Genetic Counseling and the Fiction of Choice: Taught Self‐Determination as a New Technique of Social Engineering

In the twentieth century self‐determination was a main goal for women activists struggling against co‐optation of female fertility by the state. Today, educational and counseling services in medicine impose “autonomous decisions” upon patients. Taking the example of prenatal genetic counseling, this article argues that professionally taught self‐determination creates various paradoxes: First, it is service dependent. The act of deciding is identified with a selection from a menu of service options. Second, it is mediated by technoscience. Clients are supposed to choose technical procedures, mostly ultrasound or amniocentesis, and base their decision on scientific constructs such as chromosome numbers and probability curves. Third, to choose is compulsory because even rejection of the whole procedure will be interpreted as a choice, namely, for the no‐test option with its associated risks. Therefore, this new kind of self‐determination requires services offered by professionals, schooling in techno‐science, and decision making between risk‐laden options. Based on the results of an empirical study of genetic counseling in Germany, this article frames counseling for “self‐determination” and “autonomy” as a new technique of social engineering.