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The fulfilment of promises made 25 years ago to link clinical conditions with gene sequences has allowed patients and families to better understand hereditary conditions1-4 and make choices regarding prevention, early detection and treatment.2-4 There have also been warnings issued over this period regarding other purposes for which genetic information may be used, such as discrimination5 against people with a genetic predisposition for the purposes of employment or insurance. There has also been concern that the "geneticization" of health might divert focus to individual, rather than social, determinants of health and away from the communal responsibility for health.6- 8
These factors have not been comprehensively surveyed, particularly in law, in any jurisdiction. We analyzed the way in which genetic predisposition was used in Canadian courts and tribunals, including the clinical conditions for which genetic predisposition was cited, the area of law in which the case occurred, the legal issues that were raised, the results of the proceedings and the purposes for which genetic predisposition was introduced.
We searched the inclusive electronic databases of Canadian legal cases (Quicklaw, Canadian Legal Information Institute, and Société québécoise d'information juridique) and the websites of individual tribunals, using the search term "genetic predisposition." These were exhaustive searches of both English- and French-language cases. Each case was read to determine how genetic predisposition was used in terms of the clinical condition, area of law and legal outcome. We also undertook electronic searches for the term "genetic discrimination." The earliest case we found was decided in July 1984 and we stopped the search in May 2010. The following search terms were used: genetic predisposition, genetic pre-disposition, genetically predisposed, genetically pre-disposed, prédisposition génétique (hereinafter referred to as genetic predisposition) and genetic discrimination.
Clinical conditions
There were 490 genetic predispositions to clinical conditions cited in 468 Canadian legal cases (18 cases included claims of genetic predisposition for two or more conditions). Genetic pre disposition most often referred to conditions affecting the musculoskeletal system (188 pre dispositions), such as osteoarthritis (40 predispositions), degenerative disc disease (32 predispositions), carpal tunnel syndrome (24 pre dis positions) and Dupuytren contracture (23 predispositions). The second most frequent set of diagnoses for which genetic predisposition was cited referred to conditions affecting mental health (100 predispositions), particularly mood disorders (39 predispositions),...