Ethical concerns in occupational screening programs.

Preventive and anticipatory programs for identifying workers at higher-than-normal risk for occupational injury and/or disease can now draw on an expanding net of sophisticated diagnostic tests. New genetic screening tests may use reagents developed through recombinant DNA technologies, including cDNA probes for genetic variants such as HLA B27 associated with late-appearing disability. Assessments of the readiness of these technologies to be incorporated into standard occupational policy turn on their predictive value, applications, and the locus of control of the data which they generate. The question of responsibility for health protection and obligations accruing to those who uncover genetically fixed risk status has major ethical implications. Issues of potential stigmatization, discrimination, and protection of equal employment opportunity must be resolved before these tests are put into practice. The possible use of genetic testing to assure minimal risk and its equitable distribution among workers is highlighted as a possible benefit of this new applied technology.