Paths of legal recognition of genetic counselors in Canada: A framework for action

Abstract

Genetic counseling is not a legally recognized profession in the majority of Canadian provinces and territories. Research indicates that genetic counselors (GCs) are becoming increasingly autonomous, expanding their presence beyond genetics clinics within academic institutions. In certain clinical settings, they serve as the sole healthcare practitioners with expertise in genetics. Alongside this increasing professional autonomy, research also highlights that the unregulated practice of genetic counseling poses risks of harm to the health and well‐being of the public. This underscores the need for legal recognition to protect and mitigate these risks. Achieving legal recognition can be a lengthy and complex process, often requiring the fulfillment of stringent legal criteria and significant resources. While previous initiatives in Canada have faced challenges, interest in legal recognition for GCs remains strong. To support GCs in their ongoing and future efforts to achieve legal recognition, this article synthesizes the findings of a series of Working Group discussions on legal recognition. Based on these discussions, we propose a set of Points to Consider and a roadmap that GCs can use in their pursuits of legal recognition. Although the pathway to legal recognition will vary by jurisdiction, this article highlights key factors that GCs should consider when applying for legal recognition to help facilitate both current and future initiatives. While this article focuses on the legal recognition process in Canada, our roadmap may also be useful for GCs in other jurisdictions where legal recognition may be sought.

What is known about this topic

In Canada, legal recognition serves to regulate professions that, if not properly regulated, can expose the public to the risk of harm. Previous scholarship has highlighted the need for regulation and identified legislative models that can be used to regulate genetic counseling.

What this paper adds to the topic

This article proposes a roadmap for achieving legal recognition based on discussions with primary interested parties. It supplements previous scholarship on the legal recognition of genetic counselors by proposing Points to Consider to help advance legal recognition initiatives in Canada and beyond.

1. INTRODUCTION

Genetic counseling is not a legally recognized profession in the majority of Canadian provinces and territories. Consequently, most genetic counselors (GCs) in Canada are not governed by legislation that ensures safe, competent, and ethical practice. As the practice of genetic counseling is rapidly expanding in Canada, there is an increasing need for regulation to promote public protection through mechanisms such as professional entry requirements, title protection, and formal standards of practice (Lambert et al., 2022; Patrinos et al., 2020; Shugar et al., 2017; Zawati, 2012, 2018).

Legal recognition serves to protect the public by regulating professions that, if not properly regulated, pose risks of harm to the health, safety, and well‐being of the public. In Canada, research has shown that GCs hold roles that directly or indirectly impact patient care, often performing these roles with minimal or no supervision by regulated healthcare providers, such as medical geneticists (Knoppers et al., 2025; Rojas et al., 2025). Risks of harm in the unregulated practice of genetic counseling have been previously explored in the literature and include title misuse, incomplete risk assessment, inaccurate test interpretation, as well as psychological and financial harms (Bensend et al., 2014; Knoppers et al., 2025; NSGC, 2016; Rojas et al., 2025; Shugar et al., 2017).

Interest in legal recognition is quickly gaining momentum, both in Canada and internationally, with several calls for regulation in the literature (Hoskins et al., 2021; Lambert et al., 2022; Patrinos et al., 2020; Shugar et al., 2017; Zawati, 2012, 2018) and by professional associations and regulatory bodies. In 2011, for instance, the Canadian Association of Genetic Counselors (CAGC) formed the Professional Governance Committee (PGC) to address issues regarding the regulation of GCs in Canada. Among its recommendations, the PGC proposed that the CAGC endorse a move toward regulation in Canada (CAGC Professional Governance Committee, 2014). Similarly, in 2014, the Commission de l'éthique en science et technologie, a governmental body established by the Government of Quebec to advise on ethical issues related to science and technology, called on the Office des Professions (the provincial professional supervisory body) to legally regulate genetic counseling in the province (Commission de l'éthique en science et en technologie, 2014).

Despite these recommendations, prior efforts for legal recognition in Canada have been largely unsuccessful. However, GCs in the province of Manitoba have obtained limited recognition through a delegation model, which allows physicians to delegate the act of communicating the diagnosis of a genetic disease or disorder to a GC under specific conditions (Government of Manitoba, 2018).

In 2018, the GenCOUNSEL project, the first research project to examine the genetic counseling issues associated with the clinical implementation of genome‐wide sequencing (GWS), was launched (Borle et al., 2021). A multi‐pronged project composed of four activities, GenCOUNSEL comprises a multidisciplinary research team including GCs, clinical geneticists, health economists, and specialists in ethics, law, and policy. Its overarching objectives are to better understand the current and future needs for GCs, to investigate and develop best practices for the delivery of genetic counseling services, to improve access to genetic counseling, in particular for underserved patient populations, and to develop a framework for the legal recognition of GCs in Canada (BCCHR, 2025). Figure 1 represents the objectives and research activities of the GenCOUNSEL project. As part of the policy component of GenCOUNSEL, our team at the Centre of Genomics and Policy, housed at McGill University, was tasked with determining the feasibility of and developing a roadmap for legal recognition.

