Ableism is a value: The limits of the reciprocal-engagement model in prenatal care

Prenatal genetic counselors hold obligations to patients and to the wider community, including disabled people. The profession's commitment to disabled people is best encapsulated by NSGC's 2024 disability position statement, which “denounce[s] ableism.” However, the major model of practice, the reciprocal-engagement model (REM), is not well-equipped to dislodge ableism in prenatal care and reproductive decision-making because it treats ableism as an information deficit and prioritizes patient values and self-esteem. Research shows that education alone is often not enough to dislodge ableism because ableism is itself a value system that is deeply embedded in beliefs, practices, and habits. Yet, REM offers few clear mechanisms for deliberating values or the meaning of disability with patients. Rather, patient values are privileged, even when they might conflict with the genetic counseling profession's values. In effect, the REM may lead counselors to tacitly endorse ableism in the pursuit of providing patient support. This article argues that prenatal genetic counselors might better thread the needle to both support patients and uphold their professional commitments to disabled people through developing a “rhetorical mode” of counseling in addition to the education and counseling modes. Drawing from the ancient discipline of rhetoric, such a mode could both help prenatal genetic counselors articulate an anti-ableist professional position and invite patients to engage in intentional deliberation about ableism and disability.