'Relatively Speaking' : relativisation of genetic risk in counselling for predictive testing

The activity of risk communication in the healthcare setting is contingent upon the associated notions of uncertainty, normality and decision making. Focusing on the context of counselling for predictive genetic testing, we point out that because there is 'medical' uncertainty surrounding such testing, the discourse of risk assessment concerning an unwanted event is articulated in terms of the likelihood (in objective, probabilistic language) and the relative aversiveness (in subjective, evaluative language) of the different possible test results. Our data, taken from counselling clinics for Huntington's Disease and Familial Cancers (of the breast and colon), allow us to make a distinction between the risk that the genetic disorder will manifest (the 'risk of occurrence of disease') and the risk that might arise from undergoing genetic tests to clarify that risk (the 'risk of knowing'). In a given counselling session, both types of risks - the strictly genetic risk of occurrence of disease, and the more contextual risk of 'knowing' - become conflated, and in fact the risk of occurrence of disease is understood in the light of the other, external risk factors. We suggest the analytic notion of relativisation to capture this dynamics and go on to identify six discourse strategies that are used by participants, i.e., abstraction, reformulation, externalisation, localisation, temporalisation and agentivisation. Although it is not possible to determine the exact valency of these discourse strategies and plot them into a continuum, we argue that these strategy-types are selectively and cumulatively drawn upon by both counsellors and clients so as to escalate or de-escalate the risks under discussion. These manoeuvres serve as a way of managing the pragmatically informed decision-making process, while simultaneously attending to the relevant epistemological levels of uncertainty