FIGURE 1.

Objectives and research activities of GenCOUNSEL.

The initial stages of our research explored the implications of the lack of legal recognition of GCs in Canada and identified models of recognition available under Canadian law. The findings from this research have been published previously (Lambert et al., 2022; Patrinos et al., 2020) and are summarized in Table 1. Our team's subsequent research sought to better understand the roles of GCs across different settings in the context of nonregulation (Knoppers et al., 2025; Rojas et al., 2025). The final stage of our research was to determine the feasibility of these models. This process involved creating a series of Working Groups, composed of primary interested parties, including GCs, a patient representative, and directors of genetic counseling training programs, to help develop recommendations that can be used by GCs in their future efforts to pursue legal recognition. Figure 2 represents the main research activities of the policy component of the GenCOUNSEL project.

TABLE 1.

Models of legal recognition under Canadian Law (Lambert et al., 2022; Patrinos et al., 2020).

Model	Description
Constitution of a professional order	Creation of an independent regulatory body to govern the profession through mechanisms such as regulating admission to the profession, title protection, continuing education, and disciplinary measures.
Inclusion in a professional order	Integration into an existing professional order, typically with significant overlap with the integrating profession.
Delegation	Adoption of legislation or regulations that permit members of a regulated profession to delegate the performance of legally reserved acts, such as communicating a diagnosis, to members of another profession.

FIGURE 2.

Policy component of GenCOUNSEL.

The Working Groups represent the culmination of this policy research. Engaging with interested parties to review our research provided practical insights into the feasibility of the models of legal recognition, helped identify areas of concern and priority, and contributed to building a roadmap to help future legal recognition efforts in Canada.

In this article, we first describe the development of the Working Groups, their respective mandates, and our analysis of the group discussions. Next, we summarize the key findings from each Working Group meeting in the form of Points to Consider. Finally, based on these points, we propose a roadmap for legal recognition that GCs and professional associations can use in their efforts to pursue legal recognition in their respective jurisdictions. While this article specifically focuses on the Canadian context, we hope the lessons learned from our research will be useful to GCs in other jurisdictions, where the genetic counseling profession is rapidly growing and evolving (Muraresku et al., 2024; Ormond et al., 2023, 2024).

2. METHODS

2.1. Recruitment

Our initial research focused primarily on the regulatory aspects of legal recognition. While meeting the formal criteria for legal recognition is essential, nonlegal factors also influence the legal recognition process. There are many practical, administrative, and organizational considerations that can affect whether legal recognition is feasible within a given province and which model of legal recognition would be most viable (Lambert et al., 2022). Indeed, achieving legal recognition can be a lengthy and complex process that demands significant resources. Previous efforts to achieve legal recognition in Canada have been unsuccessful, mainly due to the relatively small number of GCs and the costs associated with regulation (Abacan et al., 2019; Lambert et al., 2022). Nonlegal factors, therefore play an important role in obtaining legal recognition.

To better understand these factors, we formed three Working Groups, focusing on three key areas of focus: professional regulation, education, and implementation (the organizational and administrative aspects of legal recognition, such as coordination, human and financial resources, and advocacy). The groups were composed of primary interested parties who could provide valuable insights on the practical factors associated with legal recognition: GCs, directors of the Canadian MSc training programs, and a patient representative.

Potential Working Group members were initially identified through the GenCOUNSEL research team's professional networks. To recruit additional GC members, we met with the CAGC Office in May 2022 to discuss a strategy for issuing calls for expressions of interest to CAGC members. The call for expressions of interest included descriptions of both the GenCOUNSEL project and the Working Group mandates, as well as the expected timelines and time commitments for the Working Group meetings. Subsequently, the CAGC Office issued a call to its members via its organizational distribution list. The responses received were subsequently provided to us for the purposes of recruitment. Our inclusion criteria required that GCs be practicing, board‐certified GCs (certified by either ABGC or CBGC). All GCs who responded to our call for expressions of interest met the inclusion criteria and were included in our Working Groups. For the Educational Working Group, we directly contacted the directors of the MSc programs.

Although we aimed to include other parties, such as medical geneticists and other healthcare providers who work alongside GCs, and to include representation from all provinces and territories, due to challenges in recruitment, we were not able to include these additional parties and achieve complete national representation in our final group compositions.

Similar to our initial recruitment of GCs, we also sought to recruit non‐GC members from the informal professional networks of our research team, which enabled us to include one patient representative. Although we attempted to recruit medical geneticists for our working groups, none of the candidates we invited were ultimately able to participate due to time constraints. Our recruitment efforts did not extend to professional organizations such as the Canadian College of Medical Geneticists (CCMG), which may have limited participation from this group. Overall, our recruitment strategy focused primarily on GC networks, which may have limited the diversity of candidates and our ability to recruit non‐GC members.

