This is one of the fatal flaws of eugenics. The public understanding of what genetic counselling involves is sometimes inaccurate, even to the extent that some people are reluctant to attend such counselling. However unjustified, feelings of guilt or shame are common in families that have been afflicted with birth defects or genetic disease. The ethical principle of autonomy has become paramount in genetic counselling, to an extent probably not equalled in medicine. It is fairly obvious why this must be so.
Reproduction is one of the most personal and spiritual human activities.
A conscious decision to have children rests on many subjective factors including the relationship of the partners, their individual and combined desire for children, and their economic and social well-being. Only the individuals concerned can weigh these against the possible genetic risks. The code of ethics of the Canadian College of Medical Geneticists states that supportive rather than directive advice should be given to patients in regard to reproductive decisions. However, one of the disturbing findings of the Royal Commission was that counselling offered by physicians outside Genetics Centres tended to be much more paternalistic and directive. Risk Although levels of risk are easily expressed in hard mathematical terms, what such numbers mean for the individual is highly variable, subjective, and depends upon their situation.