Res Publica

, Volume 21, Issue 2, pp 185–199 | Cite as

Genetic Discrimination and Health Insurance

  • Kasper Lippert-Rasmussen


According to US law, insurance companies can lawfully differentiate individual health insurance premiums on the basis of non-genetic medical information, but not on the basis of genetic information. The article reviews the case for such genetic exceptionalism. First, I critically assess some standard justifications. Next, I scrutinize an argument appealing to the view that genetically based premium differentiation expresses that persons do not all merit equal concern and respect. In the final section, I argue that even if genetic exceptionalism is unjustified, there is a forceful luck egalitarian argument against basing premiums on genetic risks, to wit, that this tends to make some individuals worse off than others as a result of the bad brute luck involved in having a genetically determined, above-average risk of developing health problems.


Equal moral worth Genetic discrimination Deborah Hellman Insurance Justice Luck egalitarianism 



I am grateful to Ronen Avraham, Sune Lægaard, Thomas Søbirk Petersen, Jesper Ryberg, Frej Klem Thomsen, and an anonymous referee for helpful comments.


  1. Adler, Matthew. 2000. Expressive theories of law: A skeptical overview. University of Pennsylvania Law Review 148: 1363–1501.CrossRefGoogle Scholar
  2. Alexander, Larry. 2003. The legal enforcement of morality. In Companion to applied ethics, ed. Raymond G. Frey, and Christopher Welllman, 128–141. Oxford: Blackwell.Google Scholar
  3. Andrews, Lori B. 1997. Past as prologue: Sobering thoughts on genetic enthusiasm. Seton Hall Law Review 27: 893–918.Google Scholar
  4. Asch, Adrienne. 2000. Why I haven’t changed my mind about prenatal diagnosis: Reflections and refinements. In Prenatal testing and disability rights, ed. Erik Parens, and Adrienne Asch, 234–258. Washington DC: Georgetown University Press.Google Scholar
  5. Brest, Paul. 1976. In defense of the antidiscrimination principle. Harvard Law Review 90: 1–55.CrossRefGoogle Scholar
  6. Capron, Alexander M. 1990. Which ills to bear? Reevaluating the ‘threat’ of modern genetics. Emory law Review 39: 665–696.Google Scholar
  7. Cohen, Gerald A. 2006. Reply to Hurley. Philosophy and Phenomenological Research 72: 439–446.CrossRefGoogle Scholar
  8. Diver, Colin S., and Jane Maslow Cohen. 2001. Genophobia: What is wrong with genetic discrimination? University of Pennsylvania Law Review 149: 1439–1482.CrossRefGoogle Scholar
  9. Dworkin, Ronald. 2000. Sovereign virtue. Cambridge, MA: Harvard University Press.Google Scholar
  10. Gostin, Larry. 1991. Genetic discrimination: The use of genetically based diagnostic and prognostic tests by employers and insurers. American Journal of Law and Medicine 17: 109–144.Google Scholar
  11. Greely, Henry T. 2001. Genotype discrimination: The complex case for some legislative protection. University of Pennsylvania Law Review 149: 1483–1505.CrossRefGoogle Scholar
  12. Hellman, Deborah. 2000. The expressive dimension of equal protection. Minnesota Law Review 85: 1–70.Google Scholar
  13. Hellman, Deborah. 2003. What makes genetic discrimination exceptional? American Journal of Law and Medicine 29: 77–116.Google Scholar
  14. Hellman, Deborah. 2008. When is discrimination wrong?. Cambridge, MA: Harvard University Press.Google Scholar
  15. Holm, Søren. 1999. There is nothing special about genetic information. In Genetic information: Acquisition, access, and control, ed. Ruth F. Chadwick, and Allison K. Thomson. New York: Kluwer/Plenum.Google Scholar
  16. Joly, Yann, Ida Ngueng Fese, and Jacques Simard. 2013. Genetic discrimination and life insurance. A systematic review of the evidence. BMC Medicine 11(25): 1–15.Google Scholar
  17. Lemke, Thomas. 2005. Beyond genetic discrimination. Genomics, Society and Politics 1: 22–40.CrossRefGoogle Scholar
  18. Lippert-Rasmussen, Kasper. 2001. Equality, option luck, and responsibility. Ethics 111: 548–579.CrossRefGoogle Scholar
  19. Lippert-Rasmussen, Kasper. 2013. Born free and equal?. New York: Oxford University Press.CrossRefGoogle Scholar
  20. Lippert-Rasmussen, Kasper. 2015. Luck egalitarianism. London: Bloomsbury Publishing.Google Scholar
  21. Malpas, Phillipa J. 2008. Is genetic information relevantly different from any other kinds of non-genetic information in the life insurance context? Journal of Medical Ethics 34: 548–551.CrossRefGoogle Scholar
  22. Moreau, Sophia. 2010. What is discrimination? Philosophy & Public Affairs 38: 143–179.CrossRefGoogle Scholar
  23. National Partnership for Women and Families. 2004. Faces of genetic discrimination.Google Scholar
  24. Norheim, Ole, and Alexander Cappelen. 2005. Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics 31: 476–480.CrossRefGoogle Scholar
  25. O’Neill, Martin. 2006. Genetic information, life insurance, and social justice. The Monist 89: 567–592.CrossRefGoogle Scholar
  26. Rothstein, Mark A. 2005. Genetic exceptionalism and legislative pragmatism. Hastings Center Report 35: 27–33.CrossRefGoogle Scholar
  27. Stemplowska, Zofia, and Adam Swift. 2012. Ideal and nonideal theory. In The Oxford handbook of political philosophy, ed. David Estlund, 373–389. New York: Oxford University Press.Google Scholar
  28. Vallentyne, Peter. 2002. Brute luck, option luck, and equality of initial outcomes. Ethics 112: 529–557.CrossRefGoogle Scholar
  29. Zimmern, Ron L. 1999. Genetic testing: A conceptual exploration. Journal of Medical Ethics 25: 151–156.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Department of PoliticsAarhus UniversitetAarhus CDenmark

Personalised recommendations