RISK ASSESSMENT IN PREDICTIVE GENETIC TESTING FOR INSURANCE PURPOSES. Catarina Lisboa N

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1 RISK ASSESSMENT IN PREDICTIVE GENETIC TESTING FOR INSURANCE PURPOSES HEALTH LAW AND BIOETHICS Professor Helena Pereira de Melo Catarina Lisboa N

2 GENES AND CHROMOSOME Genes contains instructions that determine most of our features (e.g. eye color, height). Chromosomes are ribbon-shaped structures which contain genes. Almost every single cell of our body contains 46 chromosomes, inherited half from the mother and half from the father (two sets of 23 pairs ). DNA is the substance in which chromosomes, and therefore genes, are stored.

3 FIGURE 1. GENES, CHROMOSOMES AND DNA

4 GENETIC DISEASES Sometimes in a copy of a gene or chromosome an error occurs: we have a mutation. Mutations may cause various genetic diseases, such as: the common "Down Syndrome Amyloidosis cystic fibrosis Duchenne muscular dystrophy

5 GENETIC TESTING Medical test normally used to: identify changes in chromosomes, genes or proteins; find changes that are associated with inherited disorders.

6 GENETIC INFORMATION Includes information about an individual s genetic tests as well as information about the manifestation of a disease or disorder in an individual s family members. Often used to determine whether someone has an increased risk of getting a disease, disorder, or condition in the future.

7 PREDICTIVE GENETIC TESTS Used to detect gene mutations associated with disorders that appear after birth, often later in life. Can identify mutations that increase a person s risk of developing disorders with a genetic basis, such as certain types of cancer. Can provide information about a person s risk of developing a specific disorder and help with making decisions about medical care.

8 PREDICTIVE GENETIC TESTS Portuguese personal genetic and health information law Article 10 Tests of heterozygosity, presymptomatic, predictive and prenatal 3 - Predictive genetic tests are considered those that allow the detection of susceptibility genes, known as a genetic predisposition for a disease with complex inheritance, with onset usually in adult life.

9 GENETICS AND INSURANCE Not only to prevent diseases, diagnosis and treatment. Non-medical purposes, such as insurance decision-making. Genetic test as an advantage to the insurer when underwriting. Accurate genetic prediction is difficult and varies with the disease and type of test available.

10 (UN)PREDICTIVE GENETIC TESTS The probabilities and susceptibility Current limits in technology and understanding Evolution of techniques.

11 ETHICAL ANALYSIS Denial of insurance on the basis of genetic traits. Consequences to individuals, families and society at large. Genetic discrimination.

12 LEGAL SOLUTIONS Portuguese personal genetic and health information law Article 12 Genetic testing and insurance 1 - Insurance companies cannot ask for or use any type of genetic information to deny life insurance or set higher premiums. 2 - Insurance companies cannot ask potential ensured to perform genetic tests for the purpose of life insurance, health or other purposes.

13 LEGAL SOLUTIONS Genetic Information Nondiscrimination Act, USA Prohibition on genetic information in setting premium rates. A health insurance issuer offering health insurance coverage in the individual market shall not adjust premium or contribution amounts for an individual on the basis of genetic information concerning the individual or a family member of the individual.

14 LEGAL SOLUTIONS Convention on Human Rights and Biomedicine Article 12 Predictive genetic tests Tests which are predictive of genetic diseases or which serve either to identify the subject as a carrier of a gene responsible for a disease or to detect a genetic predisposition or susceptibility to a disease may be performed only for health purposes or for scientific research linked to health purposes, and subject to appropriate genetic counselling

15 FOR SELF-REFLECTION Knowing a person's probability of having a genetic disease, could it determine the acceptance of a life insurance? Is it fair that a genetic test result affects the health and life insurance amount? If you knew you had a genetic predisposition for having a certain disease, would you tend to immediately get a life or health insurance? Would it be fair for insurance companies?

16 CONCLUSIONS The benefits of genetic testing are numerous to public health, particularly concerning the prevention, diagnosis and treatment of diseases. But they can bring several ethical problems, partly because of a mistaken judge that genes are everything in humans. We could then move from Democracy to Genocracy. There must be a proper balance between the genetic information for medical and nonmedical purposes. Careful consideration of criteria and requirements needed to reconcile the interests of the individual person (fundamental rights) with the interests of insurers.

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