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Molecular Genetics of Coronary Artery Disease: Candidate Genes and Processes in Artherosclerosis

This book contains the written papers based on spoken presentations given at the Second European Meeting on Psychosocial Aspects of Genetic Counselling held in Leuven, Belgium in September 1990. The first such conference was organised by Dutch genetic co-workers in 1988, with the dual aims of presenting papers on psychosocial research and comparing practice with colleagues throughout Europe. The steady increase in interest and activity in this area amongst genetic co-workers (counsellors, nurses, social workers), psychologists, and clinicians (geneticists, psychiatrists, and others) was reflected in the large number of participants at the third of these meetings which was held in Nottingham last September. Despite its title, this book is not a comprehensive review of psychosocial issues in genetics, but is a collection of submitted papers (barring the invited paper by Seymour Kessler) reflecting the particular interests of their authors. The largest group of papers focus on reproductive decision making and the consequences of such decisions. Margaretha White-Van Mourik's comprehensive study of psychosocial sequelae following termination for abnormality, based on interviews with 84 couples two years' post-termination, is an important addition to the small body of publications on this topic. There are papers from groups in four different countries offering predictive tests for Huntington's disease; the paper by Guido de Wert from Maastricht on the ethical dilemmas posed in such testing is a challenging one, and points out that the right not to know is a new concept in medical ethics and solutions are far from clear. Two papers explore the extent to which genetic information is disseminated through families, and both suggest that apparent lack of interest in testing and counselling among, for example, female relatives of haemophilia patients or aunts and uncles of children with cystic fibrosis, may reflect ignorance rather than informed choice. Kessler points out that the bulk of genetic counselling psychosocial publications has focused on outcome, that is, reproductive decision making and risk recall / perception, but that research into the process is scanty. He makes the important point that there is little direct evidence of what goes on in genetic counselling sessions. Perhaps all those unmade videotapes of real genetic counselling sessions contain the true resolution of the current debate as to whether genetic counselling is non-directive! The papers in this volume do vary in quality but there is enough meat to provide several meals of thought for anyone involved in the practice or investigation of genetic counselling.