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Dáil Éireann díospóireacht -
Tuesday, 8 May 2001

Vol. 535 No. 4

Adjournment Debate. - Regulation of Genetic Testing.

Dr. Upton

The decision by the Irish Insurance Federation to introduce a voluntary code to guard against the use of genetic information in determining eligibility for life insurance is a positive step. However, this move by the industry is by no means a satisfactory tool in insuring that discrimination will not take place on the basis of genetic make up. Moreover, this initiative by the insurance industry should not act as a reason for the Government to be complacent. It is vital that legislation is put in place by the Government to ensure against discrimination on the basis of genetic make up, particularly in the area of life insurance but also in employment opportunities and in accessing credit and other such services.

Throughout Europe governments are making decisions on whether to legislate for the use of genetic information by insurance companies to determine premiums. Our neighbours in the UK have already agreed to the use of genetic information in the insurance industry and my fear is that without strict legislation here, the use of such information may eventually become a reality in Ireland also.

While the guidelines by the insurance federation are welcome, they have their limitations. They only apply to people applying for life assurance worth up to £300,000 and not above that limit. In addition, they are voluntary and this is no guarantee against the use of genetic information in determining insurance premiums. Besides, unless we have legislation outlawing the creation of what could become a genetic underclass, discrimination can occur in a whole range of areas such as employment and education.

The implications arising from the completion of the human genome this year are being ignored by the Government. While such a breakthrough in determining the mapping of the human genome will have positive outcomes, it is crucial that we keep up to speed on how this information on genetic make up is being used. When the breakthrough came in mapping the human genome I raised the point that the coding of the genome had the potential for the discrimination of people based on their genetic make up, thus possibly excluding them from employment, preventing them from obtaining insurance, biasing their opportunities for a place in school or affecting their rights in court. On foot of this I wrote to the Minister of State with responsibility for science and technology asking him to establish a special committee attached to the Oireachtas to examine developments in genetics and to prepare guidelines for the use of genetic information. To date there have been no moves to convene such a committee despite the fact that one is operational at EU level.

As politicians we have a responsibility to guard against a genetic underclass arising from this breakthrough in the mapping of the human genome. Insurance companies should not be able to access a person's genetic data. New genetic information should be used for purposes of improving the quality of life and not in order to penalise people because of their genetic inheritance. The use of genetic information by the courts should also be strictly monitored.

It is now time for this Administration to wake up to the advances which have been made in genetics. Legislation should be framed promptly in relation to the use of genetic information before we reach a situation of mass discrimination of people who are born with genes which could lead to life threatening conditions.

The mapping of the human genome is very complex and detailed. It has enormous potential, for example in the area of gene therapy, to control and even eliminate some diseases. However, we must ensure that the rights of the individual are not diminished or compromised arising from these developments.

I am glad to have the opportunity to set out the position regarding the use of genetic testing, in so far as the health services are concerned and I thank Deputy Upton for raising this important issue.

In Ireland, the National Centre for Medical Genetics has been operating in Our Lady's Hospital for Sick Children, Crumlin, for a number of years. A genetic disorder is any medical disorder which is due to a significant degree to a defect in a gene or group of genes and which may therefore be inherited. Genetic tests use a variety of techniques to determine if a person has a genetic condition or disease or is likely to get the disease.

Individuals may wish to be tested if there is a family history of one specific disease, if they show symptoms of a genetic disorder or if they are concerned about passing on a genetic problem to their children. In some cases, the risks of inheriting the gene involved can be accurately specified and the family provided with genetic counselling. It is also possible to identify those family members who are not carriers and so are not at risk of passing on the disorder. I have no plans at present to introduce statutory regulation of this service.

In so far as the possible use of genetic testing in relation to private health insurance is concerned, I wish to emphasise that the operation of private health insurance business in this country is subject to the provisions of the Health Insurance Act, 1994, and the Health Insurance Regulations, 1996. These require all health insurers to operate on a community rating and open enrolment basis. The 1994 Act specifically provides that premia payable under health insurance contracts shall not be varied by reference to the suffering or prospective suffering from a chronic disease, illness or other medical condition. The provisions of the legislation provide an effective safeguard to individuals vis-à-vis access to private health insurance in a competitive market. Genetic testing does not therefore arise as an issue, and cannot be used to the detriment of persons insured or seeking cover in that sector.

The possible use of genetic testing in other areas of insurance does not fall within the administrative remit of the Department of Health and Children. Issues pertaining generally to the regulation and conduct of insurance business in this country are the responsibility of my colleague, the Minister for Enterprise Trade and Employment.

Concerns have been raised from time to time regarding the possible use of genetic manipulation in the context of human reproduction. The potential of science to control or even alter the natural process of the creation of human life raises basic and fundamental ethical questions for the medical profession, the Government and society as a whole.

In Ireland work in the field of assisted human reproduction is not subject to statutory control. Medical practice is governed by the Medical Council's ethical guidelines. These guidelines apply only in the case of registered medical practitioners and would be ineffective in the case of any service operated by other persons. In order to ensure that a range of concerns about assisted human reproduction are addressed, last year I established an expert commission on assisted human reproduction. The terms of reference of the commission are "to prepare a report on the possible approaches to the regulation of all aspects of assisted human reproduction and the social, ethical and legal factors to be taken into account in determining public policy in this area".

Among the wide range of issues which the commission will be examining is the possible screening of embryos for genetic conditions. It will also consider whether regulation in the whole field of assisted human reproductin is best achieved by legislation or reliance on medical ethics, or a combination of the two.

The Government will await the commission's report before further considering the question of possible regulation of the whole field of assisted reproduction, of which genetic testing is just one aspect.

I will reflect on what the Deputy has said to see how best we can progress this important issue.

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