Analysis And Comment Ethics

Just a family medical history?

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7536.297 (Published 02 February 2006) Cite this as: BMJ 2006;332:297
  1. Dagmar Schmitz, scientific assistant ([email protected])1,
  2. Urban Wiesing, director1
  1. 1 Institute of Ethics and History in Medicine, University of Tuebingen, 72076 Tuebingen, Germany
  1. Correspondence to: D Schmitz
  • Accepted 28 November 2005

If you have a family history of inherited disease, giving details could lead to discrimination

A recent case in Germany has highlighted the use of genetic information obtained from family medical histories in employment decisions. Although laboratory genetic testing is rarely used in occupational health medicine, prospective employees are often asked about family medical history and may be unaware of the potential consequences. We argue that information obtained from family histories is similar to that from genetic testing and consent procedures should be the same.

Case

Teachers in Germany, like all civil servants, have to have a medical examination before getting a permanent job. In this case, a young female teacher was examined by the occupational health doctor and found to be in perfect health. But in response to questions about her family medical history, she indicated that her father had Huntington's disease. She refused genetic testing. Her risk of inheriting the disease from her father and still being in perfect health is 50% at most. At the same time, her chance of not having inherited the disease from her father is at least 50%. The doctor reported that she had an above average risk of future absenteeism because of her family history. The Hessen educational authorities then refused to give her a permanent job in the German civil service on the grounds of this medical report.1 2 The teacher has since successfully contested the decision in the German Administrative Court.

Legal position

Although the German Administrative Court abolished the decision of the Hessen educational authorities because it thought the risk had been wrongly interpreted, it explicitly approved the use of predictive medical information from a family history. Civil servants in Germany have particular privileges, which the court believes justifies questioning the future ability for performing the job.3 The occupational physician …

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