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Back to Basics: Is there a Place for Virtue-Ethics-Approach in Genetic Counseling?

Most common approach to analyzing and solving ethical dilemmas in contemporary medicine is the four-principles-approach. However, as the critique of principalism has showed us back in the 1970’ s, this framework has its limitations. These limitations especially emerge when facing the challenges of new technologies and the consequences of their usage, such as the case of clinical genetics. Our time is one of genomics, HUGO, and similar accomplishments which bring us to the gene-sequence-approach vs. the good old fashioned “ holistic” approach of treating illness. We are not helping a person overcoming pain and suffering any more, we are now helping a genome to be as healthy as possible in order to allow our (good, healthy, adequate) genes to be transferred in the next generation. This is, of course, a very simplified deliberation on what has become of modern medicine in the context of clinical genetics, more precisely in the context of genetic counseling. Going back to basics, we are definitely facing the limitations of the principalistic approach. Principles do allow us to act with clarity, simplicity and universality (Campbell AV, 2003), on the other hand, they do not take account of the importance of the emotional element of human experience (Gardiner P, 2003), thus they suffer the neglect of emotional and personal factors, oversimplification of the issues, and excessive claims to universality (Campbell AV, 2003). Exactly this “ virtues and vices” of the four principles (Campbell AV, 2003) come in the focus of moral deliberation when we as health care providers have to offer advice which will create consequences not only for the patient coming for the advice and having to make a decision upon it, but the extend of these consequences goes beyond our patient (a person, a couple, the family) and intervenes with the future of the offspring. The patient of a genetic council is, thus, not only the person seeking it, but the entire family and future generations. In this context it is very difficult to determine the rightness of the decision-making-action, neither from the deontological point of view (underlying the duties and rules all moral agents involved in the case have to obey in order to make the best possible decision), nor from the one of consequentialism, that is the “ destiny” of (the consequences for) the offspring - the most often object of moral deliberation in genetic counseling. Virtue ethics could help facing moral challenges geneticists and their patients encounter in the everyday enterprise of practicing a “ harm reduction interventions” (Christie T, Groarke L, Sweet W, 2008), in the context where moral agents act as “ time/space travelers” and council/decide for both themselves and others, both now and for the future. Virtue ethics provides insights into moral characters, offering a blend of reason and emotion, and paying attention to the context of decisions (Campbell AV, 2003). In considering the relationships, emotional sensitivities, and motivations that are unique to human society, it is also relevant for understanding our (multi)cultural concerns (Gardiner P, 2003 ; Islam G, 2007). Generally, it provides a fuller ethical analysis and encourages more flexible and creative solutions than principlism or deontology/consequentialism alone (Gardiner P, 2003). The key concept for virtue-ethics-approach in genetic counseling is a strong sense for professionalism of the genetic counselor, which (summed up to the four fundamental virtues originating from John Gregory’ s concept of professionalism) consists of integrity, compassion, self-effacement and self-sacrifice (Coverdale JH, 2007). If we try to broaden up the virtue-ethics-approach to all moral agents (patients also) engaged in the process of genetic counseling, we could follow the “ seven basic virtues in medicine” approach, that is: prudence (practical wisdom), justice, temperance, courage, faith, hope, and love (Bryan CS, 2005 ; Bryan CS, 2006 ; Bryan CS, 2007). In conclusion, it should be stated that neither virtue-ethics-approach, nor the four-principles-approach should claim to be superior to the other. Only together they provide a morally adequate context for helping patients, families, surrogates, healthcare providers, or other involved parties address uncertainty or conflict regarding value-laden issues emerging in genetic counseling.

ethics; clinical; genetic counseling; principle-based ethics; virtues

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