Genetic tests in the insurance system: criteria for a moral evaluation

Abstract

An increasing number of genetic tests are available as an early spin-off from human genetic research. Beyond their application in the context of medical diagnosis there are other possible domains of use: e.g. in the testing of individuals asking for life or health insurance. It is claimed that individuals with an increased genetic risk might have to pay higher premiums or, worse, might be unable to obtain insurance coverage at all.The main question discussed in this paper will be whether there is a right to health and/or life insurance coverage without prior genetic testing. The legal regulations of the use of genetic tests in the insurance system are various. While some countries in principle permit the use of (some) genetic tests for the calculation of actuarial risks, others banned genetic tests for non-medical uses; still other countries have not made any explicit provisions up to now.In the face of the attempted harmonisation of legal systems, as well as an increasing commercialisation of the international market for genetic tests, which neglects national borders, providing criteria for a moral evaluation of this issue appears to be a timely and urgent task. The view defended in this paper is that a right to health insurance without genetic testing is legitimised, insofar as health insurance belongs to the provision of elementary requirements, and insofar as the latter is everybody's moral right. On the other hand, it is implausible to postulate a right to life insurance without genetic testing -as long as life insurance is understood to be a part of one's provision of supplementary requirements. Zusammenfassung Als frühes Beiprodukt humangenetischer Forschung stehen heute immer mehr genetische Tests zur Verfügung. Ü ber ihre Anwendung im Bereich medizinischer Diagnose hinaus gibt es weitere mögliche Einsatzbereiche beispielsweise die Ü berprüfung von Personen, die eine Lebens-oder Krankenversicherung abschließen möchten. Es wird behauptet, dass Personen mit einem erhöhten genetischen Risiko möglicherweise höhere Prämien zahlen müssen oder gar von solchem Versicherungsschutz ganz ausgeschlossen werden könnten. Die in diesem Beitrag diskutierte Hauptfrage ist, ob Personen, die sich keinem genetischen Test unterzogen haben, dennoch ein Recht auf Kranken-und/oder Lebensversicherung beanspruchen können. Es gibt eine Reihe gesetzlicher Regelungen zum Einsatz genetischer Tests im Bereich des Versicherungssystems. Während die Anwendung (mancher) genetischer Tests zur Berechnung versicherungsmathematischer Risiken in manchen Ländern grundsätzlich erlaubt ist, ist sie in anderen verboten, sofern sie nichtmedizinischen Zwecken dient. In wieder anderen Ländern existieren bis heute überhaupt noch keine expliziten Regelungen. Angesichts der Bemühungen zur Harmonisierung der Rechtssysteme und der zunehmenden Kommerzialisierung des internationalen Marktes für genetische Tests ohne Rücksicht auf nationale Grenzen, erscheint es dringend notwendig, Kriterien für eine Beurteilung dieses Problemkreises unter moralischen Gesicht...

Practical Importance of Genetic Research Results when Developing an Insurance Product for Personal Insurance: International Experience

“…The prohibition on genetic testing is primarily considered as legitimate in case of exercising the right to health insurance that is the moral right of everyone in a civilized society because in terms of social policy, the need in basic health care differs greatly from the need to replace income and protect assets which is characteristic of personal insurance. At the same time, it is recognized that it is impossible to postulate the right to life insurance without genetic testing if the concluded agreement provides a wider insurance coverage [14].…”

Genetic Testing for Neurologic Disorders

“…In some countries, specific laws ban the use of genetic information completely or in certain contexts. 33,34 For example, to protect the prospective insured, explicit acquisition and use of genetic results, or even the question whether any genetic analysis has been performed, may be prohibited. In contrast-and absurdly-however, information about phenotypic traits that can clearly point at genetic disease (e.g., Down's syndrome) and obtaining family history, which also clearly asks about genetic risk, does not violate legal regulations.…”