2.2. Working group meetings

The mandate of the first group, the Professional Regulation Working Group, was to discuss the merits and drawbacks of legal recognition (Lambert et al., 2022; Patrinos et al., 2020). Its work provided the foundation for the subsequent Working Groups.

Furthermore, if genetic counseling were to become legally recognized, university training programs would need to adapt their curricula to ensure they meet the standards set by regulatory bodies. This could involve incorporating specific legal, ethical, and professional guidelines into training, updating certification processes, and establishing more structured frameworks for clinical practice. Accordingly, the mandate of the second group, the Educational Working Group, was to consider potential changes to university curricula in anticipation of future legal recognition initiatives. This group was composed of directors from the Canadian MSc genetic counseling programs.

Finally, the mandate of the third group, the Implementation Working Group, was to share insights from previous applications for legal recognition, discuss the practical and administrative aspects of these applications, and develop an action plan for future efforts. This group consisted of GCs who had prior experience applying for legal recognition or held leadership roles within professional GC associations. A patient representative, the parent of a rare disease patient, also participated to ensure that patient perspectives and the importance of patient involvement would be reflected in future legal recognition initiatives. We held one meeting for each Working Group. Prior to each meeting, members were provided with a short briefing document with the meeting's agenda and discussion points.

2.3. Analysis

The outcomes of the Working Group discussions were documented by DP and AEB through structured summaries that captured the main points raised, areas of agreement, and issues for further reflection. The meetings, which were held via Zoom, were recorded and transcribed by AEB and SL. This process was intended as transparent descriptive documentation rather than interpretive analysis. The structure of all meetings and our subsequent analyses were all informed by Reason & Bradbury's “Participative Inquiry and Practice” (2008).

As previously mentioned, before each meeting, we provided Working Group members with our topics for discussion. These topics were informed by our prior research on this topic (Lambert et al., 2022; Patrinos et al., 2020), as well as regulation‐related documents available via the CAGC, CBGC, NSGC, and ABCG. These topics were tailored to each Working Group's mandate. We recorded and transcribed their responses into a summary format, which we subsequently shared with members for their feedback, in line with participatory practices of collective reflection and representation (Reason & Bradbury, 2008). We then compiled these summaries, which represent the points of discussion that were either the subject of consensus among Working Group members or those with the majority agreement, into a set of Points to Consider.

3. RESULTS OF THE WORKING GROUP DISCUSSIONS: KEY POINTS TO CONSIDER FOR LEGAL RECOGNITION

3.1. Professional regulation working group

To discuss the types of factors that should be considered in seeking legal recognition, the Professional Regulation Working Group met in October 2022 to: (1) discuss the practical advantages and disadvantages of each model of legal recognition and (2) share experiences of working in multi‐ or interdisciplinary teams and associated challenges that may influence future legal recognition initiatives.

Overall, the deliberations of the group highlighted the divergent needs for legal recognition across different jurisdictions and the factors that may influence the feasibility of each model of legal recognition. To begin considering legal recognition in their jurisdictions, GCs should: (1) assess the relative feasibility of the three models of legal recognition and (2) consider the factors that will guide their applications for legal recognition.

3.1.1. The constitution of a professional order

There was broad agreement among members that the constitution of a professional order would be the ideal model, as it would grant GCs the highest level of professional autonomy. Members emphasized that the primary reason for advocating greater professional autonomy was to allow GCs to tailor their practice to patient needs. They also noted that greater autonomy would benefit the profession itself by fostering professional growth, creating more jobs, and improving access to care for patients.

Nevertheless, members recognized the challenges of implementing this model in most provinces, primarily due to the small size of GC workforces, lack of governmental recognition of the risks associated with genetic counseling, and significant financial barriers. They also expressed concerns about potential conflicts of interest in complaints and disciplinary proceedings, given the difficulty of ensuring impartiality within the small GC workforces in Canada. However, members noted that if these barriers could be overcome, the constitution of a professional order would be the ideal model, particularly in provinces with larger GC workforces.

3.1.2. Inclusion in a professional order

Working Group members highlighted several advantages of this model. First, integrating GCs into an existing professional order would be more feasible for provinces with smaller GC workforces, as it could help avoid potential conflicts of interest by ensuring that professional oversight includes members from both professions (i.e., the existing profession and GCs). Additionally, joining an established professional order would allow GCs to learn from and gain experience in managing a professional order—knowledge and experience that could later be leveraged to establish an independent professional order for GCs.

Nevertheless, some members expressed concerns that joining an existing order might restrict their professional autonomy. Moreover, the dual nature of genetic counseling, which comprises both medical and therapeutic aspects, could make it challenging to identify an existing order sufficiently related to genetic counseling. Overall, however, members acknowledged the benefits of integration into an existing professional order, particularly given the relatively small numbers of GCs in Canada compared to other professions.

3.1.3. Delegation

Delegation was the least preferred model among members, despite being the most attainable, as it requires fewer legal formalities than the other two models of legal recognition. The main concern was the lack of professional autonomy, as delegation inherently depends on the supervision and oversight of delegating physicians. Members also expressed concerns about professional responsibilities in the event of patient injury. Additionally, depending on the province and its professional legislation, delegation may not be available in all provinces. Ultimately, delegation would simply formalize existing working relationships with physicians without granting GCs professional autonomy.

