Editor—The interaction between clinical genetics and insurance is controversial. The remit of the government's Genetics and Insurance Committee is to assess the clinical and actuarial relevance of DNA test results to insurance practice. Its first ruling was that the industry could continue to use the results of DNA tests for Huntington's disease in underwriting applications for life insurance.
One way of dispelling much of the controversy surrounding genetics and insurance would be to establish whether access to insurance is a basic right. If, as perceived and endorsed by the government, it is not regarded as a right, then mutual insurance mechanisms should work according to the usual principles. Underwriters would seek to use the results of tests that have already been performed and the industry and the person seeking cover would want the same information about the risk being insured. The committee's decisions would then be free of questions about equity and justice. If society rejects that view, access to solidarity style cover is required. No government in the United Kingdom is likely to extend the welfare state to such insurance provision, given that the Scottish Executive alone seems to want to implement fully the recommendations of the Royal Commission on Long Term Care.
A solution might be negotiable, given that governments generally want to privatise and that the insurance industry wants to sell cover at standard rates to as many people as possible. The British insurance industry recognised that many life insurance policies are bought as part of getting a mortgage, a step towards the fundamental human right of shelter, and agreed to disregard DNA test results for people arranging moderate cover (up to £100 000), with the mortgage for their main home. Income protection and insurance for critical illness and long term care are not big sellers. If the government gave tax relief on these premiums, companies might then offer standard rate policies to everyone who wanted moderate cover starting at the usual age, retaining the right to ask penetrating questions of people wanting large amounts of cover in unusual circumstances.
This solution would not only quell worries about fairness for people in families with inherited adult onset conditions but also give equity between them and others at high risk of claiming through no fault of their own. The subsidy from those at normal risk to both these groups would be overt, assuaging the majority's social conscience.