Medical examinations preceding employment and/or private insurance: a proposal for European guidelines

Nowadays, the possibilities of diagnostic tests for early detection of serious, incurable diseases, for collecting prognostic information on the future health of the individual, and for detection of susceptibility to environmental and other conditions, are rapidly increasing. The growing diagnostic and predictive potential of modern medicine may have beneficial effects in the field of health care and health protection, but adverse effects, for the individual and for society, if used for other purposes.

At the same time, health system reforms, changes in the employment sector, and the overall tendency to decrease social security coverage are making the economic and social position of the individual less secure. To have a reasonable position in modern society, it is of increasing importance to be employed and/or to have adequate insurance.

Against this background, it is not surprising that the call for the development of standards to be observed when medical examinations are being carried out, makes itself felt, not only in individual countries, but also internationally. Medical examinations may be justified and necessary – at least to some extent – to assess the fitness for a job or eligibility for insurance.

However, if not properly used, medical examinations may give rise to social exclusion, particularly in the fields of employment and insurance, and compromise unrestricted access to health care.
Furthermore, medical examinations have a growing potential to encroach disproportionately on individual human rights as protected by the Convention for the Protection of Human Rights and Fundamental Freedoms, the European Social Charter, and the Convention on Human Rights and Biomedicine.

Finally, the collection of medical data in connection with medical examinations raises special concerns with regard to data protection, especially since these data are collected and used for other than health purposes. It needs to be ensured, therefore, that medical examinations are carried out in accordance with Convention for the Protection of Individuals with regard to Automatic Processing of Personal Data and other international data protection standards.

Abstract:

In accordance with the terms of reference of the Committee of Experts, this report deals with medical examinations in connection with employment and private insurance.

‘Medical examination’ is defined in a broad sense. That means that it can be carried out by a physician as well as by another health professional (for instance a nurse or paramedical),
although such a person will usually work under the responsibility and supervision of a physician.

It does not only – and not even primarily – relate to the diagnosis of disease, but to the assessment of all health characteristics of an individual which are relevant to establish his or her fitness or eligibility. This assessment may take place by various means, including health questionnaires. It may also include genetic testing or other ways to collect genetic data.

The focus of this report is on health assessments taking place prior to the conclusion of an employment or insurance contract. ‘Employment’ refers to every occupation. It includes all types of work carried out in the service of a public or private employer. ‘Insurance’ concerns all situations in which insurance cover is provided on a voluntary basis under a contract
governed by common or civil law; it does not include social insurance arrangements, which come under public law and include obligatory participation by the individuals covered. In such
a case, there is no contractual freedom and no risk of the use of medical examinations for purposes of selection.

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