By Amy Mueller, Michael A. Grodin

from GeneWatch 26-4
Aug-Oct 2013

s.w. anderson / genewatchIntroduction

Advancements in medical genetics have challenged the long-standing relationship between science and religion. Both genetics and religion can affect notions of family and parenthood, appreciation of diversity and equality, conceptualization of health and disease, and personhood. As noted by Larry R. Churchill: "To study the interface of religion and spirituality and genetics is to study the interaction of two powerful interpretive schemes for self-understanding."[1] The implications of this convergence on a personal and public level are largely unknown. A Pubmed search of "genetics and religion" and "genetics" reveals that approximately 0.01% of publications on genetics address religion. This is a deficiency in that a majority of U.S. citizens report an affiliation with a faith tradition[2] and the use of genetic technology can raise morally licit questions, many with an origin in religious doctrine. As varying and increasing genetic analyses become a more accessible and prevalent part of healthcare, it is important to be sensitive to how religion and genetics interface.

To test, or not to test

The 2008 American religious identification survey indicates approximately 80% of the American population surveyed reported a religious self-identification.[3] A majority of U.S. citizens report an affiliation with Christianity, but the prevalence of other religions grows as the population becomes increasingly diverse. As genetics integrates into more areas of medicine, patients and practitioners will confront major questions about the appropriate use of genetic technology. Religions are generally pronatalistic, which implies support for the genetic technology that promotes childbearing. Some studies indicate a negative correlation between attitudes toward genetic testing and religious involvement.[4] Virginia L. Bartlett, Assistant Director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center writes, "Religious affiliation or faith can affect whether one sees the use of genetic testing as a scientific tool, as an illustration of God's creation, or as an unwarranted human intervention..."[5]

The decision of whether or not to order genetic testing can be overwhelming because of both the medical and moral implications. Advancing maternal age and greater access to prenatal care has resulted in more women facing decisions about prenatal genetic testing. How do patients reconcile their medical decisions with religious traditions, such as Catholicism, that prohibit prenatal testing if undertaken with the intention to terminate a pregnancy with a genetic abnormality? Does reproductive genetic technology effect conceptualizations of parenthood and procreation? What are the implications of the use of this technology to various religions that emphasize the importance of kinship and lineage? How do religious themes of "Creation" or "God's will" allow for genetics based intervention? Does use of prenatal testing reveal what characteristics we value and who we value? It is expected that when faced with these and other meaningful questions, many people will look to religion for guidance.

Coping with genetic test results

The field of human genetics has expanded rapidly and the association of genetic variants with phenotypic outcomes in the population has improved the utility of genetic testing. The results of a genetic test can have implications for reproductive capacities, the health of family members and one's own mortality. Thus, the psychosocial consequences of genetic testing can be as significant as the medical effects of the genetic condition itself. Additionally, tests cannot always predict severity, onset or progression of disease because genetic conditions often vary in presentation. When a genetic result presents in the form of a risk, or probability, a person frames the risk using their own experience or values to give it subjective meaning.[6] Decisions can be influenced by personal experience with disease, family dynamics, and social contexts. Depending on one's religious standpoint, a diagnosis could be seen as a curse, a punishment, or even opportunity to experience meaningful suffering. When confronting a grave genetic diagnosis, such as Huntington's disease, or a high cancer risk due to an identified deleterious mutation in the BRCA1 or BRCA2 genes, religiosity is likely to impact if and how a person finds hope or acceptance. Different contexts, goals, fears, and levels of self-determination inevitably lead to variation in how one copes with newborn genetic screening results versus results for an adult onset genetic condition or cancer. However, the degree to which religious beliefs impact a person's interpretation of risk, decisions to get genetic testing, or medical decisions following genetic testing is often unclear and is likely quite personal and individualized.

Challenges for providers

How might internal struggles of genetic professionals regarding personal faith and conflicts in their profession affect patient care? Research has demonstrated that genetic counselors report lower levels of religiosity than the general population.[7] Cragun, Woltanski, and Myers et al. speculate that this may positively influence regard for patient autonomy and tolerance, but they note that more research is necessary to determine the causation and significance of this difference. Alternatively, lower levels of religiosity could result in less familiarity with or sensitivity to religious perspectives. If consideration of religion is another aspect of cultural competency, professionals in genetics must be aware of how their own religious perspectives may influence interaction with patients.

Both genetics professionals and religious leaders may feel unprepared to deal with issues in religion and genetics.[8,9,10] Is it feasible for genetics professionals to address religious issues in the clinic? What resources and referrals would be beneficial? The public has indicated that ability to engage health care providers in religious discussion is important.[11] The development of a religious assessment tool that is geared toward medical genetics could be advantageous. For example, we have developed a mnemonic device that guides genetics professionals through religious assessment in prenatal genetic counseling:


V - What is the value of prenatal testing to you?

         Could this genetic test affect your pregnancy decisions?

         How do you ascribe value to the conditions for which you could test?

         How would you ascribe meaning to a positive result or a negative result?

A - Advise me about your religious beliefs or affiliations.

         Do you consider yourself to be religious?

         Is religion a source of support in your life?

L - Do you see a link between your religious beliefs or doctrines and this situation or decision?

