title: Making the normal deviant: the introduction of predictive medicine in life insurance.
abstract: Over the past years, one of the most discussed topics in policy debates on genetics has been the use of genetic testing in insurance. Many of these debates have been rather speculative and abstract. In a recent contribution to this journal, Kaufert therefore urged for "a proper research agenda" to study the issue, arguing for the need of anthropological and sociological research of the insurance world. This article will make a start with this. Based on ethnographic fieldwork in two Belgium insurance companies, this study analyses the ways insurers account for predictive medicine (lifestyle, genetics) during underwriting. We demonstrate how insurers highlight predictive lifestyle health information and how this articulates with a fault based approach in underwriting. Individual responsibility for health risks becomes the golden standard for assessing one's fitness for membership of the insurance pool. Moreover, these developments imply a changed concept of "normal standard" in insurance, increasing the conditions to fulfil to be part of the insurance group. Predictive medicine constitutes new ground in the old debates about individual control, responsibility and blame for health. This goes to the heart of the basis for citizenship and how this articulates with membership--or, if you want, exclusion--of the insurance pool.
authors.affiliation: Health Ethics and Philosophy Unit, University of Maastricht, the Netherlands. i.vanhoyweghen@zw.unimaas.nl
authors.forename: Ine
authors.initials: I
authors.lastname: Van Hoyweghen
authors.forename: Klasien
authors.initials: K
authors.lastname: Horstman
authors.forename: Rita
authors.initials: R
authors.lastname: Schepers
mesh_terms: D001530:Belgium; D020022:Genetic Predisposition to Disease; D015438:Health Behavior; D006801:Humans; D007343:Insurance Carriers; D019458:Insurance Coverage / Q000458:organization & administration*; D015273:Insurance Selection Bias; D007348:Insurance, Health; D016134:Organizational Policy; D012308:Risk Management / Q000458:organization & administration