Acting In Bad Faith? A Proposed Religion-Based Genetic Counseling Training Program

As some DNA Exchange readers may know, Union University, a self-described Christ-centered school in Tennessee, is working to establish a faith-based genetic counseling training program. According to the school’s website, the program’s goal is “to train and equip excellent genetic counselors who are compassionate pro-life Christians.” As far as I know, the program has not yet applied for accreditation through the Accreditation Council For Genetic Counseling (ACGC), though it is apparently planning to do so. The program is also seeking endorsements from the American Association of Pro-Life Obstetricians and Gynecologists and the Christian Medical and Dental Association. For all that, it does not yet appear to have the funding to support the program.

Let me be clear up front – I am not anti-religion. Religion plays a critical role for many of us in establishing our identities, values, core beliefs, communities, and how we cope with and understand the world around us. Nor am I critical of any genetic counselor who has deeply held religious beliefs or opposes abortion; religious diversity only enriches the profession. But I am critical of religious teachings that can cause harm and that are used to justify sub-standard medical care.

The program describes pro-life genetic counseling as focusing on these values:

  • Relationship and community within a Christian context, including prayer for and with the patients
  • Carefully and lovingly applying Scripture to each situation
  • An in-depth interpretation of the genetic data, including ambiguities, in ways that all patients can understand
  • Connecting patients with others in similar situations
  • Advocating for children born with non-traditional genetic profiles
  • Advocating for adoption in all of its Biblical forms
  • Applying Christian genetic counseling principles to patients making genetically-related decisions at any age, including decisions regarding reproduction or end of life issues
  • Providing continuing education on the latest data and advancements in the field through the academy and to the greater public

I am not sure who the faculty might be. The program’s administrator has a PhD in Experimental Pathology and specializes in plant tissue culture but does not appear to have training, publications, or accreditation in medical genetics or genetic counseling. A director is not named though the site acknowledges that this person needs to be a certified genetic counselor.

I suspect that, like me, many genetic counselors are not comfortable with the idea of a faith-based training program. It’s like having a Creationist teach a course on evolution. I don’t know which specific Christian tenets the Union program will adhere to as there is some variability in the moral positions and beliefs of different branches of the Southern Baptist Convention and the Tennessee Baptist Convention, which the school is affiliated with. But there are a number of potential concerns in terms of the ability of the program to produce appropriately trained graduates whose practice can conform to the NSGC Code of Ethics and provide compassionate care that supports the wide spectrum of core beliefs, values, and life styles across the patient population.

Reproductive options such as abortion, gamete and embryo donation, and carrier screening for purposes of avoiding or terminating a pregnancy are explicitly prohibited by most Evangelical Christian churches. Hence faith-based genetic counseling does not provide, as the NSGC Code of Ethics states, “the necessary facts, and clarifying the alternatives and anticipated consequences.” This violates a long-standing core principle of the practice of genetic counseling. One might argue that these are not viable options anyway for some Evangelical Christians and so it is not a serious ethical lapse if they are not offered. But a good counselor will clarify up front what the patient’s values are and, if patients are opposed to certain courses of action, then those options will not be offered or judged. A good counselor will also not assume that Evangelical Christians are a monolithic block who all strictly adhere to their church’s teachings about contraception and abortion. What matters is not what choices are available to all patients. Rather what is important is to explore the choices available to a specific patient based on their values, beliefs, and social situations.

Another area of concern about faith-based genetic counseling relates to matters of sex, sexuality, and gender. For most Evangelical Christians, there are two and only two sexes and two genders based on sex and gender assigned at birth, gender is biologically determined (man and woman), anything other than sex between husband and wife is not permissible, and homosexual behavior is not tolerated. If an unmarried couple or a single pregnant person came for genetic counseling, could the counselor withhold overt moral judgment? This belief would also make it impossible to utilize the most recent pedigree standardization guidelines, which emphasizes the importance of appropriately depicting people of different genders as well as those who do not identify with the sex they were assigned at birth.

And the school takes their censure of homosexuality seriously. In 2015, Union University withdrew from its association with the Council of Christian Colleges and Universities (CCCU) after CCCU failed to censure two other affiliated schools that altered their hiring and benefits policies to include same-sex couples. In 2017, Union’s president and 3 faculty were signatories to The Nashville Statement, a document that condemns homosexuality. In 2020, Union University rescinded the admission of a student in their graduate-level nursing program after it was discovered that he was in a same-sex relationship, and other LGBQT+ students claim the school has tried to them to undergo harmful conversion therapy. The school’s code of conduct, called a Community Covenant, states that “The promotion, advocacy, defense, or ongoing practice of a homosexual lifestyle (including same-sex dating behaviors) is also contrary to our community values.” So a genetic counselor who graduated from such a program could not even publicly or professionally support patients who are not cisgender heterosexual.

