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Book and Media Reviews
June 18, 2008

DNA: Promise and Peril

JAMA. 2008;299(23):2801-2802. doi:10.1001/jama.299.23.2801

Imagine you are an Orthodox Ashkenazi Jew with a family history of Tay-Sachs disease (an untreatable recessive genetic disease that results in death during infancy). Your prospective marriage partner has a similar history. You each test positive as carriers of the disease. Your rabbi informs you that abortion is not an option. You and your prospective partner agree not to get married to avoid the possibility of bringing a Tay-Sachs–afflicted child into the world. Your community applauds your decision and works to find you other acceptable partners. Now imagine that you are a medical insurer. A recently married couple, each with a family history of Tay-Sachs, applies for medical insurance. Your company insists that the couple be tested for carrier status before issuing an insurance policy. The results are positive for both applicants. Your company decides to issue an insurance policy only on condition that any pregnancy resulting in a Tay-Sachs infant will not be covered, nor will any medical costs incurred by such an infant. The insurance applicants charge that your company is coercing them to have an abortion in the case of a Tay-Sachs pregnancy.

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