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HYPERSUSCEPTIBILITY TO OCCUPATIONAL HAZARDS 87 original typesetting files. Page breaks are true to the original; line lengths, word breaks, heading styles, and other typesetting-specific formatting, however, cannot be About this PDF file: This new digital representation of the original work has been recomposed from XML files created from the original paper book, not from the retained, and some typographic errors may have been accidentally inserted. Please use the print version of this publication as the authoritative version for attribution. certain situations, for example, monitoring the urine of hospital workers who have the potential for exposure to antineoplastic drugs. FAIRNESS At various times during life, everyone exhibits one or more forms of hypersusceptibility. In addition to these common forms of hypersusceptibility experienced by all, each person is likely to belong to smaller subpopulations with unique hypersusceptibilities. Society has long recognized and made special provisions for protecting hypersusceptible groups such as the young, the aged, and the sick. Advances in science and medicine are increasing man's ability to detect and remedy more forms of hypersusceptibility. Decisions based on these findings are raising issues of ethics, law, and the distribution of costs and benefits (Lappé, 1983). Central to these issues is a basic premise of public health that states that society has an obligation to provide all persons equal protection against avoidable health hazards. Ideally, this means establishing legally permissible exposure levels that protect even the most sensitive individuals. However, questions of feasibility may necessitate special measures for hypersusceptible groups. There are three requirements for fair application of these special measures: (1) the need for special protective measures must be clearly established; (2) intervention measures must be adopted to deal with actual risks; and (3) these measures must provide the greatest degree of protection consistent with the individual freedom. Where the scientific evidence of risk is uncertain, one must weigh the gravity of the potential adverse effect before implementing protective measures. If the adverse effect is severe and irreversible (cancer, for example), then a strict protective approach must prevail. If the adverse outcome is relatively benign and reversible (such as mild dermatitis), then a watchful, waiting, de minimis approach could be taken that would lead to implementation of protective measures when symptoms began to appear. The most difficult task in providing special consideration for hypersusceptible workers may be balancing the right of protection from hazards with the right of access to jobs. Clearly, hypersusceptible workers whose conditions can be easily accommodated without interfering with job performance should not be subject to job discrimination. On the other hand, there may be no alternative but to exclude certain workers from jobs that pose hazards for which no effective protective measures can be taken or when a worker's condition significantly interferes with his work performance or endangers others. Unfortunately, there are large gray areas in which judgments will be more difficult. The true nature of hypersusceptibility is just emerging from the shadows of speculation and myth. It is hoped that research in this vital area will
