Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
Bioethics. 2021 Jul;35(6):528-539. doi: 10.1111/bioe.12861. Epub 2021 Mar 10.
The emergence of the genetic counseling profession has allowed laypeople to understand and benefit from biological advances, and to make critical decisions about their application. The discipline of genetic counseling has been criticized from its very beginning, in particular because of its early association with the eugenics movement. This paper presents a critical and reflective overview of how genetic counseling is implicitly embedded in the history of eugenics but also counteracts past eugenic practices and ideas. After World War II, attempts were made to distance genetic counseling from eugenics. The first definition of genetic counseling did not position this field as a medical encounter but "as a kind of genetic social work aimed primarily to provide people with an understanding of their family's genetics problems." This approach was a reaction to the genetic and social evolutionary ideas that informed eugenic theories during the first half of the 20th century. Professionals engaged in genetic counseling during the 1940s and1950s rejected eugenic practices, but there was still support for eugenics' goals of improving heredity and eliminating disease. From the 1960s, genetic counseling underwent professionalization alongside feminization and a definition of core values. Among these values were nondirectiveness counseling and the autonomy of the counselee. The dark shadow of Nazi ideology and other eugenic practices, attempts to employ the historical responsibility of geneticists, and the dynamic medical, social, political, and educational changes of the 1960s and 1970s helped to frame approaches and delineate the goals and limits of the new profession of "genetic counseling."
遗传咨询专业的出现使非专业人士能够了解和受益于生物学的进步,并对其应用做出关键决策。遗传咨询学科从一开始就受到了批评,特别是因为它早期与优生学运动有关。本文批判性地回顾了遗传咨询是如何隐含地嵌入优生学历史中的,但也抵制了过去的优生学实践和思想。第二次世界大战后,人们试图使遗传咨询与优生学保持距离。遗传咨询的第一个定义并没有将这一领域定位为一种医疗接触,而是“作为一种主要旨在帮助人们了解其家庭遗传问题的遗传社会工作。”这种方法是对 20 世纪上半叶遗传和社会进化思想的反应,这些思想为优生学理论提供了信息。20 世纪 40 年代和 50 年代从事遗传咨询的专业人员反对优生学实践,但仍支持优生学改善遗传和消除疾病的目标。从 20 世纪 60 年代开始,遗传咨询与女性化和核心价值观的定义一起专业化。这些价值观包括非直接咨询和咨询对象的自主性。纳粹意识形态和其他优生学实践的黑暗阴影、遗传学家历史责任的尝试、以及 20 世纪 60 年代和 70 年代医学、社会、政治和教育的动态变化,有助于形成方法,并划定这一新职业“遗传咨询”的目标和界限。