious harm. Inevitably, there will be different opinions about where the line SIS 3 between risks that are and are not in this category must be drawn (Wertz and Knoppers 2002). Acknowledgement of these differences does not stand in the way of maintaining that there are moral limits to the ideal of non-directivity. What it does entail, however, is

that there is a grey area in which the justification for directive counseling is far less obvious than in the more extreme cases that would not lead to much disagreement. Responsible practice: confidentiality and the interests of relatives A further situation where non-directivity cannot be guiding may emerge when genetic counseling or testing has revealed that close-relatives of the proband are at a risk of serious, avoidable harm. In such cases, the counselor should urge the proband to inform those relatives (or to take steps in order Venetoclax ic50 to have them informed by somebody else). But what if the proband refuses and is also not willing to discharge the professional of her duties of confidentiality? It has been suggested that not the individual, but the 4-Hydroxytamoxifen mw family should be taken as the ‘unit of confidentiality’ (Lucassen 2007). However, this ‘solution’ is rejected in most of the relevant ethical and legal literature (Clarke 2007; Knoppers 2002; Offit et al. 2004). The principle remains that only when facing a conflict of duties, professionals may inform a patient’s or client’s relatives without his or her consent (Lacroix et al. 2008).