3.1.4. Points to consider

• Legal recognition can be a complex and lengthy process, requiring consideration of various practical, organizational, and administrative factors.

• There are three models of legal recognition available to GCs under Canadian law (Table 1). Although each model has its own advantages and disadvantages, the constitution of a professional order was the preferred model among the Professional Regulation Working Group members, as it would grant GCs greater professional autonomy.

  1. The first two models provide a higher degree of public protection and professional autonomy than delegation. However, there are logistical and financial barriers, as well as potential risks of conflicts of interest. The constitution of a professional order may be more feasible for jurisdictions with larger GC workforces.
  2. Inclusion in a professional order and delegation may be more feasible for jurisdictions with smaller GC workforces. Integrated within an existing professional order may also help GCs learn from and gain experience through collaboration with another professional order.
  3. Delegation may not be an available model in some provinces. It was the least preferred model among working group members, as it does not provide the same level of professional autonomy as the other models. However, delegation is the most straightforward model to implement, as it does not require meeting the formal legal criteria imposed by the other models.

3.2. Educational working group

The Educational Working Group convened in January 2023 to discuss potential changes to university curricula to reflect future legal recognition initiatives. The group consisted of directors from the MSc genetic counseling programs in Canada.

The training of GCs will be an important factor for future legal recognition initiatives. Regulation helps protect the public from the risk of harm, in part by accrediting educational programs, setting professional admission requirements (e.g., education and training programs), and maintaining continuing education and professional development programs. As a result, if genetic counseling becomes legally recognized, training programs may need to adapt their curricula. This section outlines key considerations for university training programs in Canada, as identified by the Educational Working Group: curriculum changes, program structures (specifically program quotas, length of training, and inter‐program collaboration), professional certification, and program accreditation.

There are currently five MSc programs in genetic counseling in Canada: the University of British Columbia, the University of Manitoba, the University of Toronto, the Université de Montréal, and McGill University (QAGC, 2025). All programs last for two years. Except for the Université de Montréal, all programs have achieved and maintained full accreditation by the Accreditation Council for Genetic Counseling (ACGC). The ACGC is the organization responsible for accrediting master's‐level genetic counseling programs in the United States and Canada. It sets and enforces educational standards to ensure programs adequately prepare students for professional certification and practice (ACGC, 2025a).

Throughout each program, trainees develop a broad array of practice‐based competencies, including effective communication, counseling skills, and advanced knowledge spanning diverse areas of genetic counseling practice. The programs involve coursework, fieldwork placements in medical settings, and a research component. Each program admits three to eight students per year (Table 2). Graduates will usually proceed with certification by the CBGC and/or ACGC (QAGC, 2025). Due to limited training programs and available spots in Canada, several graduates choose to pursue education in the United States, where there are more accredited training programs (ACGC, 2025b). Table 2 provides an overview of key information on Canadian training programs. Data were obtained from each program's institutional website (McGill University, 2025; Université de Montréal, 2025; University of British Columbia, 2025; University of Manitoba, 2025; University of Toronto, 2025). Note that we did not review curricula or course syllabi for each program.

TABLE 2.

Overview of genetic counseling training programs in Canada.

	Université de Montréal (Université de Montréal, 2025)	McGill University (Human Genetics Department, 2025)	University of Toronto (University of Toronto, 2025)	University of Manitoba (University of Manitoba, 2025)	University of British Columbia (University of British Columbia, 2025)
Program Quota	5 per year	5 per year	6 per year	3 per year	8 per year
Program Length	2 years (5 semesters)	2 years (4 semesters +4–8 weeks summer rotation)	2 years (4 semesters)	2 years with a summer external elective ‐thesis‐based program	2 years
ACGC (Program) Accreditation	No	Yes	Yes	Yes	Yes
Certification (Canada/United States)	Not Eligible for ABGC (US). Yes, for CBGC (Can)	Eligible for ABGC and CBGC	Eligible for ABGC and CBGC	Eligible for ABGC and CBGC	Eligible for ABGC and CBGC
Examination pass rate for first‐time test takers	N/A	Cumulative Board Examination pass rates (first‐ time test takers) for last 3 most recent classes: ABGC: 77% CBGC: 83.3%	94% on the first attempt within the last three graduating classes (ABGC and/or CBGC)	100% cumulative board pass rates for the CBGC and/or ABGC (for first‐time test takers in the last 3 years)	2019–2022: 100% (CBGC) for first‐time takers 2022–2024: 83% (ABGC) for first‐time takers
Job placement rate in genetic counseling‐related positions	N/A	For last 3 years: 100%	For the last 3 years (within 3 months of graduating): 78%	For the last 3 years: 100%	100% of graduates from 2020 to 2022

3.2.1. Program quotas

Working Group members generally agreed that increasing the number of genetic counseling students would require an expanded workforce to supervise students during their fieldwork placements and research projects. This would necessitate more funding for genetic counseling within healthcare institutions. With more practicing GCs, program quotas could be increased. However, one member noted that they did not see a clear correlation between program quotas and legal recognition.

