• A
  • |
  • A
  • Text size

Opinion 2.132 - Genetic Testing by Employers

As a result of the human genome project, physicians will be able to identify a greater number of genetic risks of disease. Among the potential uses of the tests that detect these risks will be screening of potential workers by employers. Employers may want to exclude workers with certain genetic risks from the workplace because these workers may become disabled prematurely, impose higher health care costs, or pose a risk to public safety. In addition, exposure to certain substances in the workplace may increase the likelihood that a disease will develop in the worker with a genetic risk for the disease.

(1) It would generally be inappropriate to exclude workers with genetic risks of disease from the workplace because of their risk. Genetic tests alone do not have sufficient predictive value to be relied upon as a basis for excluding workers. Consequently, use of the tests would result in unfair discrimination against individuals who have positive test results. In addition, there are other ways for employers to serve their legitimate interests. Tests of a worker’s actual capacity to meet the demands of the job can be used to ensure future employability and protect the public’s safety. Routine monitoring of a worker’s exposure can be used to protect workers who have a genetic susceptibility to injury from a substance in the workplace. In addition, employees should be advised of the risks of injury to which they are being exposed.

(2) There may be a role for genetic testing in the exclusion from the workplace of workers who have a genetic susceptibility to injury. At a minimum, several conditions would have to be met:

(a) The disease develops so rapidly that serious and irreversible injury would occur before monitoring of either the worker’s exposure to the toxic substance or the worker’s health status could be effective in preventing the harm.

(b) The genetic testing is highly accurate, with sufficient sensitivity and specificity to minimize the risk of false negative and false positive test results.

(c) Empirical data demonstrate that the genetic abnormality results in an unusually elevated susceptibility to occupational injury.

(d) It would require undue cost to protect susceptible employees by lowering the level of the toxic substance in the workplace. The costs of lowering the level of the substance must be extraordinary relative to the employer’s other costs of making the product for which the toxic substance is used. Since genetic testing with exclusion of susceptible employees is the alternative to cleaning up the workplace, the cost of lowering the level of the substance must also be extraordinary relative to the costs of using genetic testing.

(e) Testing must not be performed without the informed consent of the employee or applicant for employment. (IV)

Issued June 1991 based on the report "Genetic Testing by Employers," adopted June 1991 (JAMA 1991; 266: 1827-1830).