ABSTRACT
This chapter assesses the status of a nondirective ethos in genetic counseling today. Three changes are so basic as to demand comment. First, at the time of fieldwork, ethical concerns were an unpredictable occurrence with only inchoate workplace routines for resolving serious problems. Second, much of the work of genetic counseling that was a jealously guarded prerogative of the physicians of Nightingale Children’s Center has now become a standard part of obstetrical care. Third, we have become increasingly aware of some of the ambiguities of health care. A workplace ideology is a set of values, working rules of thumb, and self-evident truth shared by workers about everyday problems, proper solutions, or acceptable explanations when things go awry. In practice, “nondirectiveness” means a reluctance to make therapeutic recommendations. This reluctance derives from the fact that often the only option available is second-trimester abortion.
