Center Acting Director and Professor Dr. Len Fleck held a workshop at the annual Michigan Occupational Health Conference in Grand Rapids, MI on September 28. Dr. Fleck’s workshop was on “Occupational and Environmental Medicine: Ethical Challenges.”
The primary ethical challenge for physicians in occupational medicine is the dual loyalty challenge. More specifically, they are employed by (or contracting with) some large company to address health issues related to employees. In the workshop itself, attendees considered several concrete examples of this challenge, in particular, what might be regarded as emerging challenges related to emerging genetic technologies. A concern in many workplace situations that involve numerous chemicals is the health and safety of workers. Some workers may be susceptible to serious medical disorders related to such exposures for genetic reasons, but the required exposure might have to be over a prolonged period of time. An employer might offer to pay for whole genome sequencing to identify workers with such risks, in part for morally sound reasons (not wanting to cause avoidable harm to these workers), in part for more selfish economic reasons (not wanting to be at risk for large future health costs). An occupational physician would receive that information, and be expected to pass it along to an employer (who paid for it).
However, there are privacy rights that seem to be at risk; there are also issues of respect for patient autonomy. One worker, in the example Dr. Fleck gave to the audience, was found to be at 30% increased risk for colorectal cancer after ten years of exposure to a specific chemical. He did not want the physician to report that genetic vulnerability to his employer for fear of losing his job. He was willing to accept the risk. What is the right thing to do, all things considered? Several physicians said their responsibility extended only to determining “fitness to work.” And this worker was not going to drop dead next month or next year as a result of this vulnerability. So they would not report that result. Others asked about the details of the agreement with the company. Should the occupational physician strongly counsel this patient? One response was that this was the job of the primary care physician that this individual might have. In brief, discussion was vigorous and interesting.