There was consensus that financial barriers are the primary obstacle in increasing program quotas. Members emphasized the strong demand for genetic counseling programs, as evidenced by the number of yearly applicants far exceeding the available positions (Genetic Counselor Educators Association, 2025).

3.2.2. Length of training

Working Group members agreed that a two‐year MSc program is the most effective length of training. Extending the program would exacerbate the shortage of supervisors for these programs, and there is little evidence to suggest that a longer program would increase the caliber of GCs. As such, members considered the two‐year MSc program to be sufficient to prepare students for certification and employment.

3.2.3. Inter‐program coordination and curricular changes

Members expressed a willingness to increase inter‐program discussion and collaboration, which could prove essential for the continued support of legal recognition initiatives for GCs across Canada. Additionally, members showed interest in incorporating materials on legal recognition and implementing courses on the ethico‐legal aspects of genetic counseling into program curricula. Notably, the University de Montréal offers a three‐credit course on the ethical, legal, and societal aspects of genetic counseling, where issues related to legal recognition and professional responsibility are addressed. This could serve as a model for other MSc programs looking to include similar content in their curricula.

3.2.4. Organizational issues

Organizational issues within universities were noted as obstacles to the visibility and autonomy of genetic counseling programs. Some members noted that, apart from medical geneticists, other healthcare professionals are generally not accustomed to working with unregulated practitioners like GCs. They therefore believed that title protection—through regulation—would lend GCs greater professional “legitimacy” when working with non‐geneticist colleagues. The need for title protection was further emphasized when some members raised the issue of private practice, where patients may have limited familiarity with the qualifications of GCs; in this setting, title protection would serve to indicate professional legitimacy and trust (Patrinos et al., 2020).

3.2.5. Certification and accreditation

As previously discussed, all but one of the Canadian training programs (the Université de Montréal) are ACGC‐accredited. Members widely agreed that the lack of a Canadian accreditation body for the training programs is an important issue, especially as there are now five training programs in Canada. A Canadian accreditation body would establish a set of requirements and standards for the country.

In Canada, GCs may become certified through either the American Board of Genetic Counseling (ABGC) or the Canadian Board of Genetic Counseling (CBGC), except for graduates of the Université de Montréal program, who are only eligible for CBGC certification. Certification is granted upon fulfilling criteria to ensure that the trainee has the knowledge, skills, and expertise required to practice genetic counseling (ABGC, 2025; CBGC, 2025b). CBGC certification is founded on the competencies as outlined by the Practice‐Based Competencies and Knowledge‐Based Competencies documents (CBGC, 2023).

Eligibility for CBGC certification entails completion of a Master's degree from an ACGC‐accredited program, with additional certification pathways available for graduates of non‐ACGC‐accredited master's programs (CBGC, 2025d). Certification ensures accountability to the public by signaling that required competencies and skills have been achieved (CBGC, 2025b). Furthermore, maintaining certification and pursuing continued education demonstrate a commitment to the continued provision of quality of care (CBGC, 2025b).

The criteria for certification closely align with those required for legal recognition. During the Working Group meeting, program directors suggested that, for the moment, the most straightforward path to legal recognition would be to make CBGC certification a legal requirement for GC practice. This approach is similar to that in the United States, where ABGC certification is a requirement for licensure in certain states (Abacan et al., 2019).

3.2.6. Points to consider

• Integrating ethical and legal considerations into program curricula can promote internal awareness of current professional issues.

• As a first step toward legal recognition, the CBGC certification process could be “imported” as a legal requirement for GC practice.

3.3. Implementation working group

The final group, the Implementation Working Group, composed of GCs and a patient representative, convened to discuss the practical and administrative aspects of legal recognition and to deliberate on points of action for future legal recognition initiatives. This section summarizes the Working Group's discussions.

3.3.1. Practical and administrative aspects of legal recognition

Some members of the Working Group had previously been involved in provincial applications for legal recognition or are currently involved in such initiatives. For example, in Alberta, GCs have applied to join the College of Physicians and Surgeons of Alberta; the process of which is currently pending.

Members involved in prior legal recognition initiatives noted encountering many challenges, both practical and administrative, in their efforts. For example, they highlighted the lack of documented harms in genetic counseling in Canada. In Quebec, this resulted in GC's application for legal recognition being given lower priority by the provincial government. Furthermore, one member pointed out that in their province, there was no mechanism for applying for legal recognition due to the pending implementation of the new health professions' regulatory structure.

The main barrier, however, has been the significant resources required to assemble an application for legal recognition. Previous applications have generally been siloed, with few GCs leading these initiatives with limited support from interested parties. In these prior efforts, GCs have volunteered their time to work on assembling applications for legal recognition, dedicating substantial time to understanding the intricacies of professional regulation, with limited resources and support. As GCs are not trained as lobbyists or strategists, past legal recognition initiatives have had little to no political impact. Nevertheless, the resources required to secure external lobbying support can be significant and limiting.

