ACOEM: Genetic screening at work OK if done ethically
Consensus statement urges caution, privacy
Genetic screening of workers, if conducted ethically and legally, "is not conceptually different from other types of medical testing or screening," and can be endorsed when the condition being tested for could affect an employee's job performance, safety, or health, the American College of Occupational and Environmental Medicine (ACOEM) stated in a consensus statement released in December.
"The mapping and sequencing of the human genome has resulted in an explosion of information, which may ultimately lead to improved capability for detecting diseases or increased susceptibility to disease, treatment of a wide range of diseases, and the identification of those at increased risk for adverse reactions to pharmaceuticals and environmental or workplace chemicals," the ACOEM ad hoc Committee on Genetic Screening of the Council on Scientific Affairs wrote. "Genetic screening offers the prospect of a new era for prevention and treatment and a growing array of effective new interventions."
In its consensus statement, which was approved by the college's board of directors, ACOEM acknowledges that genetic screening has been accompanied by "some misunderstanding, mistrust, and fears that it could be used inappropriately."
In fact, the statement cites previous uses of genetic screening that were "inconsistent with good ethical standards and sound scientific practice, and have led some to advocate that genetic screening be treated as a separate category with special safeguards."
ACOEM's position is that genetic screening is not much different in concept than other types of medical testing, and that ultimately, adherence to existing ethical standards, good scientific practices, and laws regulating medical confidentiality are the factors that will make genetic screenings acceptable.
"Since genetic screening may be conducted in the workplace, or employees may present genetic testing information to their employers, it is imperative that practitioners of occupational and environmental medicine be well-grounded in the relevant ethical, legal, social, and scientific considerations, and be prepared to offer sound advice to employees, employers, insurance companies, and regulatory agencies," the committee states in releasing the consensus report.
ACOEM recommends the following guiding principles for conducting genetic screening:
- genetic screening must be conducted in accordance with the law, medical ethical standards, and good scientific practices;
- until extensively validated, genetic screening is a form of human investigation and subject to the appropriate ethical and scientific controls;
- due consideration should be given to the quality and reliability of the screening tests and the predictive value of the results;
- caution should be exercised in the use and interpretation of screening tests; and
- if performed, genetic screening should always be accompanied by an opportunity to discuss the meaning of the results with an appropriately trained health professional.
"[T]here is potential for immediate harm from the misuse of genetic screening through discrimination in employability or insurability," the report continues. "There are also risks that the adoption of specific screening that has not been adequately validated will lead to inappropriate regulations and unnecessary litigation. Improperly used or interpreted screening test results may additionally mislead individuals, employers, and insurance companies about potential risks."
To avoid possible harm, ACOEM sets out the following recommendations for who may be tested, and what the information yielded may be used for:
- Genetic screening may be performed on current or prospective employees when it is clear that the genetic trait directly affects job performance, when the trait being screened for predisposes a worker to a significant, consistent adverse outcome following an otherwise acceptable workplace exposure, or when done as part of a medically confidential general health assessment offered to employees;
- In all instances, employees should be informed of the screening, have the option to decline non-job-specific screening, be given the test results, and be guaranteed that the test results will not be disclosed to others without their consent;
- In accordance with the ACOEM Code of Ethical Conduct, specific screening test results should not be released to employers, and the disclosure of information derived from such testing should be limited to its impact on the employee's fitness to perform a particular job;
- Decisions by employers and insurance companies about insurability should not be based on genetic status nor should genetic screening results be used to make decisions on the issuance or pricing of health care insurance.
The ad hoc committee's consensus report on genetic screening is available on-line at www.acoem.org. For more information, call ACOEM at (847) 818-1800.
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