Genetic counseling provides nondirective communication of medical information and options, as well as psychosocial support, for the individual or couple making these difficult decisions. Also, knowing that a genetic disorder is present allows for planning and for delivery at a center that is equipped to deal with potential perinatal complications. Cancer is so common in family histories. Most cancers are multifactorial, meaning they are due to both hereditary and environmental factors. My patient is concerned that she may lose her insurance if she is found to have a genetic disease.
Concerns focus on both symptomatic and presymptomatic disorders.
For example, Huntington's disease testing and inherited cancer predisposition are two clinical scenarios about which patients often fear insurance and job discrimination if a genetic alteration is detected. With this procedure, patients are identified only by a code number or pseudonym. Legislation such as the Kennedy-Kassebaum Bill, which protects parties from being denied insurance coverage because of a preexisting condition, and the Americans with Disabilities Act of 1990, which protects persons with disabilities against discrimination, is being evaluated to determine its role in the protection of people seeking genetic testing. New legislation is sure to also address these complex issues. In the meantime, patients should carefully weigh the benefits of genetic testing against the potential social and financial ramifications.