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Why results from genetic tests should be available to medical insurance companies (P 395)

January 28, 2004

Authors of a Viewpoint article in this week's issue of THE LANCET discuss the ethical considerations surrounding genetic test results and disclosure to medical insurance companies-the authors outline their reasons for supporting the disclosure of such test results to make health insurance more equitable.

Nick Raithatha and Richard D Smith from the University of East anglia, UK, discuss the public concern that genetic testing will be misused by insurers, discriminating between those identified as low risk and high risk. The ethical arguments related to this concern rely on the nature and predictive power of the test, the requirement for the test, and disclosure of the test result. The authors discuss these issues, using the example of two individuals at increased risk of coronary heart disease. Individual A has a higher risk of the disease compared with the age and sex adjusted average, identified by a blood cholesterol test, and individual B has the same increase in risk, but it was identified by a hypothetical genetic test. At present, individual A has to declare this information to the insurance company, whereas individual B does not. The authors comment: 'Our contention is that this situation is unjustifiable, that genetic testing poses no new ethical issues compared with already accepted (non-genetic) practices adopted by insurance companies, but rather that the present inconsistency concerning disclosure of results of genetic and non-genetic based tests seems unethical. The shortage of information on the links between genetic status, lifestyle, and future health might make use of genetic tests inappropriate, rather than unethical, for premium assessment. However, with the rapid progress made in the area of genetics, these links may soon be clearly established, and our contention is based on this development.'

Dr Raithatha concludes: "Perhaps the biggest obstacle remains public perception of genetic testing. The primary task facing the medical community is to acknowledge and seek to reassure patients that, in terms of fairness, this novel medical (genetic) test needs to be dealt with in a similar manner to other tests required by insurance companies."

Lancet