In Evangelical Christian teaching, people who are intersex are accepted into the church but told, quoting from the Bible (Matthew 19:12), that they are “eunuchs who were born that way from their mother’s womb” and that God will reveal their “true” sex and they will be “healed” on the Last Judgment Day. It is, of course, biologically inaccurate to state there are only two sexes and genders and that people who are intersex are somehow broken. It is also psychologically and socially damaging and leads to higher suicide rates and psychological trauma for people who are intersex and/or non-binary. There’s nothing pro-life about that. And I suspect that most intersex people would be offended at being called “eunuchs.”

Some Evangelical Christian teachings, and Catholic teachings for that matter, typically prohibit contraception and sterilization, except in certain rare circumstances, even though contraception – surgical or otherwise – can result in improved health and economic well-being for women and families. For some Evangelicals and Catholics, this ban could also be interpreted to mean that women who carry pathogenic BRCA1/2 mutations might not be able to obtain a pre-menopausal risk-reducing oophorectomy. Not surprisingly, the Evangelical stance on sterilization and contraception has historical ties to eugenics (of course, so does genetic counseling so we can’t claim the moral high ground here) and the fear that Christians, especially White Christians, are reproducing at lower rates and will be replaced by other races and people with other religious beliefs who purportedly  have higher fertility rates (I know of no direct connection between eugenics and Union University or its genetic counseling program). Madison Grant continues to raise his ugly head. Furthermore, Union is affiliated with the Tennessee Baptist Association, which itself is, as noted above, affiliated with the Southern Baptist Convention. The Southern Baptist Convention was founded in Georgia in 1845 by white supremacists and supported slavery and anti-miscegenation laws, and opposed the Civil Rights Movement well into the 20th century, though by the 1990s, the Southern Baptist Convention denounced its past ties to these beliefs and is now ethnically and racially more diverse.

People who identify as Christian, especially conservative Christians, are less likely to utilize genetic testing and counseling and providers who identify as Christian are less likely to offer these services to their patients. Since about 14% of Americans identify as White Evangelical Protestants, they represent a significant minority who are possibly not being reached by currently available genetic services. Faith-based genetic counselors could argue that they would increase the utilization of genetic counseling in this population, which would align with principles that are key to NSGC’s JEDI initiatives. However, they are doing nothing to address JEDI issues, and in fact are working at cross-purposes to it if they are providing sub-standard and inaccurate counseling and condemning anything other than heterosexual behavior and telling people who are born with sexual variations that they are “broken.” The genetic counseling profession embraces diversity, including religious diversity, but it does not support intolerance.

On the other hand, the genetic counseling profession needs to make clear that it is very supportive of the range of religious views of their patients. We are perfectly capable of working with conservative religious patients while also maintaining our personal religious beliefs. The experience of even some of the more conservative Amish groups with genetics by and large shows this.  And, as Frances Collins and other scientists demonstrate, Evangelical Christian and other religious scientists and physicians participate in first class and ethically acceptable genetic services and scientific endeavors while accepting standard scientific theory, research, and data and without receiving training from a conservative religious institution. But clearly the genetic counseling profession can do better at actively working with religious groups to demonstrate that genetic counselors can provide services in a supportive, respectful, and non-judgmental manner and supporting our colleagues who are religiously conservative.

I am not familiar with the fine details of obtaining ACGC accreditation, but I do know that it is a lengthy, demanding, and complicated process. It is possible, maybe even probable, that ACGC will deny certification to Union University. The program could then decide to develop their own accrediting organization that specifically certifies only graduates of faith-based programs. After all, that’s what genetic counselors did when we separated from the American Board of Medical Genetics back in 1992. While this would likely be illegal in some states that already have genetic counseling licensure, it might be less of an issue in states that don’t currently have licensure. It’s also possible that some conservative legislatures in states that already have licensure would be willing to modify existing laws to extend genetic counseling licensure to graduates of faith-based programs.

Faith-based genetic counseling can be read as being part of a larger problem of some religious groups using legislatures and judiciaries to dictate medical care guidelines for the general population that aligns with the religion’s beliefs. In addition, some religious groups have increased their control of the practices and policies of health care institutions by purchasing them as well as by creating versions of health insurance plans, something I warned about a decade ago in a 2013 plenary session at the NSGC Annual Education Conference (Thursday, October 10, 2013 at 9:45 AM, to be precise). For example, Catholic hospitals comprise the largest non-profit group of health care providers in the US. This can result in severely limiting access to abortion in states where it is still legal and and reducing access to contraception and surgical sterilization. They are literally trying to force the entire US population to embrace a very narrow minority interpretation of Christian theology.

