Skip to main content
Log in

Conflicts Between Non-Directive Counseling and Unbiased Patient Care: the Influence of Medical Students’ Personal Beliefs on Proposed Huntington’s Disease Genetic Testing Recommendations

  • Original Article
  • Published:
Medical Science Educator Aims and scope Submit manuscript



Non-directive counseling is a key component of physician-patient interactions, yet adequate education on this topic is limited in medical education. In this study, we examined whether students would have bias or instead would use non-directive counseling in the specific example of genetic testing for Huntington’s disease.

Methods and Findings

First-year medical students were surveyed if they would personally obtain genetic testing and how they would counsel patients in the following three clinical genetic testing scenarios: pre-symptomatic, diagnostic, and prenatal. Student recommendations were analyzed for how many students picked the standard practice of care extrapolated from the technical standards of the Huntington’s Disease Society of America. Fifty-one of ninety-two students (55.4 %) correctly remained neutral for their counseling of patients regarding pre-symptomatic testing. Sixty-eight of ninety-one students (73.9 %) correctly encouraged genetic testing in the diagnostic clinical scenario. Twenty-nine of ninety-two students (31.5 %) correctly remained neutral for counseling on prenatal testing when the patient would terminate her pregnancy if the fetus were found to have HD. Twenty-two of ninety-two students (23.9 %) correctly discouraged testing when the patient would not terminate her pregnancy.


The results suggest that students may lack the expertise needed to appropriately counsel patients for genetic testing. This may possibly be due to personal bias, which was especially evident in the prenatal testing scenario. Students would benefit from further training to understand how to analyze a variety of commonly encountered clinical scenarios in order appropriately provide non-directive counseling that preserves patient autonomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Pennacchini M, Pensieri C. Is non-directive communication in genetic counseling possible? Clin Tera. 2011;162(5):141–4.

    Google Scholar 

  2. Elwyn G, Gray J, Clarke A. Shared decision making and non-directiveness in genetic counseling. J Med Genet. 2000;37:135–8.

    Article  Google Scholar 

  3. Bartels DM, LeRoy BS, McCarthy P, et al. Nondirectiveness in genetics counseling: a survey of practitioners. Am J Med Genet. 1997;72:172–9.

    Article  Google Scholar 

  4. Yarborough M, Scott JA, Dixon LK. The role of beneficence in clinical genetics: non-directive counseling reconsidered. Theoret Med. 1989;10(2):139–49.

    Article  Google Scholar 

  5. Craufurd D, MacLeod R, Frontall M, et al. Diagnostic genetic testing for Huntington’s disease. Pract Neurol. 2015;15:80–4.

    Article  Google Scholar 

  6. Frank S. Treatment of Huntington’s disease. Neurotherapeutics. 2014;11(1):153–60.

    Article  Google Scholar 

  7. Myers R. Huntington disease genetics. NeuroRx. 2004;1:225–62.

    Article  Google Scholar 

  8. Tibben A. Predictive testing for Huntington disease. Brain Res Bull. 2007;72(2–3):165–71.

    Article  Google Scholar 

  9. Schuffham TM, MacMillan JC. Huntington’s disease: who seeks presymptomatic genetic testing, why and what are the outcomes? J Genet Couns. 2014;23(5):754–61.

    Article  Google Scholar 

  10. Toufexis M, Gieron-Korthals M. Early testing for Huntington’s disease in children: pros and cons. J Child Neurol. 2010;25(4):482–4.

    Article  Google Scholar 

  11. Carresse JA, Malek K, Watson K, et al. The essential role of medical ethics education in achieving professionalism: the Romanell Report. Acad Med. 2015;90(6):744–52.

    Article  Google Scholar 

  12. Nance M, Myers R, Wexler A, and Zanko A. Genetic Testing for Huntington’s Disease: Its Relevance and Implications. United States Huntington’s Disease Testing Group. 2001. Accessed from on August 25, 2016.

  13. Kromberg JG, Wessels TM. Ethical issues and Huntington’s disease. S Afr Med J. 2013;103(12):1023–6.

    Article  Google Scholar 

  14. Brennan MJ, van der Westhuyzen J, Kramer S, et al. Neurotoxicity of folates: implications for vitamin B12 deficiency and Huntington’s chorea. Med Hypotheses. 1981;7(7):919–29.

    Article  Google Scholar 

  15. Fletcher JC, Evans MI. Ethics in reproductive genetics. Clinic Obstet Gynecol. 1992;35(4):763–82.

    Article  Google Scholar 

  16. Minkoff H, Marshall MF, Liaschenko J. The fetus, the “potential child,” and the ethical obligations of obstetricians. Obstet Gynecol. 2014;123(5):1100–3.

    Article  Google Scholar 

Download references


We thank Dr. Samuel Frank and Dr. Richard Myers for advice on initial survey design. We thank Dr. Janice Weinberg and Denis Rybin for statistics consultation. We dedicate this study to Meghan Sullivan and the entire Sullivan Family for their contribution to the Medical Genetics course and inspiration for this study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Shoumita Dasgupta.

Ethics declarations

Declarations of Interest

The authors declare that they have no competing interests.

Electronic Supplementary Material


(DOC 35 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mundluru, S.N., Therkelsen, K.E., Verscaj, C.P. et al. Conflicts Between Non-Directive Counseling and Unbiased Patient Care: the Influence of Medical Students’ Personal Beliefs on Proposed Huntington’s Disease Genetic Testing Recommendations. Med.Sci.Educ. 26, 639–646 (2016).

Download citation

  • Published:

  • Issue Date:

  • DOI: