Code of ethical principles for genetics professionals

Genetic services and testing in South Africa

South Africa is a developing middle-income country with a population of over 49 million people. It has a health system, based on national, provincial and private health programmes, which is in transition. There are well organised but small genetic services, based mostly in academic centres, provincial health departments and the National Health Laboratory Service. Trained medical geneticists, genetic counsellors and medical scientists are available to deliver the service. Funding for this service is limited, due partly to the extensive demands made by the rampant HIV/AIDS epidemic (which has lead to a falling life expectancy, and increasing maternal, child and infant mortality rates) and partly due to some ignorance, among both health professionals and the public, concerning the benefits of genetic counselling and testing in affected families. There are four academic human genetics departments across the country providing counselling (7,313 cases were counselled in 2008), testing services (16,073 genetic tests were performed in 2008) and professional training. They also undertake research. Only one tenth of the required staff, according to the WHO recommendations, is available at present to provide these services, and further employment opportunities are urgently required. However, training of professionals continues, comprehensive genetic testing facilities are available, research on many of the genetic conditions of specific concern to the country has been and is being undertaken, and patients from all over Southern and Central Africa make use of these services.

Ethics instruction in an issues-oriented course on public health genetics

Public health ethics and genetics in public health have in the last decade emerged as fields in their own right. This article describes the ethics component of an "Issues in Public Health Genetics" course uniting the fields of genetics, ethics, and public health. As the third member of the University of Michigan Interdepartmental Concentration in Genetics, the course emphasizes the translation of ethical-social issues into substantive policies. A central tension repeated throughout the course exists between respect for individuals' libertarian interests and the welfare of the entire population. Students become familiar with the process of resolving conflicting values through interactive exercises addressing the health needs of diverse communities. Key lessons in course design are described.

Should genetic health care providers attempt to influence reproductive outcome using directive counseling techniques? A public health prospective

Many areas of agreement exist among genetic health care (GHC) professionals (i.e., MD and PhD clinical geneticists, master's level genetic counselors, and others) and public health (PH) professionals. However, there are in our opinion at least two areas or tenets where a distinct difference of opinion exists. Two tenets widely expressed by prenatal GHC professionals are: (1) they should never attempt to influence the outcome of a pregnancy, and (2) they should only use non-directive genetic counseling techniques. From a PH perspective, these tenets could be viewed in some instances as counterproductive and contrary to a major goal of PH (i.e., to improve the health and well-being of all residents, including newborns). For example, PH's message regarding fetal alcohol syndrome (FAS) prevention is clear: If you are pregnant, don't drink; and if you drink, don't get pregnant. PH's message regarding neural tube defect (NTD) prevention is equally clear: all women of childbearing age who are capable of becoming pregnant should consume 0.4 mg of folic acid daily to reduce the risk of NTDs. In the past, issues such as eugenics, abortion of affected fetuses, and a lack of methods for the primary prevention of birth defects and genetic disorders have caused GHC providers to perform genetic counseling according to the two tenets mentioned above. Clearly, there are no moral or ethical reasons why children who are at risk for FAS, NTDs, fetal rubella syndrome, or many other conditions should not have the opportunity to be born healthy. Also, we know of no laws that prohibit providers from telling a woman to do something to improve her baby's chance of being born healthy. In our opinion, it is time for prenatal GHC professionals to re-examine the two tenets noted above on a case-by-case basis to determine when it is appropriate to use directive counseling techniques to improve reproductive outcomes in accordance with the goals of PH. A framework is provided here that could serve as: (1) a guide for future discussions dealing with these issues, and (2) a method to ensure that prenatal GHC policy and practice regarding these issues conform with one another.