Medical counselling in the clinical management of BRCA mutation

Among medical activities, the choice of an intervention is less and less the primacy of experts over persons, whom under the current dominant model of autonomy are the ones in charge of the decision. However, counselling is ethically relevant and acceptable provided that three conditions are fulfilled: 1. Besides information, patient asks for advice; 2. Advice is not given in an authoritative way, with strong incitement or directiveness; 3. It should be explicitly expressed that, if the patient doesn't follow the physician's advice, this will by no means prevent treatment nor the continuation of their relationship. Within an utilitarian perspective, a decision is something like a balance of facts and values. Therefore, the main (insurmountable?) difficulty lays in the assessment of patient's values. Counselling is all the more difficult and should be cautiously delivered as the situation at stake is assumed to exhibit a huge range of inter-individual values. Physicians should have deep respect for genuine individual values and/or cultural factors. The aim of clinical management is to increase life expectancy, taking into account quality of life and dignity of the person. Deliberative, iterative process seems to be a good way to reach a fair decision. While counselling the patient, the physician has to know for whom (or what) (s)he is acting. Indeed it is not always easy to distinguish among the interest of the patient, of its relatives, of the community of patients or even the interest of science or... self-interest.