Personal values, professional responsibilities and non-invasive prenatal testing: reflections of genetic counsellors in Australia.

The reproductive autonomy rationale endorses the provision of non-invasive prenatal testing (NIPT) to enable individuals to make decisions about their pregnancy in accordance with their personal values. While the personal values of healthcare professionals may promote autonomous reproductive decision-making in light of increasingly complex genetic information, they may also impinge upon reproductive autonomy through limiting patient access to care. This paper provides timely insight into genetic counsellors' perceptions and implementation of professional responsibilities as well as their views on potential conflicts between healthcare professionals' personal moral values and the provision of NIPT. Semi-structured interviews were conducted with 23 genetic counsellors involved in the provision of NIPT in Australia. Data was analysed using inductive content analysis. Participants expressed a shared understanding of their primary professional responsibilities, however varied in their views around operationalising this responsibility in the context of personal value conflicts. Participants reported emerging conflicts in personal values where NIPT was used to detect conditions perceived to have mild phenotypes. Instances of NIPT provision being impacted by conscientious objections to abortion among colleagues were also reported. Participants empathised with concerns of disability discrimination arising from the provision of NIPT but suggested that this could be addressed through nuances in counselling practice. Participants viewed personal values that impeded patient access to care as incompatible with reproductive autonomy. This has important implications for how reproductive autonomy is operationalised in prenatal genetic counselling practice, particularly as the complexity and quantity of genetic information returned via NIPT continues to increase.