Predictive health information in pre-employment medical examinations

The German National Ethics Council published its Opinion “Predictive health information in pre-employment medical examinations“ in August 2005. The issue addressed by this Opinion is the permissibility of making the conclusion of a private-sector contract of employment or appointment as a permanent civil servant conditional upon the collection and use of predictive health information. The Opinion is thus concerned with the medical potential, the ethical evaluation and the legal limits of the use of information on the risks of illness in the engagement of private-sector employees and permanent civil servants.

There are a number of questions arising in this context: Can a person be compelled by law or on social grounds to generate predictive genetic information about himself and to disclose it to third parties? If one carries a genetic predisposition to a disease that is likely, with a certain degree of probability, to become manifest in the future, or if one is a member of a group with a corresponding familial risk, must one expect to be disadvantaged when, for example, seeking employment or concluding an insurance contract?

A widespread consensus exists on the need for regulation of these matters. Modern medicine and genetics are identifying associations with genetic predispositions for more and more disorders. Each such association permits the development of methods of examination whereby predictive health information can be generated. The collection and use of such information already has a statutory basis in a number of countries; a corresponding law is in preparation in Germany. In this Opinion, the National Ethics Council considers some of the issues in question – in particular, whether it should be permissible to make the conclusion of a contract of employment or appointment as a permanent civil servant conditional upon the collection and use of predictive genetic or non-genetic health information.

The discussion concerns the striking of an appropriate balance between the interests of the private- or public-sector employer, on the one hand, and those of the applicant for a post or for appointment as a permanent civil servant, on the other. The issue for the applicant is the right to informational self-determination. The knowledge that one is at risk of developing a serious illness in the future may cause appreciable distress. Hence no one should have such information forced on him against his will: protection of the right of self-determination in this case entails a right to remain in ignorance. This right may be violated if candidates are required to have their predisposition to future illness established and to disclose it in order to preserve their prospects of engagement for a private-sector post or appointment as a permanent civil servant. Again, it should not be permissible for applicants for private-sector jobs or for appointment as permanent civil servants to be unjustifiably disadvantaged (discriminated against) because they carry a risk of developing a given disease. On the other hand, the private- or public-sector employer has a justified interest in obtaining a fit and efficient employee or civil servant who will not be incapacitated by illness in the foreseeable future. An appropriate balance must be struck between these two interests.

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