Additionally, the lack of resources and support is not simply due to a lack of interest within the genetic counseling community. Genetic counseling is a relatively small profession in Canada, which generally translates to limited human and financial resources. Beyond the fees associated with regulation, GCs may also need to obtain liability insurance, which can add additional financial burdens. Indeed, one member acknowledged that while many GCs may view regulation as beneficial, they questioned whether the benefits would outweigh the costs.

3.3.2. Plan of action

After discussing the practical and administrative aspects of legal recognition, members focused on how to move forward with legal recognition initiatives in Canada. They identified engaging with interested parties as an effective strategy for building support for legal recognition. The involvement of patient representative groups was emphasized as critical for future initiatives. In fact, the patient representative expressed enthusiasm about involving patients in legal recognition efforts.

Additionally, members emphasized the importance of securing leadership and support from medical geneticists. They also pointed out that the CAGC had previously established a task force on professional regulation, which was interrupted by the pandemic. Furthermore, they noted that the CAGC has a strong media brand that could be leveraged to build support for legal recognition. Indeed, in 2017, the CAGC Board of Directors mandated the creation of an independent body, the CBGC, to oversee the national certification of GCs. This helped ensure that the mission of protecting the public through Canadian credentialing was not at odds with the CAGC's mission of advocating for the genetic counseling profession in Canada.

One important factor raised by members in building support for legal recognition was the establishment of provincial professional associations. Distinct from professional orders, professional associations serve to promote the interests of the profession and its members. In Alberta, GCs had met with government officials, who advised the creation of a professional association. Working Group members highlighted the importance of ensuring that GCs applying for legal recognition in their jurisdiction represent the majority of GCs, compared to prior siloed initiatives that were led by small groups of GCs. Establishing professional associations would help ensure that future applications for legal recognition reflect the collective voices of GCs. To date, there are five provincial genetic counseling associations in Canada (Table 3) (CAGC, 2025).

TABLE 3.

List of provincial genetic counseling associations in Canada.

Province	Association
Alberta	Alberta Association of Genetic Counselors
British Columbia (joint association with the Yukon Territory)	The Society of Genetic Counselors in British Columbia and the Yukon
Manitoba	Association of Genetic Counselors in Manitoba
Ontario	Ontario Association of Genetic Counselors
Quebec	Quebec Association of Genetic Counselors

While professional regulation falls under provincial jurisdiction in Canada (Patrinos et al., 2020), members supported the sharing of experiences across provinces and fostering coordination at the national level. They suggested that the CBGC and CAGC could serve as platforms for national collaboration, as all provinces share common goals of public protection and increasing accessibility to care. The availability of tools, literature, and historical knowledge related to legal recognition initiatives was seen as crucial to share nationally. Indeed, there has long been national interest in establishing national licensing systems for healthcare providers in Canada. Such a system would also help improve interprovincial mobility and highlight the importance of taking a collaborative national, rather than piecemeal, approach to legal recognition.

Members agreed that GCs, through their professional associations, should invest in public relations and communication strategies to foster public awareness and engagement with the regulatory process. Members also viewed the allocation of sufficient funds for the development of communication materials, press releases, and related efforts as essential. Furthermore, they prioritized the formation of a dedicated group with a well‐defined mandate to engage with diverse interested parties. Additionally, they noted that fostering informal communication channels among leaders involved in legal recognition initiatives would enable collaboration across provinces.

Members highlighted that resources concerning legal recognition are currently available in Canada. The CAGC, for instance, provides a list of provincial, national, and international genetic counseling organizations on its website (CAGC, 2025). It also has a section on its Members‐only website dedicated to regulation. Furthermore, the CBGC offers credentialing certification exams and is well established to serve as a partner in provincial regulation. Its website also contains regulation‐related resources and tools that could be further used as a central repository (CBGC, 2025a). The Ontario Association of Genetic Counselors (OACG) also includes materials on regulation on their website (OAGC, 2025).

Finally, while legal requirements for legal recognition are primarily concerned with risks of harm to the public, some members suggested that future arguments for legal recognition should focus on how such recognition could help decrease barriers to accessing care, which would help strengthen the case for legal recognition. Members also highlighted that legal recognition is tied to good stewardship and responsible delivery of healthcare.

3.3.3. Key points to consider

• Engagement from non‐GC interested parties, including patient representatives and medical geneticists, will be important in building support for future legal recognition initiatives. Steps should be taken in the future to engage, gain buy‐in, and support from medical geneticists and other non‐GC interested parties.

• The establishment of provincial professional associations will play a key role in applications for legal recognition, providing increased professional visibility, unified leadership, and stronger lobbying power.

• While legal recognition occurs at the provincial level, adopting a national approach will help build greater support and momentum for legal recognition.

