Predictive Genetic Testing by the U.S. Military: Legal and Ethical Issues.

Abstract

Precision medicine is a significant component of the military medical vanguard. One area of growing interest involves predictive genetic testing (PGT)-which can be used for both medical evaluation and operational planning. Predictive genetic testing is likely to play an increasingly important role in the military, in terms of both medically related testing to predict the risk of disease or injury and testing for non-medical traits that may be relevant to military performance. This article describes predictive tests that currently are in use by the military or that might be of interest to the military. The article also explores the risks and benefits associated with PGTs, describes the ambiguities in the current laws and directives governing the military use of PGT, and proposes a set of guidelines for the use of PGTs by the military. There is no publicly available law or DoD policy that prevents the military from conducting PGT before or after accession. Currently, the only genetic testing routinely employed by the U.S. military is for medical purposes. In addition to non-routine genetic testing to diagnose genetic diseases and conditions, the military also uses targeted testing for predictive purposes. As additional predictive genetic tests are developed and become widely used, the military can be expected to employ those that are of relevance. Predictive military genetic testing of active duty service members could reduce their risk of illness and injury, improve their physical and mental fitness, enhance the health and well-being of the unit, make mission accomplishment more certain and efficient, and reduce medical and other costs for the military and veterans. Moreover, individuals with genetic variants that might enhance the likelihood of successfully completing a military mission could be preferred for certain positions or assignments, such as special operations. At the same time, there are risks that genetic information may be used for improper purposes or may stigmatize service members. Predictive genetic testing is likely to play an increasingly important role in the military, in terms of both medically related testing to predict the risk of disease or injury and testing for non-medical traits that may be relevant to military performance. In instances where PGT meets standard scientific measures of validity and utility, test results can be used to promote the health and welfare of individual service members, units, and military missions. In cases where PGT does not rise to the level of meeting standard scientific criteria, officials should proceed cautiously in incorporating the information into clinical care and military decision-making. There needs to be an appropriate method of collectively calculating risks and benefits. Moreover, although military directives prohibit "unlawful discrimination," this term has received no elaboration in any publicly available military pronouncements. This lacuna should be rectified to provide proper guidance to service members, medical personnel, and the public. Although the promise of PGT may compel military officials to consider ways to maximize the use of test results, the risk of undermining military goals with unverified uses also should be considered appropriately.