Abstract
Life is risky, and insurance provides one of the best developed ways of controlling risks. By pooling, and so transferring risks, those who turn out to suffer antecedently uncertain harms can be assured in advance that they will be helped if those harms arise; they can then plan their lives and activities with confidence that they are less at the mercy of ill fortune. Both publicly organized and commercial insurance can organize the pooling of risk in ways that are beneficial for all concerned. They provide standard ways of securing fundamental ethical values such as solidarity and mutuality. Although policy holders do not know or contract with one another, each benefits from the contribution of others to a shared scheme for pooling and so controlling risk. Although there is a limit to the degree to which commercially-based insurance, where premiums depend on risk level, can go beyond mutuality towards solidarity, in practice it too often achieves a measure of solidarity by taking a broad brush approach to pooling risk. However, the ordinary practices of insurance, and in particular of commercial insurance, also raise ethical questions. These may be put in simple terms by contrasting the way in which an insurance market discriminates between different people, on the basis of characteristics that (supposedly) determine their risk level, and our frequent abhorrence of discrimination, in particular on the basis on religious, racial and gender characteristics. Are the discriminations on which insurance practice relies upon as standard acceptable or not? The increasing availability of genetic information, which testing (of individuals) and screening (of populations) may provide, could lend urgency to these questions. Genetic information may provide a way of obtaining more accurate assessment of individual risks to health and life. This information could be used to discriminate more finely between the risk levels of different individuals, and then to alter the availability and the costs of health, life and unemployment insurance to them. Since all of these forms of insurance bear very directly on the way most people live, it will matter to them how (if at all) insurers take account of genetic information. Will use of this information improve or damage the capacity of insurance to provide confidence in the face of uncertain harms, and help if they happen? Will it discriminate in acceptable or in unacceptable ways? Will it support or damage the sorts of mutuality and solidarity various sorts of insurance schemes have successfully institutionalized?
Full Text
The Full Text of this article is available as a PDF (130.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abbott A. Complexity limits the powers of prediction. Nature. 1996 Feb 1;379(6564):390–390. doi: 10.1038/379390a0. [DOI] [PubMed] [Google Scholar]
- Clifford K. A., Iuculano R. P. AIDS and insurance: the rationale for AIDS-related testing. Harv Law Rev. 1987 May;100(7):1806–1825. [PubMed] [Google Scholar]
- Eeles R. Testing for the breast cancer predisposition gene, BRCA1. BMJ. 1996 Sep 7;313(7057):572–573. doi: 10.1136/bmj.313.7057.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hill C. M., Littman D. R. Natural resistance to HIV? Nature. 1996 Aug 22;382(6593):668–669. doi: 10.1038/382668a0. [DOI] [PubMed] [Google Scholar]
- Murray T. H. Genetics and the moral mission of health insurance. Hastings Cent Rep. 1992 Nov-Dec;22(6):12–17. [PubMed] [Google Scholar]