Genetic discrimination, insurance, and solidarity: an analysis of the argumentation for fair risk classification

Abstract

This article analyzes the argumentation used in European governmental and expert discussion on genetic discrimination in life insurance. The article focuses on competing justifications for fair risk classification in private insurance, and explores the ambiguity of the principle of solidarity in this context. The analysis starts by examining common justifications for the necessity of discrimination in life and health insurance. After that, the article explores the arguments used, in particular, for problematizing genetic discrimination, and shows what kind of implications this may have for the relationship between private and social insurance. In the final section, the discussion on this issue in Finland is contrasted with the diverse debates found elsewhere in Europe and internationally to show how the discussion varies locally, depending much on what is considered to be the social task of life insurance in a given societal context.

The Forms and Limits of Insurance Solidarity

“…For example, in the Finnish discussion, the role of subsidizing risk solidarity has not been considered as pertinent a question for private insurance as in some other countries, for example, in the Netherlands or UK (Liukko 2010;McGleenan 1999;UK Actuarial Profession 2001). An essential reason for this is that in the Finnish public debates, social insurance is seen to take care of all the subsidizing solidarity and basic security needed.…”

“…When we have discussed our earlier work on insurance and solidarity (Lehtonen 2009;Lehtonen and Liukko 2010;Liukko 2010) at various academic and non-academic events, the reception has often been somewhat perplexed. It is a rule that someone in the audience has wanted to recount a personal experience of the way in which an insurance company has not taken into consideration the rightful claims put forth, and has only seemed eager to diminish the costs in an unfair manner; this experience is presented as a contrast to the idea of insurance based on solidarity.…”

“…In 2009, the Finnish Parliament followed 22 other European countries and ratified the Council of Europe's Convention on Human Rights and Biomedicine, which prohibits the performance of genetic testing as a condition for entering into an insurance contract. In addition to this international convention, some European countries have enacted much stricter national prohibitions by also restricting the use of already existing test results by insurers (Knoppers et al 2004, p. 185;Liukko 2010). This kind of regulation implies that the limits of solidarity have been defined in a fundamentally new way by increasing the role of subsidizing risk solidarity in private insurance.…”

“…More specifically, recently the so-called genetic discrimination and insurance companies' right to use the results of genetic testing, which can reveal the likelihood of a disease emerging, has been a hotly debated issue (Harper 1993;Launis 2003;Liukko 2010;McGleenan et al 1999;Van Hoyweghen 2007). It has been surmised that if the use of predictive genetic information is not regulated, its proliferation could lead to a situation where those especially prone to illness can be completely left out of the pools of solidarity.…”

Genetics and insurance in the United Kingdom 1995–2010: the rise and fall of “scientific” discrimination

“…The survey of Joly et al (2010) of regulatory policy on genetics and insurance in 47 countries emphasizes the role of contextual factors in each country in influencing policy, in particular legal traditions, the social role of insurance, and the interplay between private and public healthcare systems. Liukko (2010) describes the distinctive terms of public debate in Finland, where the focus is primarily on ensuring the privacy of genetic test results, rather than their potential effects on social solidarity.…”