Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease

Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system''s focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body.     

基因信息在保险核保中的应用及其限度

基因信息可应用于保险核保的理论基础在于保险的风险分类理论与保险法的对价平衡原则。政策、伦理、道德、技术等方面的反对意见并不足以否定基因信息应用于保险核保的正当性,因为商业保险不应承担社会保障职能;基因信息相比一般医疗信息不具有特殊性;保险承保的本来就是具有不确定性的风险,基因检测的准确性也在逐步提高。是故,应当允许基因信息应用于保险核保,但为防止基因信息的滥用,还须通过规范的方式明确基因信息的应用限度:明晰保险人获取基因信息的方式;设定保险人使用基因信息的条件;规定保险人对于依据基因信息作出不利被保险人决定之理由的披露义务;强化基因咨询师的咨询与建议职责;完善对被保险人的救济机制及其具体运作规范。     

禁止就业歧视的"人本"之维

禁止就业歧视的"人本"价值在于:实现人的生存权和发展权,维护人格尊严、实现正义,维护人类共同利益、实现社会和谐。我国禁止就业歧视的法律较好地体现了"人本"精神,但也有一些不足,应当加以完善。     

Dilemmas and consequences of prior criminal record: a criminological perspective from England and Wales

This article considers the contemporary architecture of criminal record usage in England and Wales. We focus upon impact on ‘employment status’, partly because work is often now seen as key to good health and other self-esteem indicators in the modern world. First, we examine in the context of England and Wales, (a) the development of the contemporary criminal record system and extent of availability of prior record information in terms of employment (and other licensing purposes) and (b) the factors that helped shape the current architecture. Second, this article outlines what is known from the British criminological literature on employment and conviction records and what more is needed in terms of criminological research. Finally, we consider how convictions become ‘spent’ – in particular the English approach to ‘expungement’/sealing of the criminal record according to the 1974 Rehabilitation of Offenders legislation.     

我国反就业歧视法律规控研究

就业歧视现象在我国普遍存在,而反就业歧视法制相当落后。就业歧视的本质特征是没有正当理由的差别对待,法律禁止就业歧视的主要目的是保障平等就业权并实现社会正义。在市场化就业背景下,反就业歧视必须正确处理用工自主权与平等就业权这对“轴心”权利的相互关系。我国应当以正面赋予劳动者平等就业权作为反就业歧视的权利基础,以准确界定就业歧视作为反就业歧视的中心任务,从立法、执法和司法三个层面逐步建立健全我国反就业歧视的法律规控体系。     

乙肝歧视的“变种”及其规制思路

《就业促进法》施行后,乙肝歧视往往呈现出更加隐蔽的形式,为有效保护乙肝病毒携带者的平等就业权,要对乙肝歧视的＂变种＂进行分类解读并提出规制思路。     

我国就业中年龄歧视的实证研究——以1995～2005年上海和成都两市30万份招聘广告为例

就业中的年龄不属被劳动法禁止的歧视种类。据对1995年我国《劳动法》施行到2005年这11年期间30万份报刊广告招聘条件的统计,用人单位录用劳动者主要集中在35岁以下,40岁以上普遍受到用人单位的差别排斥。年龄歧视成为劳动法规定的平等就业与现实差距最大的一个现象。用人单位对劳动者实行不合理的年龄差别,严重限制、剥夺并影响到劳动者平等就业权利的实现。消除这个普遍的、严重的歧视种类:一方面可以在制定劳动就业促进法中增加禁止年龄歧视的种类,另一方面可以考虑在制定反歧视法中明确把年龄歧视作为法律禁止的歧视类型。     

A Review and Critique of the Sexual Experiences Questionnaire (SEQ)

This paper reviews and critiques the Sexual Experiences Questionnaire (SEQ), "... a self-report inventory representing the first attempt to assess the prevalence of sexual harassment in a manner that met traditional psychometric standards" (Fitzgerald, Gelfand, & Drasgow, 1995, p. 427). Widely used by its developers and others as a measure of sexual harassment, the SEQ is not a finished product, has a number of problems, and has weak psychometric properties. Because of inconsistencies (e.g., in time frame, number of items, wording of items), the SEQ lacks the advantages of standardized measures, such as the ability to assess changes over time. It defines sexual harassment very broadly, having the effect of distorting findings about sexual harassment. Most importantly, it is not clear what or whose definition of sexual harassment the SEQ assesses.     

Ethical,legal, social,and policy issues in the use of genomic technology by the U.S. Military

Advances in genomic science are attracting the interest of the U.S. military for their potential to improve medical care for members of the military and to aid in military recruitment, training, specialization, and mission accomplishment. While researchers have explored the ethical, legal, and social issues raised by the use of genomic science in a wide variety of contexts, there has been virtually no examination of these issues in connection with the use of genomics by the military. This article identifies potential uses of genomic science by the military, proposes an applicable ethical and legal framework, and applies the framework to provide ethical and legal guidance for military decision-makers.     

The FDA and genetic testing: improper tools for a difficult problem

The US Food and Drug Administration (FDA) has recently issued draft guidance on how it intends to regulate laboratory-developed tests, including genetic tests. This article argues that genetic tests differ from traditional targets of FDA regulation in both product as well as industry landscape, and that the FDA''s traditional tools are ill-suited for regulating this space. While existing regulatory gaps do create risks in genetic testing, the regulatory burden of the FDA''s proposal introduces new risks for both test providers and patients that may offset the benefits. Incremental expansion of current oversight outside of the FDA can mitigate many of the risks necessitating increased oversight while avoiding the creation of new ones that could undermine this industry.     