4. DISCUSSION: DEVELOPING A ROADMAP FOR LEGAL RECOGNITION

In the preceding section, we outlined key points to consider based on each Working Group's discussions. Drawing on these points and our previous research, we now propose a roadmap for GCs seeking legal recognition within their respective jurisdictions. This roadmap is intended to provide a foundational framework for future efforts toward legal recognition and may be adapted by GCs to reflect the specific needs of their provincial and professional contexts.

4.1. Laying the groundwork: Assess the needs, resources, and perspectives of the GC community

As a first step, it will be important for GCs to better understand the current landscape of the profession in their respective jurisdictions, which includes, but is not limited to, the number of GCs, the number of consultations, the requirements for practice, and the availability of resources. In particular, available financial and human resources should be assessed, as these factors may influence the feasibility of pursuing legal recognition in their jurisdiction. As previously mentioned, the relatively low number of GCs and the costs of pursuing regulation have been the main reasons why prior efforts have had limited success (Abacan et al., 2019). Properly assessing these resources will help determine whether legal recognition would be feasible and which model(s) of legal recognition would be most achievable.

Furthermore, the perspectives of GCs on legal recognition within each province should also be gathered to better inform which model(s) best align with the realities and preferences of the GC workforce. Finally, the formation of professional associations, as proposed by the Implementation Working Group, can help increase the visibility of the profession and ensure greater consensus among GCs on the question of legal recognition.

4.2. Conduct legislative research

As a next step, professional regulation legislation should be researched to identify the models of legal recognition available in the relevant jurisdiction and their associated legislative requirements. While our previous work discusses these models (Lambert et al., 2022; Patrinos et al., 2020), legislation can vary across provinces and may include different requirements. Furthermore, GCs must determine the relevant governmental authority to which to apply for legal recognition, whether it be a Ministry or a designated regulatory body. This may differ depending on which model is being pursued.

4.3. Obtain external support and advocacy

In addition to internal support from the GC community, the CBGC or CAGC should be consulted to provide national guidance and support for legal recognition initiatives in the different provinces. Furthermore, involving other interested parties, such as patient representative groups, medical geneticists, and other healthcare providers who work with GCs, can help build broader support for legal recognition by highlighting the crucial roles played by GCs in the healthcare system. Additionally, support from professional lobbyists could be sought to help establish an action plan, strategize, educate, and represent the interests of GCs. Information from the National Society of Genetic Counselors (NSGC) regarding hiring lobbyists is available through the CBGC (CBGC, 2025c), though its practical application in Canada may require adaptation due to differences in regulatory and political environments between Canada and the United States. Furthermore, the strong media brand built by the CAGC could also be leveraged to advocate and educate on legal recognition and build better public relations.

4.4. Define qualification processes for Canadian GCs

National certification for Canadian GCs is managed by the CBGC (CBGC, 2025b). The criteria for certification—training, experience, competencies – closely align with the criteria for legal recognition. Drawing from licensure models in the United States, CBGC certification could serve as a first step toward legal recognition and become a legal requirement for GC practice. Furthermore, the creation of an accreditation body for Canadian GC programs can promote professional identity, define scopes of practice, and establish educational standards for GCs in Canada. It is important to note that, while CBGC certification is the most common standard in Canada, some Canadian GCs are only ABGC‐certified (Lambert et al., 2022). Canadian employers typically accept ABGC certification, and the CBGC currently provides a credentialing pathway for ABGC diplomates to apply for Canadian credential reciprocity (CBGC, 2025d).

4.5. Engage in National‐level Discussions

Although legal recognition occurs at the provincial level in Canada, the formation of a national working group or task force on legal recognition, as has previously been done by the CAGC, can help build and maintain support for legal recognition. Resources and experiences should be shared between provinces, making efforts more collaborative compared to prior “siloed” approaches. For a relatively small profession like genetic counseling in Canada, this national‐sharing approach can be especially beneficial. Indeed, siloed approaches may lead to missed opportunities to learn from other provincial experiences, challenges, and successes. A collaborative approach can help provinces build on each other's efforts and adapt existing strategies.

4.6. Limitations and future directions

Limitations of our research include the small sample size of Working Group members. We were not able to ensure GC and non‐GC representation from all provinces and regions of Canada. Excluding our Educational Working Group, our group compositions were not fully representative of the larger Canadian GC community. Furthermore, it is possible that the individuals who agreed to participate in our working groups may have had stronger opinions, more extensive knowledge, and greater interest in legal recognition than other GCs. This self‐selection may have introduced bias, as members' views might not fully represent the wider Canadian GC community.

Our Working Group discussions took place in late 2022 through early 2023, when the COVID‐19 pandemic was still ongoing. At that time, GCs and other healthcare providers were experiencing significant workload pressures, which may have significantly affected their ability to commit to participating in our Working Group discussions. This aligns with recent research conducted with GCs and other healthcare providers (Haley & Zawati, 2024; Knoppers et al., 2025).

