Disclosure of genetic tests for health insurance: is it ethical not to?
| Autor: | Nick Raithatha, Richard D. Smith |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Actuarial science
Insurance Health business.industry Self-insurance Coronary Disease General Medicine Liability insurance Group insurance Disclosure General insurance United Kingdom Fees and Charges Predictive Value of Tests Insurance policy Life insurance Auto insurance risk selection Medicine Humans Casualty insurance Genetic Predisposition to Disease Genetic Testing business Genetic Privacy |
| Zdroj: | Lancet (London, England). 363(9406) |
| ISSN: | 1474-547X |
| Popis: | Preparing medical reports for patients seeking health insurance is part of normal general practice: health insurance in this context covers critical illness and disability cover, income protection and long-term care, and life insurance. Doctors routinely report family history, results of investigations, and findings of clinical examinations. However, genetic tests usually cause doctors and applicants apprehension. In the UK, there is debate about whether genetic tests raise novel ethical issues, or whether simply that genetic tests themselves are novel and we need to apply them consistently with other disclosures. This debate concerns so-called genetic exceptionalism, in which genetic tests are seen as exceptional or different from other tests. For example, Wolf 1 argues that family history and other medical tests are not substantively different to genetic tests. Private insurance works on a mutuality basis, whereby individuals contribute to a pool of funds at a premium based on their specific risk at the time the insurance is taken out. The risk is subject to the uberrima fides principle, that the individual declares all relevant medical (eg, cholesterol concentration), lifestyle (eg, smoking), and other (eg, family history) information, and the insurer justifies the premium on actuarial grounds—ie, expected cost of care per year. 2 By contrast, the solidarity basis for insurance is based on losses according to need and premiums fixed or based on ability to pay, and is the basis for social insurance, such as the UK National Health Service. Insurers in a mutuality system generally work on risk groupings, tolerating within-group variance in risk because of the high costs of fine-tuning for individuals. However, precise determination of individual risk leads to accurate actuarial premiums and an efficient insurance market. 3 |
| Databáze: | OpenAIRE |
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