Genes, jobs, and justicCe: Occupational medicine physicians and the ethical, legal, and social issues of genetic testing in the workplace

The application of new genetic technologies in the workplace not only holds the promise of improving worker health and safety but also raises significant ethical, legal, and social issues which could have serious adverse effects on workers, including effects on their employability and insurability. In the workplace, one appropriate target for study and intervention concerning the use of genetic technologies and information is the occupational health care professional, particularly the occupational medicine physician. Occupational medicine physicians frequently are directly involved in the development and implementation of employer policies regarding medical testing in the employment setting as well as in the control, interpretation and application of the resulting information. Therefore, a study was undertaken to determine the extent of involvement of occupational medicine physicians in the U.S. in genetic testing in the workplace and their level of knowledge and concern about the ethical, legal, and social issues of such testing. A questionnaire survey of members of the American College of Occupational and Environmental Medicine (ACOEM) was performed with distribution by email and in-person at the organization's annual national meeting. Among respondents, 7.7% reported being currently engaged in genetic testing in the workplace, primarily to protect workers from workplace hazards. Overall, 40% of respondents felt that workplace genetic testing should be used in decisions about job placement, but 17% felt that workplace genetic testing was never appropriate. Most respondents (57%) did not feel competent dealing with genetic testing issues, and the vast majority (75%) reported feeling ethically conflicted about workplace genetic testing. For guidance in the resolution of ethical conflicts, respondents reported relying primarily on professional codes of ethics and guidelines, but their level of familiarity with ACOEM's position on genetic testing in the workplace was generally low. These results suggest that occupational medicine physicians do not feel prepared to deal with the ethical, legal, and social issues of genetic testing in the workplace and that professional organizations should consider increasing their educational efforts in these areas.