This book provides an elaboration and evaluation of the dominant conceptions of genetic counseling as they are accounted for in three different models: the teaching model; the psychotherapeutic model; and the responsibility model. The elaboration of these models involves an identification of the larger traditions, visions and theories of communication that underwrite them; the evaluation entails an assessment of each model¿s theses and ultimately a comparison of their adequacy in response to two important concerns in genetic counseling: the contested values of non-directiveness and the recognition of differences across perspectives, with special focus on how religious and spiritual beliefs of patients are coordinated with the networks of meaning in genetics. Several insights are made explicit in this project through the work of Robert Brandom. Brandom¿s deontic scorekeeping model demonstrates how dialogue is at the root of grasping a conceptual content. Against this backdrop, professional communications such as genetic counseling can be seen as late developments in linguistic practices that have structural challenges. Brandom¿s model reminds us that the professional needs the client¿s understanding to grasp conceptual content in a particular context.

Joseph B. Fanning is Assistant Professor of Medicine in the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center. He serves as the Director of the Clinical Ethics Consultation Service and works with patients, families and clinicians on ethical concerns that arise in health care.

He received undergraduate training at Birmingham-Southern College (B.A. 1993) completed masters work at Princeton Theological Seminary (M.Div., 2000, Th.M., 2001); and earned his doctorate in the Graduate Department of Religion at Vanderbilt University (Ph.D. 2008).

His research focuses on the role of communication and interpersonal skills in the development of therapeutic relationships across clinical contexts. Most recently, he and other members of a research team authored an article in Qualitative Health Research identifying obstacles to sharing expectations in a critical care context. He has co-authored a book based on fifty-five patient interviews titled, What Patients Teach: The Everyday Ethics of Healthcare (Oxford University Press, Fall 2013). In 2009, Fanning co-edited with Dr. Ellen Wright Clayton a special issue of the American Journal of Medical Genetics that focused on spiritual and religious issues in medical genetics.

Fanning also teaches healthcare ethics across Vanderbilt working with students in the schools of Medicine and Nursing as well as with trainees across multiple residency and fellowship programs. He is also the lead instructor for undergraduate course in the College of Arts and Science titled "Death and Dying in America" that combines experiential learning through hospice volunteering with interdisciplinary engagement of the issues that surround death and dying.

LIST OF TABLES.- INTRODUCTION.- Methodology and Terminology.- Debbie's Case.- Mapping the Project.- Chapters; I. GENETIC COUNSELING:  MODELS AND VISIONS.- Teaching and Psychotherapeutic Models of Genetic Counseling.- Spiritualist Tradition.- A Technical Vision of Communication.- Theses of the Technical Vision.- The Technical Vision and the Teaching Model of Genetic Counseling.- Evaluation.- A Therapeutic Vision of Communication.- Theses of the Therapeutic Vision.- The Therapeutic Vision and Psychotherapeutic Model of Genetic Counseling.- Evaluation.- Summary.- II. A RESPONSIBILITY MODEL OF GENETIC COUNSELING.- Responsibility Model.- Embodiment Tradition of Communication.- A Pragmatic Theory of Communication.- What is communication?.- What is meaning?.- Underwriting the Responsibility Model.- Summary.- III. GENETIC COUNSELING AND NONDIRECTIVENESS.- A Brief History of Nondirectiveness.- Nondirectiveness and the Teaching Model.- Nondirectiveness and the.- Psychotherapeutic Model.- Nondirectiveness and the Responsibility Model.- Evaluation of Models: Debbie's Case.- Summary.- IV. GENETIC COUNSELING AND SPIRITUAL ASSESSMENT.- Spiritual Assessment in Genetic Counseling.- Defining Spirituality.- Initial Motivations for Spiritual Assessment.- Explorations of Spiritual Assessment in Genetic Counseling.- HOPE Approach.- CEGRM.- Evaluation of Harms and Benefits.- Spiritual Assessment and Debbie's Case.- Teaching Model.- Psychotherapeutic Model.- Responsibility Model.- Summary.- CONCLUSION.- Implications.- Genetic Counseling and Professional Communication.- Medicine and Spirituality.- APPENDIX.- BIBLIOGRAPHY.