Abstract

This dissertation examines the concept of autonomy reflected in nondirective genetic counseling. I argue that counselors interpret autonomy primarily as clients' right to non-interference in decision-making, a construal that may permit both poorly reasoned and unethical decisions. I propose that counselors reconfigure their view of autonomy to emphasize instead deliberative competence in the decision-making process. This is expressed in what I develop as a "dialogical" counseling approach, framed within the interpretive ethics of H. Richard Niebuhr. Dialogical counseling requires careful and thorough deliberation of the medical, psychosocial, and ethical issues germane to a decision, attained through dialogue between counselor and client. In this dialogue, the counselor is free to introduce unsolicited information and alternative perspectives. While the client makes the final decision, the counselor ensures that it is well considered and includes acknowledgement of the ethical issues and social consequences of individual choices. The goal of successful counseling is a decision in "reflective equilibrium" with respect to clients' circumstances, ethically responsible decisions being those that are accountable to their social consequences.