Screening for Deficits: The Legal and Ethical Implications of Genetic Screening and Testing to Reduce Health Care Budgets
![handle is hein.journals/hthlj3 and id is 243 raw text is: Screening for Deficits: The Legal and Ethical Implications
of Genetic Screening and Testing to Reduce Health Care
Budgets
Roxanne Mykitiuk° and Steven Penney**
Introduction
The Human Genome Project promises to produce a wealth of new
knowledge about human molecular and biochemical genetics. One of the earliest
and practically significant spin-offs of this initiative has been the identification
of genetic variations associated with various diseases and disabilities. The
expectation is that this information will be used in the treatment and prevention
of genetic diseases and conditions, and that it will consequently lead to
improvements in human health and well-being.
At the same time, in Canada and in much of the Western world, there has
been an ongoing, and now extremely urgent discussion about the need to contain
or control health care costs. It is widely believed that expenditures for health
care are too high and that they ought to be reduced or, at least, held constant.
As with any other medical technology, decisions about the provision of genetic
services' are likely to become enmeshed with considerations of efficiency, cost
Assistant Professor, Osgoode Hall Law School. The author acknowledges the generous
support of the University of Alberta and in particular, the Vice President of Research for
funding this project.
LL.M. candidate, Harvard Law School.
The term genetic services will be used in this paper to refer to both genetic screening
and genetic testing. According to Natowicz and Alper, Genetic screening is a search in
a population for persons possessing certain genotypes that (1) are associated with disease or
predispose an individual to disease, (2) may lead to disease in the individual's descendants,
or (3) may produce other variations not known to be associated with disease. M.R.
Natowicz and J.S. Alper, Genetic Screening: Triumphs, Problems, and Controversies
(1991) 12(4) J. Public Health Policy 475 at 476 [emphasis added]. Natowicz and Alper
identify five different types of currently-available screening programs: (i) disease detection
in newborns; (ii) carrier detection; (iii) prenatal disease detection; (iv) workplace screening;
and (v) forensic screening. Ibid. In addition, the pre-implantation screening of embryos is
a more recent development and should be added to this list. See J.A. Nisker & R.E. Gore-
Langton, Pre-Implantation Genetic Diagnosis: A Model of Progress and Concern (March
1995) J. of the SOGC 247. Genetic testing, in contrast, refers to tests taken by
individuals in families where disease has already occurred. N. Holtzman, The Diffusion](ViewImageLocal?handle=hein.journals/hthlj3&div=15&collection=&method=preview&ext=.png&size=3)
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Screening for Deficits: The Legal and Ethical Implications of Genetic Screening and Testing to Reduce Health Care Budgets
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