当代中国女性就业权利的现状分析及救济机制的完善

目前我国关于女性就业方面的法律规范保障不够全面,加上现实中职场中的不公正的潜规则的影响,致使损害女性这一社会弱势群体的合法权益的现象时有发生。本文在对我国目前女性就业权利的现状进行考察和分析的基础上,提出相应的保护和救济机制的完善建议。     

论我国失业保险功能的缺陷与完善

保生活、促就业、防失业是世界各国失业保险制度发展的普遍趋势。我国的失业保险制度存在保生活的功能不足、促就业的功能不强、防失业的功能缺失等缺陷。为了更好地实现社会的充分就业,我国的失业保险制度应该逐步增强其保障失业者基本生活的功能、完善其促进再就业的功能、充分发挥其预防失业的功能。     

医疗服务合同的问题分析及对策

以合同的方式处理医疗纠纷存在不少理论障碍 ,本文从医疗服务的特殊性入手 ,分析了现行合同法难以规制医疗服务行为的原因 ,提出了建立和公示诊疗规范制度、设立基本救治基金、完善多层次的医疗保险制度 ,从而明确医、患双方的权利、义务 ,以实现合同法对医疗行为的规范。     

社会保险基金管理的现状及对策分析

作为一个稳定的基金制度，社会保险基金是社会保险可靠的物质基础和后盾。建立基金是发挥社会保险互动调剂职能的需要，是发挥社会保险储备积累、经济预防职能的需要，是增强社会保险经济实力的需要，也将有利于对宏观经济的调控。本文在分析社会保险基金管理现状及其存在问题的基础上，对完善我国社会保险基金管理提出了相应的对策。     

中国保险基金的困境及其出路

当前，我国保险业又一次面临着巨大危机和困境，保险资金投资渠道狭窄，投资方式、投资工具单一，难以支持我国保险业全面应对加入WTO后年资保险公司纷至沓来的局面。中国保险基金必须加快和更大规模地进入资本市场，这既是保险业摆脱困境的必然选择和唯一出路，更是中国金融市场体系得以完善的必然要求和客观规律。中国证券市场、特别是股票市场当前还存在严重缺陷，保险基金大规模贸然入市风险很大。中国保险基金进入资本市场的途径主要有：成立各种形式的投资基金，大规模增加购买企业债券，提高购买金融债券和国债的比重等。     

海上保险保证制度的过去、现在与未来

在英国的海上保险法中，保证已经成为诚信原则之下的一项具体的制度。在海上运输和通信技术不发达的年代，该项制度的价值是以表面上的不公平实现了事实上的公平，在维护海上保险的良好秩序方面可谓功不可没。但是，伴随海运和科技的发展，该项制度也逐步暴露出一些弊端，故在新的历史条件下对此项制度加以必要的改革已成为必然趋势。     

保险受益人指定制度的缺陷、实务与对策

保险受益人虽不是保险合同当事人,但却在保险关系中占据重要地位,由于我国保险受益人指定制度立法的缺陷致使保险实务中出现了许多难题。文章拟通过对受益人指定制度的几个典型实务问题逐一加以分析,以期达到完善我国保险法制、正确指导我国保险实践之目的。     

高校在促进大学生就业中的职责定位与政府管理的法律纬度

高校在大学生就业问题上的角色界定模糊,政府主导的就业率导向和行政化管理体制是其深层原因。法治政府的权力治理要求政府的权力行使应有相应的法律纬度。解决问题的途径是淡化高校与政府间的＂行政关系＂,发挥政府服务功能,依法落实高校办学自主权,回归高校的办学本质。     

保险合同权利结构与保险利益归附之主体——评《中华人民共和国保险法(修改草案送审稿)》第12条、33条、53条之规定

保险利益是保险法的灵魂,也是保险法的独特范畴,其所应归附的主体如何影响着保险利益法律规则设计的合理性及其防止道德危险功能的发挥。而保险合同的权利结构决定着保险利益所须归附的主体,所以在设计保险利益主体规则时,必须明了保险合同权利结构与保险利益归附主体之间的关系。我国现行保险法上关于保险利益主体的规则存在着诸多失误,这会影响人们通过保险合同实现其生活目的,妨碍保险利益规则防止道德危险功能的发挥。在未来保险法修订时,立法者须在确切理解保险合同权利结构与保险利益应归附主体之间关系的前提下进行相应修改。     

单亲亲子鉴定及其法律问题思考--附275例单亲鉴定分析

目的探讨单亲鉴定及其有关的法律及社会问题. 方法对1998年1月至2002年12月275例单亲鉴定进行回顾分析,对案例的数量、来源、鉴定事由、鉴定结论等作统计分析. 结果单亲鉴定近3年明显增多,占亲子鉴定总数的三成.案例来源以自诉为主,占95.27%.鉴定事由中,怀疑妻子有婚外性关系为主 ,占88.36%.275例单亲鉴定中,排除亲生关系39例,占14.18%.结果表明,非婚生子女只占少数. 结论自诉单亲鉴定存在法律盲区,但在维护家庭稳定具有一定作用.受理单亲鉴定宜取慎重态度,有关的社会及法律问题需要解决.