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Shouldn't employers
and insurers be allowed to consider the future health – and
associated costs – of applicants for jobs and insurance coverage?
One important
reason to prohibit genetic discrimination is that the information
on which it is based may be wrong. Genetic explanations of illness
are compelling but often unsupported by solid evidence. For example,
the genetic screens of workers that were formerly used in some
industries are no longer considered effective in decreasing work-related
disorders.
Prohibiting
genetic discrimination will prevent adverse consequences from
incorrect attributions of genetic susceptibility or causation.
Alternatively, epidemiological or other scientific validation
can be required as a precondition to the discriminatory use of
genetic information about job or insurance applicants.
Even if a
genetic test accurately identifies the risk of future illness,
discrimination against persons who test positive may be unfair.
Employment
is crucial for self-support and also the means for most persons
in the US to obtain their health insurance. Qualified persons
should not be denied employment merely because of genetic risks
of future illness. The value of individuals' opportunity for employment
and health coverage outweighs the possible savings of employers
and insurers from genetic discrimination.
Nonetheless,
economic and social considerations may sometimes justify genetic
discrimination. Life and health insurance require different sorts
of regulation to avoid unfairness from the use of genetic information,
and genetic discrimination in employment may be warranted in very
limited circumstances involving health and safety.
For example,
when a substance used in the workplace is harmful only to individuals
with a particular genetic variant, the most efficient way to prevent
harm is not to hire those genetically susceptible individuals.
To be equitable, however, the workplace should be cleaned up so
it is safe for everyone, and no one need be excluded because of
genetic susceptibility. But achieving a safe exposure level of
the substance may not be feasible in some cases. If the harm to
genetically susceptible persons would be serious and irreversible,
exclusion of those persons might then be warranted.
Turning to
insurance, most states prohibit any genetic discrimination by
health insurers, but the few states with laws on genetic discrimination
by life insurers prohibit only "unfair" genetic discrimination
in that area. "Unfair" refers to discrimination based on genetic
information that has not been validated as a predictor of early
death.
Thus, the
state laws permit life insurers to discriminate on the basis of
accurate genetic predictions of shortened life. If life insurers
were barred from using genetic information, the pool of insured
persons might be skewed by those who have learned from genetic
testing (but not disclosed to insurers) that they have shortened
life expectations. Such "adverse selection" would make it unfeasible
to provide life insurance.
Gina
Kolata
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