Furthermore, our supporting data sources on Canadian MSc programs may not fully reflect the scope or accuracy of program structures and content. Online information can be incomplete or outdated and may not capture how these programs are implemented in practice.

Future research should aim to include and better represent perspectives from key interested parties that were missing or underrepresented in our Working Groups. Including medical geneticists will be critical in future pursuits of legal recognition. In recent initiatives in other jurisdictions, the support of medical geneticists has been crucial (Hoskins et al., 2021), and research has shown that medical geneticists are supportive of regulation and increasing integration of GCs into the healthcare system (Knoppers et al., 2025; Lungu et al., 2025). Additionally, input from regulatory bodies, healthcare policy makers, and other related healthcare professional associations will be critical to understanding the broader landscape of legal recognition.

Furthermore, during our Educational Working Group discussions, the reasons why a Canadian accrediting body has not been established were not explored. Future research should investigate why such an organization has not yet been established. This will help better understand potential barriers to professional recognition and the formalization of accreditation processes within Canada. Future research should explore the feasibility of establishing such a body, considering factors such as regulatory frameworks, funding, and support from interested parties. Additionally, research should examine the experiences of other professions in Canada and internationally to identify potential accreditation models for genetic counseling.

5. CONCLUSION

Legal recognition serves to protect the public by regulating professions that, if not properly regulated, pose risks of harm to the health, safety, and well‐being of the public. Legal recognition can also benefit the profession itself, increasing its visibility and granting it greater professional autonomy (Lambert et al., 2022; Patrinos et al., 2020). As previous efforts for legal recognition in Canada have demonstrated, the process to achieve regulation can be lengthy and complex, requiring careful consideration of several legal, organizational, and administrative factors. Indeed, it can take several years for a profession to gain legal recognition, especially when creating a professional order or integrating into an existing one, as these processes require the adoption or amendment of legislation, which can be a lengthy process.

Prior efforts for legal recognition in Canada have encountered significant challenges, although GCs in the province of Manitoba have achieved recognition through a limited delegation model (Government of Manitoba, 2018; Lambert et al., 2022). Nevertheless, interest in legal recognition is rapidly growing, making it necessary to develop a strategy that can be used by GCs across Canada in their pursuit of legal recognition. This article represents the culmination of several years of policy research on the legal recognition of genetic counseling in Canada as part of the pan‐Canadian GenCOUNSEL project. Building on this research, this article outlines the process and outcomes of our Working Groups, with the objective of developing recommendations for legal recognition. It outlines Points to Consider and provides a roadmap for legal recognition for Canadian GCs.

As legal recognition occurs at the provincial level in Canada, the specifics of legal recognition will necessarily vary between provinces. Nonetheless, our article highlights the key factors that GCs and professional associations wishing to apply for legal recognition should consider to facilitate the process. We also hope it may provide useful considerations for GCs in other jurisdictions where legal recognition may be sought.

AUTHOR CONTRIBUTIONS

Dimitri Patrinos: Conceptualization; writing—original draft; writing—review and editing. Ana Eliza Bonilha: Conceptualization; writing—original draft; writing—review and editing. Bartha Maria Knoppers: Conceptualization, funding acquisition, project administration, resources, supervision, writing—review and editing. Alison M. Elliott: Funding acquisition, project administration, resources, supervision, writing—review and editing. Ma'n H. Zawati: Conceptualization, funding acquisition, project administration, resources, supervision, writing—original draft, and writing—review and editing. All authors gave final approval of this version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

CONFLICT OF INTEREST STATEMENT

The authors all declare that they have no conflict of interest.

ETHICS STATEMENT

Human Studies and Informed Consent: No human studies were carried out by the authors for this article.

Animal Studies: No nonhuman animal studies were carried out by the authors for this article.

AI STATEMENT

The authors did not use AI or AI‐assisted technologies during the preparation of this manuscript.

APPENDIX A.

GenCOUNSEL was funded through the Large Scale Applied Research Project (LSARP) Genome Canada competition with co‐funding from: Canadian Institute for Health Research (CIHR), Genome BC, Genome Quebec, Provincial Health Services Authority, BC Children's Hospital Foundation, and BC Women's Hospital Foundation. The GenCOUNSEL Study is led by Alison M. Elliott, Jehannine Austin, Bartha Maria Knoppers, and Larry D. Lynd with Project Manager Alivia Dey, and includes the following co‐investigators: Shelin Adam, Nick Bansback, Patricia Birch, Lorne Clarke, Nick Dragojlovic, Jan Friedman, Deborah M. Lambert, Daryl Pullman, Alice Virani, Wyeth Wasserman, and Ma'n H. Zawati.

Patrinos, D. , Bonilha, A. E. , Knoppers, B. M. , Elliott, A. M. , Zawati, M. H. , & (2026). Paths of legal recognition of genetic counselors in Canada: A framework for action. Journal of Genetic Counseling, 35, e70159. 10.1002/jgc4.70159

DATA AVAILABILITY STATEMENT

All data is shown in Tables 2 and 3.