Constructing an account by contrast in counselling for childhood genetic testing

Abstract

Genetic counselling sessions are rich and complex sites of accounting practices for decision-making in which clinicians are meant to facilitate rather than control the decisions made by their clients. This often means the adoption of a non-directive stance as counsellors lay out various possible courses of action from which the client can choose, while both client and counsellor may need to bear in mind a wide range of practical and ethical issues. With regard to childhood predictive testing, the complexity of decision-making is manifest not only in relation to the severity of the genetic condition being discussed, but also in terms of who controls the information, who might be affected by it and who makes decisions on whose behalf. In this paper we use discourse analytic methods to examine a single case where the clinician and the parent negotiate decisions about childhood testing and the extent to which the parent can influence this process. In discursive terms, we show how the child's future autonomy is juxtaposed against the parent's current rights. In order fully to understand the various characters and events deployed in the accounting practices of the parent and the genetic counsellor, we focus on one rhetorical device, i.e., contrast, as it is manifest at different levels of representation. We conclude that the interplay between a selected set of the contrast pairs contributes towards recursive interactional patterns as far as non-directive counselling is concerned, and consequently has implications for procedural outcomes.