But the profession can’t only be angry about it, however justified the anger might be. We can’t ignore and dismiss it. We have to understand it, adapt our practice, respond thoughtfully, examine some of our core ethical principles, and be willing to take a stand on controversial issues. It raises some tough questions, but we have to answer them.

7 Comments

Filed under Robert Resta

7 responses to “Acting In Bad Faith? A Proposed Religion-Based Genetic Counseling Training Program

  1. Sam Stover

    I have many thoughts about this new potential program – thanks for putting many of them into a much more eloquent style than I could muster. Just a quick comment – Baylor University and Baylor College of Medicine are separate entities. The BCM GC program is not based in a Christian school.

  2. Lauren Westerfield

    This perfectly encapsulates my feelings about this “program” and the important distinction between genetic counselors who identify as part of a particular faith community and trying to set up genetic counselors who define their scope of practice by the tenants of a particular faith community. I also want to point out that even if such a program framework was able to abide by the core tenants of the profession and the NSGC code of ethics (which it wouldn’t), it would be naive to think that any faith group outside of an Evangelical/Christian/Catholic one could have equal access to setting up a similar program give the racism and discrimination against other religions in the US.

    Also seconding Sam’s request – please remove the reference to the BCM program. I’m a faculty member there and it’s a common misconception but we are not Baylor University/not a Christian-based school. 🙂

  3. Robert Resta

    Lauren and Sam – Thank you for pointing out my error about the Baylor program. I have amended the posting accordingly. I apologize for any confusion I created.

  4. Joy Redman

    As usual, you present this so nicely, and nicer that I would have. Sounds like they need to train more religious counselors for their needs, NOT genetic counselors.

  5. Jennifer Lemons

    I’ll try to keep this short as I’ve invested much time and energy (and my thesis! 😆) in and around the intersection of faith, spirituality, religion, and genetic counseling. Glad to see someone tackle this topic! I’ve been surprised at how little I’ve seen it discussed.

    I remember looking into this program awhile ago and am encouraged to see there has been little to no change or movement in their endeavors. Faith aside, the first sentence of the program website fundamentally doesn’t align with the core scope, purpose, value, etc. of a certified/licensed genetic counselor saying, “The primary role of genetic counselors is to provide information about the results of genetic tests to patients, loved ones, or caregivers.”

    Is that my primary role? Is EVERY genetic counselor’s primary role as simple as providing information about genetic test results? What about the rest of our scope of practice? Practice-based competencies? Do these suddenly not apply, or are de-emphasized because they conflict with the program’s faith-based values? The answer is most certainly, “No.”

    The genetic counseling profession should continue on, as all other healthcare professions have done, in solidarity, without sanctioning alternative solutions that would result in multiple factions, ironically creating our own faith-based genetic counseling “denominations” in the process, yet all of us will somehow still be called “genetic counselor”.

    This program and any variation of it is not the answer. They will only create more problems, division, inequality, injustice, and discourage inclusivity. These types of programs cannot be an answer to any one faith-based patient population because “conservative Christianity” cannot even agree on what issues they should be conservative, thus all the denominations. If this or any faith-based program succeeds in getting accredited-miraculously – there’s no argument or reason to stop there. The proverbial flood gates would be opened and any other faith-based program would have grounds for accreditation, too.

    There’s so much to say on this topic for me, not just because of my time spent researching it, teaching on it, but I also live some version of it every day as both a GC and as someone who has been married to a pastor for over 14 years.

    Great job getting the word out and raising discussion! Hopefully it helps continue the conversation.

  6. Renee Laux

    I will say more than a few words, though, mostly when I do, I annoy people, and everyone flocks to my LinkedIn to see who I am – so I tend to be quiet. I will start with these two comments:

    “But there are a number of potential concerns in terms of the ability of the program to produce appropriately trained graduates whose practice can conform to the NSGC Code of Ethics and provide compassionate care that supports the wide spectrum of core beliefs, values, and life styles across the patient population.” HOW DO WE KNOW THIS?

    “I also want to point out that even if such a program framework was able to abide by the core tenants of the profession and the NSGC code of ethics (which it wouldn’t) HOW DO WE KNOW THIS? it would be naive to think that any faith group outside of an Evangelical/Christian/Catholic one could have equal access to setting up a similar program give the racism and discrimination against other religions in the US.”

