BLOODLINES . Making Precedent . Do you have a duty to warn?

Your final case arguments: Read on and rule again

Your patient's personal story is spiraling into a disturbing social drama. It carries profound and startling implications for everyone—for the sons who might not want to know whether they carry the affected gene, for you as a physician whose obligations are no longer clear and for those who travel by air.

As you are struggling to decide what to do, you wake up one morning to news of a train crash in another state. Though the cause of the crash is under investigation, early reports suggest that the engineer suffered a heart attack. Fifty people are dead with many more injured. You begin your day wondering whether and how it is possible to prevent such disasters. Should there be any difference, from a public health and policy perspective, between the threat of a silent heart problem and a known (and deadly) genetic predisposition?


Yes		No

	Yes, and I changed my mind		No, and I changed my mind
	Yes, and I did not change my mind		No, and I did not change my mind


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	The legality of special health screening for people working in jobs tied to public safety depends largely on whether they work in private industry or for the government. If working for the government, an individual could raise constitutional challenges to screening based on the Fourth Amendment's prohibition on unreasonable searches and the Fourteenth Amendment's due process and equal protection clauses. If working in the private sphere, an individual would seek protection under the Americans with Disabilities Act (ADA) and its provisions for medical testing of current employees, i.e., that testing be job-related and of business necessity. In addition, he/she would have protections under the Fourth and Fourteenth Amendments if those protections were adopted in his/her state's law.


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