         Does this association influence your ideas about genetic disease or genetic testing?

U - Do you feel any uncertainty?

         If so, what is the source of the uncertainty?

E - If needed, how would you like to extend this conversation?

         Could I make a referral to a spiritual leader?

         Could I make a referral to a support group or parent of a child with the genetic condition?

         When would be a good time to talk again?

S - Summarize the issues, decisions and plan of action.


This template would need to be piloted to determine efficacy. Inviting this discussion is important because, as Rebecca Anderson, attorney and genetic counselor, notes, in a medical setting "patients may assume these topics are 'off limits.'"[12] Significant factors that were found to influence the performance of religious assessment were the genetic counselor's comfort with and perceived relevance of the religious assessment itself.[13] A clearer understanding of what to address, when and why would improve the ability of professionals to navigate this sensitive area.

Policy and Politics

Topics in the realm of family and procreation are effective rallying points in politics and often find a basis in religious doctrine. Hudson, Scott, and Kalfoglou, editors for The Genetics and Public Policy Center, an organization committed to providing unbiased information about genetic technologies, surveyed 1,211 respondents from the general public about reproductive genetic technology (in-vitro fertilization, pre-implantation diagnosis, prenatal testing, or genetic engineering to avoid disease) and preferences about government regulation in 2004.[14] The authors found: "Fifty-four percent think about these technologies primarily in terms of health and safety while 33 percent view them in religious or moral terms." As to be expected, people who conceptualize these issues in the realm of health and safety view genetic technology more favorably than those who think about it in a religious or moral context. Political affiliation was associated with the classification of genetic technologies as health and safety or moral and religiously orientated, with Democrats and Independents favoring the former. However, support for government regulation of genetic testing was politically bipartisan.  How will religion influence public and institutional policy or regulations on medical genetics and the use of genetic technology? How can religiously informed policy in genetics be balanced in a secular, pluralistic society?

Need for research

Religion and medical genetics share similar goals, most important of which is promoting the wellbeing of people.  Consideration of the implications of advances in genetics on all religious paradigms will better serve patients. Religious assessment is a way of opening the doors for dialogue about values that come into play when making decisions regarding genetics. Harold Koenig, co-director of the Center for Spirituality, Theology, and Health at Duke University Medical Center, stated, "Neglecting the spiritual dimension is just like ignoring a patient's social environment or psychological state, and results in failure to treat the whole person." Awareness of the areas of contention in this relationship is the first step toward resolution. Respectful practice and policy will promote more valuable use of genetic technology in medicine.

Amy Mueller received her MPH from Boston University. Michael Grodin, MD, is Professor of Health Law, Bioethics & Human Rights at the Boston University School of Public Health.



1. Churchill LR. Religion, Spirituality, and Genetics: Mapping the Terrain for Research Purposes. Am J Med Genet Part C Semin Med Genet 2009;151C:6-12.

2. Pew Forum on Religion and Public Life. Religious Landscape Survey. 2008.

3. Kosmin BA., Keysay A. American Religious identification survey (ARIS 2008). Hartford: Trinity College.

4. Botoseneanu A, Alexander JA, Banaszak-Holl J. To Test or Not to Test? The Role of Attitudes, Knowledge, and Religious Involvement Among U.S. Adults on Intent-to-Obtain Adult Genetic Testing. Health Educ Behav 2011;38:617-628.

5. Bartlett VL, Johnson RL. God and Genes in the Caring Professions: Clinician and Clergy Perceptions of Religion and Genetics. Am J Med Genet Part C Semin Med Genet. 2009;151:41-51.

6. White, MT. Making sense of genetic uncertainty: the role of religion and spirituality. Am J Med Genet Part C Semin Med Genet 2009;151:68-76.

7. Cragun RT, Woltanski AR, Myers MF, Cragun DL. Genetic Counselors' Religiosity & Spirituality: are genetic counselors different from the general population? J Genet Counsel 2009;18:551-566.

8. Bartlett VL, Johnson RL. God and Genes in the Caring Professions: Clinician and Clergy Perceptions of Religion and Genetics. Am J Med Genet Part C Semin Med Genet. 2009;151:41-51.

9. Lemons J, Ragsdale J, Vaughn L, Grossoehme D. "I didn't know it existed before you called": protestant clergy experience, education and perceptions regarding genetics. J Genet Counsel 2013;22:226-237.

10. Reis LM, Baumiller R, Scrivener W, Yager G, Warran NS. Spiritual Assessment in Genetic Counseling. Journal of Genetic Counseling 2007;16:41-52.

11. Puchalski CM. The role of spirituality in health care Proc (Bayl Univ Med Cent). 2001;14:352-357.

12. Anderson RR. Religious traditions and prenatal genetic counseling. Am J Med Genet C Semin Med Genet. 2009;151C:52-61.

13. Reis LM, Baumiller R, Scrivener W, Yager G, Warran NS. Spiritual Assessment in Genetic Counseling. Journal of Genetic Counseling 2007;16:41-52.

14. Hudson K, Scott J, and A Kalfoglou, eds. Public Awareness and Attitudes about Reproductive Genetic Technology Washington, DC: Genetics and Public Policy Center, 2004.

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