Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
Copyright 1999 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.1999
In Reply: Dr Wendel makes an excellent point
about the distinction between risk factors (eg, BRCA1)
and presymptomatic disease (eg, human immunodeficiency virus infection). A
major social problem posed by genetic advances is the misconception that genes
are our destiny. We respectfully disagree, however, that a distinction should
be drawn for civil rights purposes. As a legal and ethical matter, discrimination
against a person with risk factors is just as inappropriate as discrimination
against a person with presymptomatic disease. Both forms of discrimination
are wrong because the person is adversely treated because of a condition that
does not currently exist. Individuals who are currently able to perform the
essential functions of their job should not be subject to employment discrimination.
Future disability does not justify current discrimination; if and when an
individual becomes sick and loses the ability to perform adequately, then
(and only then) is it morally and legally permissible to take discriminatory
action. Health insurance is more complicated, but the question remains whether
it is morally right to deny individuals coverage for the very disease they
are likely to develop. Since health is a condition necessary for human fulfillment,
strong societal reasons exist for ensuring access to health insurance coverage.
Gostin LO, Feldblum C, Webber DW. Protection Under the Americans With Disabilities Act—Reply. JAMA. 1999;282(12):1131-1132. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922