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September NaN, 1999

Protection Under the Americans With Disabilities Act—Reply

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

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.

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