Gene testing is set to become routine for all large insurance policy applications. Lessons learned from HIV-related fraud suggest it as the way forward however undesirable the risks of creating a genetic underclass. Both the Genetics Advisory Commission and the Association of British Insurers support gene test results being given to insurance companies (BMJ 2000; 321:977). This has become both necessary and reasonable.
We have been here before with HIV. Insurance companies were defenceless against people who had secret positive HIV test results and then took out huge policies, while their GPs gave them a clean bill of health. After a number of high profile fraud cases most companies insisted that everyone taking out large policies should be tested. The alternative would be a jump in premiums.
The equivalent of a private HIV test is already upon us for gene screening, using swabs of saliva. Expect gene testing to be widely available by e-mail order within three years.
We cannot have a situation where applicants know they are a terrible risk and the insurance company does not. It is vital that applicants are asked to disclose any information they possess, including gene test results, which might significantly alter their risk rating. But, as we have seen with HIV, without proper testing this requirement alone will not protect against active deception.
The only alternative will be for insurance companies to start excluding illnesses which can be predicted easily using gene tests. That is what happened with HIV where some companies decided not to go down the testing route. But every day that list of gene exclusions is likely to grow, until testing becomes the more palatable option.
Urgent thought will need to be given to the plight of growing numbers of people who then find themselves unable to get life, health or mortgage cover. Christian doctors should respond by being informed, being truthful in documentation, acting as advocates for patients and encouraging the church to care and provide for those marginalised by the system.