When people undergo genetic testing—something that is happening with growing frequency—they bring their religion with them.

Rituals, texts, patterns of meaning, social support systems, and moral authorities as old as Moses are all in the room when samples are drawn and results are presented. Genes and Genesis, high tech and old text, statistics and scripture, probabilities and providence fuse together in novel patterns of understanding and misunderstanding. In genetic testing and counseling, it is family and parenthood, life and God that are tested and interpreted, not merely genes.

Any health care professional who provides genetic testing services knows how difficult it is to help patients understand the meaning of such screening. Information must be presented in a clear and comprehensible way, and the patient's cultural sensitivities must be respected. But more than that, anyone helping patients understand genetic testing must know at least a little bit about how religion might affect the way people understand genetics and make decisions related to the test results.

Consider, for example, how a Christian couple might understand the meaning of a prenatal genetic test. If the test reveals a problem with the fetus, many people would consider terminating the pregnancy. But this might be profoundly offensive to the couple because it runs counter to core convictions, not so much about the fetus as about God and trust and acceptance of imperfection.

Sometimes Christians choose in favor of faith, which can mean an openness to loss, grief, and imperfection. Such a rejection of medical and genetic rationality can be nearly incomprehensible to those who do not understand its grounds. After all, why not embrace the control that genetics offers? Why not do the sensible thing and do it automatically, without any deep hesitation? Why do some Christians refuse to accept the offer of technological control over life's vulnerabilities and pains? How can anyone defend such irrationality, such wholesale rejection of the ethos of modern medicine?

It is not that Christians seek pain for themselves, much less for their unborn children. Indeed, herein lies a deep and unresolvable conflict. On the one hand, some Christians may reject excessive reliance on technology to avoid contact with pain and will instead be willing to allow life to unfold on its own terms, trusting its Creator not for perfect health but for perfect love. But on the other hand, a Christian mother or couple might also feel a deep religious motivation to protect new life from pain and suffering. For a Christian, the decision about therapeutic abortion is not made on the basis of a simple calculus of risk and benefit. That would be too easy. It is instead a decision made in that costly space between two inescapable obligations, to accept unconditionally the new life within and to protect that life from pain and suffering. Between these two obligations there is no compromise and no sensible middle ground, only anguish followed by grief.

Such grief is not relieved by diminishing the status of the unborn, saying it is only a fetus, only potential, not yet a child, nor by suggesting that those who grieve should "try again," as if a replacement removes grief. What may be true biologically and even theologically is not true in the experience of parental love. Aborted or not, this is a child, irreplaceable, wanted, loved, grieved.

A therapeutic abortion may be the most intensely moral of the religious questions raised by clinical genetics. But it is not the only question. Questions about the future and its determination, the goodness of the Creator, and the nature of religious community also arise with distressing urgency.

For example, when a Christian learns that she tests positive for BRCA1, what is she to think of her future? Should she think that her health and perhaps that of her daughters is determined by fatalistic processes and that she will develop breast cancer? Of course genetics will help to challenge that outlook. But as a Christian, she may also bring her own built-in rejection of such fatalism. She has been taught not to trust in horoscopes, and while she will distinguish between a genetic test and astrology, she will tend to reject the idea that anyone can use an exotic technique to predict her future. More profoundly, she will see the creation as open always to the effects of free actions, her own and God's. So of course she will accept the idea that her behavior will count in determining the course of the disease. She might even think it is possible that by her actions or God's, the mutation or its possible effects can be reversed. Precisely where non-Christians may exaggerate fatalism, Christians may underestimate the power of genes and the predictions of genetics.

Beneath this lies a deeper issue, namely, the goodness of the Creator. What kind of God allows genetic diseases to destroy a life before it begins? What kind of creator allows cells to become cancerous, allowing a basic mechanism of life, the proliferation of cells, to go haywire and destroy the whole body? How can a loving God allow such tiny errors to cause such catastrophic suffering? What is this thing called a genetic defect? Does God create defects?

Or are genetic defects a result of sin? That, of course, is the classic Christian answer. Disease and distress in nature result from human sin, that of Adam and Eve but also our own. Contemporary theologians will no longer defend that view, at least as a comprehensive explanation of natural causes of suffering, but it is still commonly held among the faithful. Evolution and genetics combine here to correct what traditional theology has taught, but very little has been done by today's theologians to offer a new view of creation in light of evolution and genetics.

The challenge to theology is great. On the one hand, theology needs to maintain its view that God is creator and therefore involved in the origins of the fundamental processes of life. On the other, few will want to implicate God directly as the cause of a particular DNA sequence or its mutation. How can we affirm that God is our creator without blaming God for our inborn imperfections or our inherited propensities to disease? The question stumps academic theologians. Little wonder, then, that it will distress the ordinary believer.

This is distressing because much more is at stake than academic theology. At issue is the believer's experience of the closeness of God and the extent to which the believer may trust God. De-linking God from mutations may protect God from blame for causing pain and disease. But it also tends to make God distant, uninvolved, and inconsequential. Herein lies a quandary, or as religious people would prefer to say, a mystery. It must be true that God did not cause the mutation that killed my child. It must at the same time also be true that God is near, active, trustworthy, a strong and abiding companion. Can both be true? Can God be held blameless for not acting to prevent a lethal mutation and still be trusted to act like God?

The quandary is not new, but it is experienced today with brutal clarity when a believer needs to trust God in a circumstance where it seems the Creator has failed and we have discovered the molecular mechanisms of the failure. It is no exaggeration to say that on top of everything else, an adverse genetic report is a crisis of faith, shaking the believer's confidence in a trustworthy God.

A less subtle quandary lies in the believer's desire for privacy and community. Faith is lived in community, and one of the great strengths of religion is the shared support that comes from others within a faith community. Many churches formalize this support by announcing requests for prayer or even publishing a prayer list. And what would be more appropriate for a prayer list than a woman undergoing a prenatal genetic test or a person learning about a genetic risk for cancer? These are the sorts of things that Christians share.

But sharing means giving up privacy, and even in the church, there is a risk that information shared may become information misused. Religious people are not naive about how information may be used against them or their extended family. They know that their nonreligious relatives can be harmed because information is shared at church. So if they have to choos between privacy and community, they may be forced to choose privacy. But that is a painful loss because it is in community that the faithful so often sustain each other through every kind of test, including genetic tests.

To be religious is to be a person-in-community, to have one's life defined by rituals and text and a social network that can be closer than family. Those who offer genetic tests and dare to interpret them need to see how religion often defines the ultimate meaning attached to the result.

Ronald Cole-Turner, professor of Theology and Ethics at Pittsburgh Theological Seminary, is an ordained minister of the United Church of Christ and chairs the UCC committee on genetics. He is the author of The New Genesis: Theology and the Genetic Revolution, co-author of Pastoral Genetics: Theology and Care at the Beginning of Life, and editor of Human Cloning: Religious Responses.