Dianne M. Bartels

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out­ stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ­ ation. Medical technology has not overwhelmed our moral­ ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss­ ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil­ ization, embryo transfer, artificial insemination, or fertil­ ity drugs. Nor is it entirely accurate to describe assisted repro­ duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip­ ment. Yet, most of the methods used to assist reproduc­ tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu­ lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en­ gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.

Genetic counseling is fairly new. The fact that the field is an accepted professional enterprise in universities, clinics, and hospitals throughout the United States is remarkable. The contributors argue that genetics and medicine rest on beliefs widely held in American society. Scientific progress is good, and highly sophisticated technologies are appropriate means to solving medical problems. The better understanding they gain about the nature and evolution of disease, the more prepared clinicians will be to treat and prevent future occurrence of disease. A belief that medicine, including genetic medicine, is clear, factually based, and objective undergirds the strategies and norms of genetic counseling. This collection of original papers explores the history, values, and norms of that process, with focus on the value of non-directiveness in counseling practice. The contributors' examination of genetic counseling issues serves as a foundation from which to address the ethical, legal, and policy considerations of clinical genetics.

Arthur L. Caplan It is commonly said, especially when the subject is assisted reproduction, that medical technology has out­ stripped our morality. Yet, as the essays in this volume make clear, that is not an accurate assessment of the situ­ ation. Medical technology has not overwhelmed our moral­ ity. It would be more accurate to say that our society has not yet achieved consensus about the complex ethical iss­ ues that arise when medicine tries to assist those who seek its services in order to reproduce. Nevertheless, there is no shortage of ethical opinion about what we ought to do with respect to the use of surrogate mothers, in vitro fertil­ ization, embryo transfer, artificial insemination, or fertil­ ity drugs. Nor is it entirely accurate to describe assisted repro­ duction as technology. The term "technology" carries with it connotations of machines buzzing and technicians scurrying about trying to control a vast array of equip­ ment. Yet, most of the methods used to assist reproduc­ tion that are discussed in this volume do not involve exotic technologies or complicated hardware. It is technique, more than technology, that dominates the field of assisted reproduction. Efforts to help the infertile by means of the manipu­ lation of human reproductive materials and organs date 1 2 Caplan back at least to Biblical times. Human beings have en­ gaged in all manner of sexual practices and manipulations in attempts to achieve reproduction when nature has balked at allowing life to begin.

Genetic counseling is fairly new. The fact that the field is an accepted professional enterprise in universities, clinics, and hospitals throughout the United States is remarkable. The contributors argue that genetics and medicine rest on beliefs widely held in American society. Scientific progress is good, and highly sophisticated technologies are appropriate means to solving medical problems. The better understanding they gain about the nature and evolution of disease, the more prepared clinicians will be to treat and prevent future occurrence of disease. A belief that medicine, including genetic medicine, is clear, factually based, and objective undergirds the strategies and norms of genetic counseling. This collection of original papers explores the history, values, and norms of that process, with focus on the value of non-directiveness in counseling practice. The contributors' examination of genetic counseling issues serves as a foundation from which to address the ethical, legal, and policy considerations of clinical genetics.