Few laypeople know enough about genetic disorders to question the veracity of information presented by experts. If a counselor is going to be directive, an open approach would be more ethical. Most geneticists thought that society would never provide enough support for people with disabilities and also that effects of some disabilities could never be overcome, even with maximum social support. Outside the United States, women geneticists were more pessimistic about disability than men, perhaps because they sympathized with mothers. Most geneticists agreed that the bulk of care for a child with a disability falls on the mother.
Many geneticists now believe that withholding any service is a denial of patients' rights.
Increased willingness to do sex selection appears to arise from increased respect for patient autonomy. As in 1984, there was no consensus about telling relatives at genetic risk against a patient's wishes. This was one of the most difficult issues in the questionnaire. National commissions, starting with the U.S. President's Commission in 1983, have recommended that confidentiality may be overridden if all efforts to persuade the patient to disclose have failed, and if there is a high risk of serious harm to family members and if the information would be used to prevent or lessen harm. The adult-onset disorders listed on the questionnaire were Huntington disease and Alzheimer disease.