The best answer to this one is “nothing.” If a couple is considering alternative methods of conceiving a healthy child, such as artificial insemination, or if the couple is going to have prenatal diagnosis and abortion of a defective fetus, they are well advised to tell as few people as possible. If enough people are told, there is certain to be someone who will disagree with the decision out of ignorance or moral outrage. The child may also face ostracism in the family. A grandparent who has a number of biologic grandchildren may not care about a child of artificial insemination. The couple should be counseled to choose their confidants wisely.

If there are other members of the family who may be at risk or are concerned for themselves, they should be encouraged to come to the genetic counselor for their information. Even patients who understand their own problems fairly well can be a mine of misinformation for others. The birth of a child with a congenital defect can stop whole extended families from having children, a tragedy when these other couples may not be at risk.