{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:09:10Z","timestamp":1788761350474,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Genetic counseling is undergoing a rapid transformation as genomic medicine becomes embedded within mainstream healthcare systems. At the same time, the profession is being challenged to respond to systemic racism, colonial legacies, technological change, and evolving expectations regarding equity and justice. Historically, genetic counseling emerged within twentieth\u2010century medical genetics and was influenced by political, social, scientific, and medical forces that included eugenic ideology, values, and practices. The profession has since evolved substantially toward psychosocial, patient\u2010centered, and non\u2010directive models of care. Contemporary debates regarding \u201cnewgenics\u201d or \u201cneugenics\u201d further demonstrate how concerns regarding equity, reproductive ethics, disability, and genomic stratification continue to shape genomic healthcare discourse. This qualitative reflexive practice paper explores how systemic racism, colonial legacy, cultural safety and structural power shape genetic counseling practice in the United Kingdom (UK), Aotearoa New Zealand and Australia, and how these forces continue to reshape the profession's future identity. A reflexive, narrative, and comparative qualitative approach was employed, grounded in the authors' lived professional experiences across UK and Australasian contexts and informed by purposively selected policy, professional and scholarly literature relating to cultural safety, dignity, anti\u2010racism, and Human Rights\u2010Based Decision\u2010Making. Through iterative reflexive dialogue, comparative analysis, and thematic synthesis, four interrelated themes were developed examining sociopolitical context, systemic racism, cultural safety and technologization within contemporary genetic counseling practice. Comparative analysis identified substantial differences in how culturally responsive practice is conceptualized and operationalized across settings. In Aotearoa, cultural safety is strongly shaped by Te Tiriti o Waitangi, bicultural accountability, and M\u0101ori sovereignty frameworks. In Australia, culturally safer genomic care has increasingly developed through Indigenous\u2010led initiatives and workforce reform, including the Australian Alliance for Indigenous Genomics (ALIGN). In contrast, UK practice remains largely situated within equality, diversity, and inclusion (EDI) frameworks that may insufficiently address systemic racism and structural power within increasingly diverse populations. Reflexive clinical examples demonstrated how inequities may emerge through undocumented patient values, standardized pathways, assumptions regarding autonomy, and misinterpretation of culturally specific communication styles. Re\u2010imagining the future of genetic counseling requires more than just technological advancement. It requires reflexive engagement with dignity, inequity, and the sociopolitical realities of the populations served. These insights re\u2010imagine a culturally grounded, socially responsive future for genetic counseling in an era shaped by genomic mainstreaming, digital transformation, artificial intelligence and workforce reform and one in which the profession remains ethically anchored, relationally attuned, and committed to justice\u2010oriented practice.<\/jats:p>","DOI":"10.1002\/jgc4.70279","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:57:03Z","timestamp":1788760623000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["(Re)imagining the Future of Genetic Counseling: A Reflexive Qualitative Analysis of Sociopolitical Power, Cultural Safety, Systemic Racism, and Comparative Practice in the United Kingdom, Aotearoa New Zealand and, Australia"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3494-4512","authenticated-orcid":false,"given":"Subhashini","family":"Crerar","sequence":"first","affiliation":[{"name":"West of Scotland Centre for Genomic Medicine NHS Greater Glasgow and Clyde  Glasgow UK"},{"name":"Genetic Counselling Registration Advisory Board (GCRAB)  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camelia","family":"Harrison","sequence":"additional","affiliation":[{"name":"West of Scotland Centre for Genomic Medicine NHS Greater Glasgow and Clyde  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Australian Genomics Health Alliance.2023.\u201cAustralian Alliance for Indigenous Genomics (ALIGN).\u201dhttps:\/\/www.australiangenomics.org.au\/align\/."},{"key":"e_1_2_12_3_1","unstructured":"Australian Health Practitioner Regulation Agency (Ahpra).2020.\u201cNational Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020\u20132025.\u201dhttps:\/\/www.ahpra.gov.au\/About\u2010Ahpra\/Aboriginal\u2010and\u2010Torres\u2010Strait\u2010Islander\u2010Health\u2010Strategy\/health\u2010and\u2010cultural\u2010safety\u2010strategy.aspx."},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.2217\/pme\u20102019\u20100048"},{"key":"e_1_2_12_5_1","unstructured":"British Society for Genomic Medicine.2024.\u201cEDI Working Group and Strategy.\u201dhttps:\/\/bsgm.org.uk\/media\/12409\/bsgm\u2010edi\u2010policy\u2010final.pdf."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2018.05.001"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939\u2010019\u20101082\u20103"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939\u2010025\u201002478\u20103"},{"key":"e_1_2_12_9_1","volume-title":"Whaiora: M\u0101ori Health Development","author":"Durie M.","year":"1998"},{"key":"e_1_2_12_10_1","unstructured":"Durie M.2005.\u201cIndigenous Health Reforms: Best Health Outcomes for M\u0101ori in New Zealand Paper Presented at the Alberta Symposium on Health Unleashing Innovation in Health Care\u201d."},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/146879410200200205"},{"key":"e_1_2_12_12_1","volume-title":"Reflexivity: A Practical Guide for Researchers in Health and Social Sciences","author":"Finlay L.","year":"2021"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","DOI":"10.1093\/acprof:oso\/9780198237907.001.0001","volume-title":"Epistemic Injustice: Power and the Ethics of Knowing","author":"Fricker M.","year":"2007"},{"key":"e_1_2_12_14_1","unstructured":"Genomics Aotearoa. 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