Non-judgmental Ethics Sunday: Must Suspicions About Personal Health Be Shared With an Insurer?

May 8, 2016 by Joshua
in Ethicist, Nonjudgment

Continuing my series of alternative responses to the New York Times column, The Ethicist, looking at the consequences of one’s actions instead of imposing values on others, here is my take on today’s post, “Must Suspicions About Personal Health Be Shared With an Insurer?


I have Parkinson’s disease — at least, I think I do. I have a slight tremor in my right hand, my posture is becoming more stooped and I have a diminished sense of smell. I have not spoken about this with a physician. I have discussed it with a couple of other people who have the disease.

I’m 70 years old, and I have decided to apply for long-term-care insurance. If I am correct about my Parkinson’s, I am statistically at much higher risk of needing long-term care than the average insurance applicant. I have answered all the questions on the insurance application honestly. One of the questions begins, “Have you consulted a physician regarding any of the following conditions,” and it lists many illnesses, including Parkinson’s. Well, I have not consulted any physician about my condition. And I don’t think I will until the symptoms become strong enough that I require the use of pharmaceuticals to help me manage.

Must I make a special effort to inform the insurance company about my suspicions? It will probably affect my eligibility or increase my premiums. Or am I just another point in their actuarial tables? A lot of people get insurance and subsequently discover a condition that needs long-term care. Name Withheld

My response: First, since you asked “must” you make that effort, there is no abstract absolute must here. There is no book in the sky or old man with a white beard declaring things that all seven billion of us somehow all agree with. People have opinions, end of story.

In any case, what will help you more is not some abstract philosophical categorization of one option but to come up with more options and to figure out which works best for you. If you think not answering is your best option, you might still wonder if it gives the insurance companies a legal excuse to avoid paying you. To answer that question, a lawyer or someone in the insurance business would probably serve you better than a philosopher.

My gut tells me that since the insurance company made the questions, you following their rules won’t hurt you, but I hear they’re skilled at finding ways not to pay. You’re probably better served talking to someone with experience in insurance without a motivation to sell you insurance. Most lawyers give you an hour free.

The New York Times response:

Insurance is about sharing risk. Among people with homeowner’s insurance, say, many will pay more in premiums than they will ever collect. Others — those whose homes burn down — will collect more than they’ll ever pay. Both groups have the confidence that a mishap won’t wipe them out financially. And the reason insurers stay in business is that people are better at predicting aggregate risk (How many of our homes will burn down?) than individual risk (Which of our homes will burn down?).

Because insurance takes on functions we consider basic to social welfare, it tends to be a heavily regulated industry. Federal statutes now mean that medical insurers generally can’t charge more for a “pre-existing condition” or take genetic information into account. Long-term-care insurance, though, is a different creature. Here, insurers can sort applicants into different risk classes based on their medical histories and even their parents’ medical histories. They can charge higher rates, or deny coverage altogether, to certain applicants.

Which brings us to you. The insurer could have asked other questions and learned facts that would have been relevant to your policy’s expected cost. Some questions go unasked because they’re not legally permitted (your race or national origin) or because the company has no way of telling if you have answered truthfully (Do you sometimes wake up with leg cramps?). Even if you think the insurer would be better off knowing the answer to a question it didn’t ask (Do you think you have Parkinson’s?), you’re under no obligation to disclose it.

After all, insurers already know about you. In the aggregate, I mean. You exemplify what they call “adverse selection.” It’s the tendency of individuals who think they may be at particular risk to seek to insure themselves against that risk. Actuaries and underwriters aim to factor in the existence of such people (albeit not always successfully). Research has shown that, say, people at risk for Huntington’s are much more likely to have long-term-care policies. Underwriters stay in business by being students of human behavior. So you’ve already been priced in.

As long as you are truthful in your application, then, you’re not the fly in the ointment. You are, so to speak, on the ointment’s list of ingredients. All that said, the long-term-care insurance market doesn’t work especially well these days. People are living longer, and ailing longer, than was anticipated two or three decades ago, when these products became available, and fewer policies have been dropped. Insurers have lost money; policyholders have faced sharp increases in rates; the overall market is small. Meanwhile, as more information about genetic susceptibilities becomes available to people, long-term-care insurers will want to know what applicants know.

We could pass laws to prevent genetic discrimination (as we have with medical insurance), but knowing less than their applicants could drive insurers out of this market. In the end, I suspect, it’s going to seem sensible to create publicly funded arrangements that cover everyone.

Finally, some medical (rather than ethical) advice. You might want to get yourself to a doctor to see whether your amateur diagnosis is right. For all you know, your symptoms might be the result of a condition best treated soon.

I am a liberal white woman whose work is focused mainly on social justice (through education). I have an aunt by marriage who often posts links on Facebook that I find to be bigoted and racist. If my aunt were to express any of these views in person, I would immediately attempt to dissuade her. However, because these are merely posts on Facebook I have not spoken up. What is my moral and ethical obligation in this situation? My students are often on the receiving end of police brutality and systemic racism, and sitting idly by seems hypocritical. Name Withheld

My response: Again with the question of obligations and morals. There are no abstract absolute rules dictating obligation. If there were, you would have consulted them and gotten your answer. You didn’t because there aren’t.

I suspect you’re more interested in what you can do that would influence your aunt to see the world more like you do. You probably realize that just telling her off will more likely result in her digging in her heels and resent you. That’s probably why you wanted someone to tell you you had an obligation, so you could act the only ways you know how, when she got angry you could absolve yourself of personal responsibility by saying you had an “ethical obligation.”

I’ve found acting with empathy and compassion influences people better than any other way. You seem far from either, more in the realm of self-righteousness. However right you consider yourself, acting on those feelings generally undermines ability to influence. If you want to help victims of racism, I think you’ll find trying to understand your aunt, however distasteful you find her views more effective.

The New York Times response:

Two things about your aunt’s posts are troubling. The first is what they reveal about her views. The second is what they add to the general level of online intolerance (which may contribute to the social wrongs that you mention). You might be able to do something about the first issue on your own. A person’s life is ethically diminished when she has odious feelings and views, even if she doesn’t act on them. Although it’s hard to get people to reconsider their positions, we have a better chance with those we know and love.

On the second front, each of us can do a little, but change will only come from the concerted actions of many. People who realize these views are not only false but also harmful should say as much when the occasion arises. In so doing, as you point out, we also express our solidarity with those who suffer as a result.

But we have to do this carefully. The object is to try to change people’s attitudes, not to make ourselves feel good. My bet is that your aunt doesn’t recognize that she’s a bigot. Some of her mistaken views may simply be the result of misinformation. Correcting facts can be more effective in changing a person’s views than accusing the person of a vice, such as racism. And criticizing someone in public can be hurtful in a way that keeps the substance of what you are saying from being heard. So let me acknowledge a potential conflict between what will help your aunt be a better person and what will help improve the atmosphere on the web, which, at least in principle, may include taking issue with these views in front of third parties. Without wading into the debates over “call-out culture,” I suspect that especially with a relative, there’s a good case for “calling in,” rather than calling out.

You don’t say how often you see your aunt in the flesh. When you do, it might be worth taking up these issues with her gently. Emails and Facebook comments are not very effective forms of communication about difficult issues. On the web, I’m convinced that it’s more productive to produce and pass on helpful, positive ideas than to keelhaul people with harmful, negative ones. Evidence suggests, however, that this is a minority view.

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