Genetic Discrimination
One
ethical issue on the genetic horizon that has already begun to
take focus is genetic discrimination. A possible scenario runs like this. In the next few years researchers
will identify and locate most, if not all, genes in the human
genome that either condition or in some cases cause disease. Already
we know that the gene for Cystic Fibrosis is found on chromosome
7 and the gene for Huntington’s disease on chromosome 4.
Alzheimer’s disease is probably due to a defective gene on
chromosome 21, and certain incidences of colon cancer to one on
chromosome 2. Disposition to muscular dystrophy, sickle-cell anemia,
Tay-Sachs disease, certain cancers and numerous other diseases
also have locatable genetic origins. More knowledge is yet to
come. When it comes, it may be accompanied by an inexpensive method
for testing the genome of each individual to see if he or she
has any genes for any diseases. Screening for all genetic diseases
may become routine for newborns, just as testing for phenylketonuria
(PKU) has been since the 1960s. A person’s individual genome
would become part of a data bank to which each of us, as well
as our health care providers, would have future access. The advantage
is clear: medical
care from birth to grave could be carefully planned to delay onset,
appropriately treat, and perhaps even cure genetically based diseases.
This
is an unlikely scenario, however. As good as it may sound, the
specter of genetic discrimination may slow it down, if not retard
it completely. Any grand plan to employ new genetic knowledge
for preventive health care for Americans is likely to be impeded,
if not blocked entirely, by the U.S. system of financing medical
care through commercial insurance. The problem begins with insurability,
and may end up in a form of discrimination that for genetic reasons
prevents certain individuals from obtaining employment and, hence,
medical services. Even with a government regulated program of
access to basic health services, the need to purchase supplemental
insurance to cover serious diseases makes many of us with certain
genetic configurations vulnerable to discrimination.
Insurance
works by sharing risk. When risk is uncertain to all, then all
can be asked to contribute equally to the insurance pool. Premiums
can be equalized. Once the genetic disorders of individuals become
known, however, this could justify higher premiums for those demonstrating
greater risk. The greater the risk, the higher the premium. Insurance
may even be denied those whose genes predict extended or expensive
medical treatment.
For
three-quarters of Americans, medical insurance is tied to employment.
Among the Fortune 500, twelve companies already report using genetic
screening for employment purposes. Although screening in the past
was justified initially for public health purposes, employers
may increasingly be motivated to use screening to cut premium
costs for the medical insurance they pay on behalf of employees.
Underwriters already deny or limit coverage to some gene-related
conditions such as sickle-cell anemia, atherosclerosis, Huntington’s
disease, Down’s syndrome, and muscular dystrophy.This list could increase.. Between thirty to forty million persons
in the United States currently live with insufficient or no medical
coverage; and, despite its promises for a better life, HGP could
inadvertently add a whole new class of poor and uninsured people.
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| Contributed by: Dr. Ted Peters
|
