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would mean supporting an action you regard as morally wrong. In most situations,
good communication will allow patients and counselors to understand one another
and respect each person’s right to act in accordance with his or her own values.
13.3.2 Nonmaleficence
Nonmaleficence means doing no harm; it is considered by many to be a bottom-line
bioethical principle. Yet, with newer technologies and the ability to provide infor-
mation about the likelihood of illness in the future, counselors often find the poten-
tial for harm coincides with providing benefit. For example, predictive testing or
sharing susceptibility information can support patients who want to plan for a future
situation. At the same time, however, this information can create stress and some-
times even major crises in the lives of the people who receive this information. “Not
only does the individual have to live with the knowledge for a long period of time,
but they also have the choice to use or disregard that knowledge when making
reproductive decisions” (Chapman 2002 , p. 362).
As we can’t guarantee we will not inflict harm, a more practical interpretation of
nonmaleficence is to consider permitting harm only when harm is unavoidable and
ensuring there is a corresponding benefit. An example might be encouraging a
patient to participate in genetic research only when she/he understands fully the
possible risks as well as the benefits to participation.
Keep in mind that harm can extend beyond the physical realm to include emotional
and financial harm and harm to one’s reputation or integrity. For instance, you might
consider harm to a marital relationship, and even harm to employment or insurance
status, as you assist patients with making decisions about genetic testing (Billings
et al. 1992 ; Trepanier et al. 2004 ). Part of honoring autonomy and preventing harm is
meeting a professional duty to provide informed consent about genetic tests. Given
relevant information, patients will be more prepared to assess for themselves the
harms and benefits of genetic testing or consequences of sharing test results.
Preventing harm requires that you have a lifelong commitment to ensuring
patient safety, to keeping current with respect to professional standards and policies,
to practicing within these standards, and to maintaining your competency to
practice.
13.3.3 Beneficence
For health-care professionals, beneficence usually means considering a patient’s
medical best interests. For example, you might believe that most people would ben-
efit by knowing whether they are highly susceptible to a familial cancer. Therefore,
from your point of view, participating in genetic testing would be in their best inter-
est. Some patients, or their family members, however, will refuse to participate in
testing because they fear they could not handle receiving a positive test result. In
13 Professionalism: Ethically Based Reflective Practice