IDEAS home Printed from
   My bibliography  Save this article

Contending visions in the evolution of genetic medicine: The case of cancer genetic services in Ontario, Canada


  • Miller, Fiona Alice
  • Giacomini, Mita
  • Ahern, Catherine


Growth in genetic medicine has provoked debate about how new and emerging genetic services should be provided, and specifically, what roles non-genetic clinicians should assume. We address this question through a qualitative interview based case study of the program in genetic testing for the hereditary cancer syndromes (breast/ovarian and colorectal) in Ontario, Canada. We argue that two communities offer parallel visions of cancer genetic care: one "genetic," the other "oncologic." Both communities argue from precedent that cancer genetics is a natural extension of their work: it is "what we do." Both communities also highlight the importance of their own expertise in providing core elements of cancer genetic care: it requires "what we know." Further, both communities perceive the need for leadership by their own (or a related) community as genetic medicine expands to include a broader array of more common and complex diseases: it is expanding "where we're leading." Yet, the "we's" articulating these visions are not reducible to professional identity; rather, both represent distinctive "communities of practice and discourse" that are constructed in relation to institutionalized professional roles, and interactions with the genetic technologies (both tests and counselling) themselves. Available literature on the role of diverse health care professionals in the provision of genetic health care presumes a fixed identity and set of approaches for each professional group that might play a role. Further, existing models tend to assume that genetic technologies are given as tools, and that service organization concerns primarily questions of who will have access to these tools and their powers, as well as the consequent professional and ethical responsibilities. Yet questions about who will control genetic technologies are not simply turf battles between the professions: they are also inescapably questions about what the genetic technologies should and will accomplish clinically.

Suggested Citation

  • Miller, Fiona Alice & Giacomini, Mita & Ahern, Catherine, 2008. "Contending visions in the evolution of genetic medicine: The case of cancer genetic services in Ontario, Canada," Social Science & Medicine, Elsevier, vol. 67(1), pages 152-160, July.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:1:p:152-160

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Robins, Rosemary & Metcalfe, Sylvia, 2004. "Integrating genetics as practices of primary care," Social Science & Medicine, Elsevier, vol. 59(2), pages 223-233, July.
    2. Koch, Lene & Nordahl Svendsen, Mette, 2005. "Providing solutions-defining problems: the imperative of disease prevention in genetic counselling," Social Science & Medicine, Elsevier, vol. 60(4), pages 823-832, February.
    3. Lehoux, Pascale & Daudelin, Geneviève & Poland, Blake & Andrews, Gavin J. & Holmes, Dave, 2007. "Designing a better place for patients: Professional struggles surrounding satellite and mobile dialysis units," Social Science & Medicine, Elsevier, vol. 65(7), pages 1536-1548, October.
    Full references (including those not matched with items on IDEAS)


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:67:y:2008:i:1:p:152-160. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.