Oklahoma, Nebraska, and Virginia have put in place genetic counseling “conscience clauses,” allowing healthcare providers to refuse to counsel patients about abortions based on moral or ethical objections. Investigators studied genetic counselors’ awareness of these laws. (Learn more here.)

Of 274 genetic counselors surveyed, 90% were not even aware the conscience clauses existed. On the issue of whether genetic counselors had the right to use a conscience clause, responses were mixed: 24% said yes, 31% said no, and 45% were unsure. Ninety percent of respondents agreed counselors were ethically obligated to refer a patient to another provider if using a conscience clause.

The 274 counselors also were asked about attitudes on whether conscience clause laws align with the National Society of Genetic Counseling Code of Ethics. Forty-five percent said neither supersedes the other, 31% said the code supersedes, 8% said conscience clauses supersede, and 16% were unsure.

“I was surprised by the overall lack of consensus on many of the questions,” says Shea Bonine, MS, LCGC, the study’s lead author and a licensed certified genetic counselor at Sioux Falls, SD-based Sanford Health. Only one genetic counselor reported actually using a conscience clause in practice. Still, about one-third believe the clauses granted some extra legal protection and wanted additional information to understand how it affects their practice.

The genetic counseling field is evolving in many ways, in light of preimplantation genetic diagnosis used with in vitro fertilization, gene therapy used for select genetic conditions, and polygenic risk scores.

“The field is rapidly changing because genetic technology, knowledge, and accessibility is rapidly increasing,” Bonine observes.

In addition to those changes presenting some new ethical questions, Bonine says ethicists also should be aware of state conscience clause laws. “All genetic counselors receive some level of ethics training during their program, but this really highlights the need for clarification,” Bonine says.