Education of the rabbinical and genetic counseling communities to promote culturally sensitive genetic testing decisions for the Orthodox Jewish patient

The tight-knit Orthodox Jewish community offers unique views on topics of prenatal testing, abortion, and carrier screening. These views gain relevance in the prenatal genetic counseling setting in which Orthodox Jewish patients are confronted with choices carrying profound religious and cultural implications. Rabbis typically offer spiritual guidance through a personalized interpretation of the Jewish law (the halacha) based on the specific situation of the Orthodox Jewish person or couple. While having religious context is an important aspect of decision-making for Orthodox Jewish patients, genetic topics are often left out of the discussion even though they may play an integral role in the decision. This omission is problematic when one considers the many reasons for which rabbis may be counseling congregants on their own and its effect on immediate and future reproductive decisions. Physicians have been referring fewer Orthodox Jewish patients to genetic counseling because of the assumption that religious constraints would lead such patients to decline genetic testing. In addition, the genetic counseling community has been seen by some to be coercive and insensitive to the unique needs of the Orthodox Jewish population. There has been an awareness of the void between the Orthodox Jewish and genetic counseling communities but it has not been filled. Spiritual assessment tools have been marketed to the genetic counseling profession but many factors have contributed to their lack of widespread use in sessions. This paper expands on how educating the rabbinical community about genetic topics, as well as encouraging the genetic counseling community to incorporate spiritual assessment tools into counseling sessions, has the potential to promote culturally sensitive genetic testing decisions for the Orthodox Jewish patient.