Genetic services.

This is a time of unprecedented increase in knowledge about the genetic basis of disease against a background of rapidly changing technology. Advances happen quickly, with the new knowledge rapidly becoming relevant to services for patients, and hence there is an increasing demand for, and expectation of, genetic services. This brings a challenge for health services worldwide to keep pace with the expectations of their populations. There is also a need for public and professional education and dialogue to dispel some of the hype and myths about what can be achieved. It should not be forgotten that any services must be provided and developed within a broad ethical framework. A statement from a WHO expert consultation (1) concluded that 'Genetic advances will only be acceptable if their application is carried out ethically, with due regard to autonomy, justice, education and the beliefs and resources of each nation and community'. That so many public bodies have commented on genetic services and their associated ethical, legal and social issues emphasizes not only the importance of this area in health care, but also that the wider issues are of great importance in democratic societies. The aim of this paper is to review the current situation in the provision of genetic services, to examine the drivers for change, to speculate on the likely need for future services and to suggest models for the development of such services. Pharmacogenetics and the determination of genetic factors indicating susceptibility to infection will not be discussed since these have been the subject of several recent excellent reviews (2, 3). Genetic services have been defined as health measures implemented to help people with a genetic disadvantage and their families to live and reproduce as normally as possible (4). Broadly they can be divided into those services which target whole populations with a view to identifying those at increased risk; and those which focus on the needs of families which are affected by a genetic disorder or who perceive themselves to be at increased risk.