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September 22/29, 1999

Protection Under the Americans With Disabilities Act

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(12):1131-1132. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922

To the Editor: In attempting to define who should be protected by the Americans With Disabilities Act (ADA), Mr Gostin and colleagues1 failed to mention the critical distinction between risk factors (eg, carriage of a BRCA1 mutation for breast cancer) and presymptomatic disease (eg, human immunodeficiency virus carriage or cervical dysplasia). The former is not a disease and may never manifest with illness and disability. To paraphrase Judge Ginsberg, no rational legislature would require nondiscrimination because of risk for a disease that may never become manifest. If we wish to allow "disability" to continue to have real meaning, we must be careful to distinguish between disability that is inevitable, as in the case of presymptomatic disease, and disability that is potential, as in the presence of risk factors.

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