    Does anyone (I’m sure Rob does) remember Dr. Garver and his wife? In my class at Pitt, 50% of us were Catholic (as was he and his wife) and some of us graduated from Catholic Universities. We met at Dr. Garver’s house very early on and discussed how we could be genetic counselors who had our own personal beliefs and yet could be genetic counselors who did not impose them on the people we counseled and helped care for – he basically said “if you don’t think you can do it, then let’s talk about what you can do in this profession (ie: pharmacogenetics, lab work, etc…). I spent many hours holding babies (yes, babies) delivered at 20 weeks, helping couples through the worst time in their lives. I made house calls with terrible news of results so that people didn’t have to be told of these results while they were alone and their partners were out to sea. I facilitated pregnancy termination support groups and helped a woman who had a termination create an online support group that helped many many people. Even after 16 years, I won’t talk about my own personal beliefs regarding this topic on social media because I would never want someone I cared for to somehow find me (and they still do) think that I judged them for their choice. At the time I was in my reproductive years as a prenatal genetic counselor, my oldest was in Catholic School and I would see many people who I counseled who were parents at that school (downside/upside of being in a small community?). We had our faith in common. Did that mean that I ever assumed anything about what they would decide in any given situation? No, not once, not ever. What did happen when one of them made the decision to end a pregnancy with a baby with a birth defect and they were afraid to talk to the priest or thought they were going to hell???? I was able to help them through that because I knew their religion. I believed, as Dr. Garver did, that there was a place for me – that it was never my place to judge (it’s not any of ours) regardless of what decision I would make in any given situation and my place was literally to use my God-given talents, training and knowledge to help people through one of the worst times in their lives. As an aside, one time a couple sitting a few pews in front of me recently ended a very wanted pregnancy. In that homily the priest talked about how brave and strong women are who find out that they have a baby with a birth defect and continue their pregnancy and I could feel the anguish a few rows back…not kidding when I say my husband literally pulled my hand down and said “you cannot raise your hand to speak during a homily.” Because I was going to. What I did do, was see them leave in tears and follow them out and give them hugs and let them know that he was a human up there and didn’t have any idea what they had just been through and that they were loved by God and that they were strong and brave too, because they made a very difficult decision not for themselves but for their unborn baby and their family. I was glad I was there (and that my husband made me put my hand down).

    There are many people I encountered then and have encountered since leaving prenatal genetics who didn’t/don’t even want to see a genetic counselor because they see our profession as being full of people who push one agenda (just read the comments below something like the article in the NYT about prenatal screening last January) and don’t trust us. It’s the truth, whether we want to believe it or not. I can remember a man standing in my doorway leaning against the door who refused to join his wife in my office because they were just told their baby had a birth defect and he did not want to talk about abortion. Once she told me that, and reassured me that she also felt the same way, I was able to convince him that was not why I was there and he could come and sit down.

    There is a Catholic Medical Association, full of doctors and nurses and other healthcare professionals – and people who do absolutely know that they would never have an abortion – choose their doctors based upon the knowledge that they they are pro-choice. (I’m not saying this is full proof… I have seen people who had no choice given to them who didn’t realize their doctor was pro-choice until it was too late and that, of course, I do NOT believe in).

    I guess what I am saying is that there is a place for pro-life genetic counseling – it definitely needs to be advertised as such, just like the doctors mentioned above – but we shouldn’t be so quick to make the thought of that provoke such anxiety.

    If there is a portion of a population, no matter the size, that does not feel comfortable discussing abortion, or other topics (let’s just say PGD and IVF), and they won’t go to anyone who they think will talk about these things so they get no genetic counseling except for some from a physician who really doesn’t do a great job at it – would it not be better for them to have a subset of trained genetic counselors to go to? Would it not be better to have a place for some people who might be excellent genetic counselors but pro-life – who are not comfortable with abortion choose this path instead of not having them in our profession at all? There is a big group of Catholics that do believe in choice and wouldn’t think that a woman with a BRCA1/2 mutation should have no choice about an oophorectomy. I’m sure there are individuals in other conservative religions who are the same way.

    I have heard one too many stories about genetic counselors who ask many times about the option of abortion even if a woman says she does not want one multiple times (I know, I know, people change their minds and they also have time limits on making that decision) – but I think it is important that we remember that being a genetic counselor who may be trained in a faith based program (I know nothing about this one except what I read here – so I’m not meaning this one specifically) may not mean at all that those individuals would be intolerant like this statement potentially implies “The genetic counseling profession embraces diversity, including religious diversity, but it does not support intolerance.” There could be a place for this – and we need to keep an open mind – either that or like Rob said, we need to start working more with faith communities and stop letting stereotype barriers stand between us and individuals in these communities that actually really do need what we can provide.

  7. Renee Laux

    In the above comment – I did make a mistake in the paragraph about the Catholic Medical Association and meant to say pro-life instead of pro-choice.

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