Deconstructing genetic counselling: haemoglobinopathy counsellors in the United Kingdom.

Abstract

The paper begins with a brief description of sickle cell anaemia and beta-thalassaemia, the main haemoglobin disorders considered here. It then moves to a consideration of the bases of deconstruction as derived from Jacques Derrida, and mediated through the medical sociology of Nicholas Fox. In doing so it raises questions of whether genetic counselling increases or reduces choices, the ideology behind the notion of 'non-directive counselling', and its relationship to the rationing of health services. The paper briefly discusses the implications of moving beyong modernist conceptions of the professions to the potential insights afforded by postmodernism. The contingent, fragmented and sometimes contradictory positions of haemoglobinopathy counsellors are highlighted as possible examples of these insights. Sociological analysis of the professions is itself amenable to deconstruction which suggest that critiques of the professions which only identify the ( very real) repressive tendencies of professional work are in danger of oversimplification and neglect other tendencies within professional roles. The paper concludes that haemoglobinopathy counsellors encompass tendencies which may both increase and decrease choices for clients, and the operational consequences of such professional roles must be sought at the level of local agency as well as historical and material structures.