Bioethics Discussion Blog: Insurance Companies and Genetic Information

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Sunday, April 10, 2005

Insurance Companies and Genetic Information

A visitor to my "Bioethics Discussion Pages" today wrote the following:

"...here is my response to
the bioethical question of should insurance companies have the right to
request and receive the results of genetic tests of close relatives or
the person requesting insurance?

In my opinion, insurance companies have no right to genetic testing
results from individuals or members of a persons family. If these
results are provided to insurance companies the whole health care system
could be sent downward. Insurance companies would then have the ability
to identify high risk patients and either cancel their coverage or raise
the premium to a point where the patient is unable to afford them. An
insurance companies responsibility is to provide a safety net for the
unexpected, hence the name insurance. It is very unethical for
insurance companies to pick and choose there clients based on the
patients genetic testing. If an individual chooses to have genetic
testing done, it is often to help plan the patients life. These
individuals should not have to worry about whether these test results
will affect the ability to receive proper health care if and when a
predicted disease comes to be."


AND apparently supporting the view of this visitor, the American Medical Association Code of Medical Ethics has stated the following in their section on Insurance Companies and Genetic Information:


"Physicians should not participate in genetic testing by health insurance companies to predict a person’s predisposition for disease. As a corollary, it may be necessary for physicians to maintain separate files for genetic testing results to ensure that the results are not sent to health insurance companies when requests for copies of patient medical records are fulfilled. Physicians who withhold testing results should inform insurance companies that, when medical records are sent, genetic testing results are not included. This disclosure should occur with all patients, not just those who have undergone genetic testing. (IV)Issued June 1994 based on the report 'Physician Participation in Genetic Testing by Health Insurance Companies,' adopted June 1993; Updated June 1996."


One would think that if an insurance company was to function and survive as a resource provider for society, it would have to base it's decision to accept a customer for health insurance and death insurance on some kind of probability determination of illness or death. Insurance companies would argue that the more reliable the data for estimating probablility the better for the company. The question arises as to whether genetic information in all cases really provides reliable data with regard to health outcomes. Since much genetic information related to diseases is not predictive that the individual will actually develop that disease, use of such data would be misleading and perhaps bias the true status of the customer. The extrapolation of genetic data from one individual to family members is also likely to be non-predictive and most importantly would represent an unethical if not illegal invasion of privacy. Are there any visitors in the insurance business out there to present the company's side of the argument? ..Maurice.

1 Comments:

At Sunday, April 17, 2005 6:06:00 AM, Blogger Dave Schuler said...

I'm not in the insurance industry but I've operated on its periphery long enough to have a pretty good idea of the argument. Insurance isn't a safety net so much as it's a wager. When you purchase health insurance, you're betting the insurance company that you'll get sick or injured; the insurance company is betting that you won't. The issue is what sorts of things affect the odds and whether you know that they affect the odds.

So if you know that you're already sick (pre-existing condition), for example, that changes the odds. Let me ask a question: is is acceptable for an insurance company to ask about family health history? Why or why not? How is this different from genetic information?

I love matchmaking and I know of a great blogger who's an actuary—I'll see if I can interest him in posting on this question.

 

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