Penetrance and Variability in Malformation Syndromes. Annual Review of Birth Defects, 1978, Part B

articles by Paula Hollerbach partially compensate for this deficit. Her careful and sensitive descriptions of psychological and other factors influencing a couple's reproductive goals and attitudes toward counseling, sterilization, artificial insemination, and selective abortion evoke empathy with and for the troubled couple. Next, John Pearn's "Decision-Making and Reproductive Choice" offers an intriguing, "soft" version of decision theory, discussing various factors affecting the counselee's subjective interpretation of genetic risks (odds). Social workers McCollum and Silverberg rightly emphasize important psychosocial dimensions in their chapter "Psychosocial Advocacy"; however, their facile assumption of the need for a "client advocate" within the genetics team generates the unfortunate implication that the counselee requires specific advocacy against the other team members. Editors Hsia and Hirschhorn return with an extremely brief chapter regarding responses to genetic counseling; they conclude that the data are insufficient and that any further conclusions would be premature. A chapter dealing specifically with "The Process of Genetic Counseling" correctly underscores the need to provide written reviews of counseling sessions for counselees as part of routine follow-up care. Marc Lappe's thoughts on "Genetic Screening" center on the role of counseling as an obligatory concomitant of any major screening program. A simple, clearly written introduction to malpractice law as it applies to genetic diagnosis and counseling is provided by lawyer Philip Reilly. Finally, Marjorie Guthrie's touching biographical/ autobiographical account of her husband's experience with Huntington's Disease issues a powerful plea for improved counseling and care for those with genetic disease. In sum, this book serves as a solid introduction to modern genetic counseling: the book mirrors this counseling's multidisciplinary character, and it invites further analysis and reflection. Its insights may not be new to most practicing genetic counselors; nonetheless, it should tend to move counseling from a behind-the-scenes and ad hoc aspect of medical genetics to a more clearly defined discipline with a structure and method which can be studied and improved. Its main faults lie in a few redundant chapters and in a more general failure to provide practical guidelines and creative strategies for dealing with the complex and difficult tasks it describes. However, most chapters include ample references with descriptive annotations which make this book likely to be particularly valuable to students, novice counselors, bioethicists, and others desiring an initiation into the theory, practice, and process of modern genetic counseling.