Genomics and Equal Opportunity Ethics

Genomics provides information on genetic susceptibility to disease and possibilities for interventions which can fundamentally alter the design of fair health policies. The aim of this paper is to explore these implications of genomics from the perspective of equal opportunity ethics. Equal opportunity ethics requires that all inequalities which arise from factors outside the agent's control, such as a person's natural and genetic abilities should be eliminated, but that inequalities or costs which arise from factors under the agent's control – assuming free and informed choices – should be accepted. Advances in genomics and relevant examples are analyzed using the case-implication approach and the prior-principle approach to ethical reasoning. Genetic information enables us to understand better how one important factor which is clearly outside individual control – a person’s genes – interacts with others to cause individual health outcomes. This has implications for social and individual responsibility for health. For example, insofar as compulsive gambling, obesity or familiar hypercholesterolemia are partly caused by factors beyond individual control, society has an obligation to fund health care for such groups. Health care systems and health insurance plans do not, on the other hand, have an obligation to reimburse the cost for e.g. statins to people with moderately raised levels of cholesterol before appropriate behavioral interventions have been tried. In addition, equal opportunity ethics provides a powerful argument against allowing genetic discrimination in the market for health insurance. The implications of genomics for justice may be different in different health care systems. In European health care systems, new genetic knowledge might provide arguments for limited introduction of personal responsibility for health. In the US, genomic medicine might provide additional arguments in favour of a public health care system where society finances the treatment of health care problems which arise from genetic- and other factors outside individual control.