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Genetic    Information and the WorkplaceDepartment of Labor    Department of Health and Human Services    Equal Employment Opportunity Commission    Department of Justice    January 20, 1998
Recent advances in genetic research have made it possible to identify      the genetic basis for human diseases, opening the door to individualized      prevention strategies and early detection and treatment. These advances      hold much promise for improving health. However, genetic information can      also be used unfairly to discriminate against or stigmatize individuals on      the job. For example, people may be denied jobs or benefits because they      possess particular genetic traits--even if that trait has no bearing on      their ability to do the job. In addition, since some genetic traits are      found more frequently in specific racial or ethnic groups, such      discrimination could disproportionately affect these groups. This report      demonstrates why American workers deserve federal legislation to protect      them from genetic discrimination in the workplace.
The Promise of Genetic Information
Unprecedented progress in identifying and understanding the 50,000 to      100,000 or so genes that make up the human genome provides an opportunity      for scientists to develop strategies to prevent or reduce the effects of      genetic disease. Scientists have shown that straightforward inherited      errors in our genes are responsible for an estimated 3,000 to 4,000      diseases, including Huntington’s disease, cystic fibrosis,      neurofibromatosis, and Duchenne muscular dystrophy. More complex      inheritance of multiple genetic errors also can increase an individual’s      risk of developing common disorders such as cancer, heart disease, and      diabetes. Genetic technologies, such as simple DNA tests, increasingly are      becoming available to identify people who might have an increased      likelihood of developing a disorder. The majority of diseases Americans      encounter, however, do not result solely from genetic predisposition but      from the interaction of genes with environmental factors, including      occupation, diet, and lifestyle. Consequently, genetic tests alone cannot      predict with certainty whether a person with a particular genetic error      will in fact develop a disease. 

With tools from the Human Genome Project, a new gene discovery is      reported nearly every week. For example, scientists recently reported the      discovery of a genetic alteration that, in early studies, appears to      double a person’s risk of colon cancer. The genetic alteration, which      can be identified with a $200 blood test, is most prevalent among Jews of      Eastern European descent. Once identified, people who carry this mutation      can use regular colon examinations to detect cancer growth early when it      is most easily treated. 

Where effective means of early detection and treatment have been      established, knowledge of genetic alterations can help a person prevent or      reduce the likelihood of illness, and in some instances actually reduce      health care costs. For example, genetic testing for hemochromatosis,(1)      glaucoma, and some cancers can alert the individual to begin preventive      measures before the disease causes harm. 
Genetic Information and Discrimination
There are several ways to gather genetic information. It can be deduced      from a family’s medical history or during a physical examination.      Routine laboratory tests that measure the body’s output of specific      substances might also suggest the genetic make-up of the individual. But      the most direct approach to obtaining genetic information is through      analysis of DNA, the material that makes up genes. Such genetic tests      identify specific DNA features in people who have already developed a      disease, in healthy people who *may* be at risk of developing a      genetic disorder later in life, or in people who are at risk of having a      child with an inherited disorder. Thus, genetic information includes      information about genes, gene products, and inherited characteristics that      may derive from individuals or their family members. 

While genetic technology increases the ability to detect and prevent      health disorders, it can also be misused to discriminate against or      stigmatize individuals. A 1996 survey of individuals at risk of developing      a genetic condition and parents of children with specific genetic      conditions identified more than 200 cases of genetic discrimination among      the 917 people who responded. The cases involved discrimination by      insurance companies, employers, and other organizations that use genetic      information.(2) Another recent survey of      genetic counselors, primary care physicians, and patients, identified 550      people who had been denied employment or insurance based on their genetic      predisposition to an illness.(3) In      addition, because an individual’s genetic information has      implications for his or her family members and future generations, misuse      of genetic information could have intergenerational effects that are far      broader than any individual incident of misuse. 

Many Americans are reluctant to take advantage of new breakthroughs in      genetic testing for fear that the results will not be used to improve      their health but rather to deny them jobs or health insurance. 
-  A 1995 Harris poll of the general public found that over 85 percent        of those surveyed indicated they were very concerned or somewhat        concerned that insurers or employers might have access to and use        genetic information. (4) 
-  Sixty-three percent of the participants in a 1997 national telephone        survey (5)  of more than 1000 people        reported that they would not take genetic tests for diseases if health        insurers or employers could get access to the results. Eighty-five        percent felt that employers should be prohibited from obtaining        information about an individual's genetic conditions, risks, and        predispositions. 
-  Researchers conducting a multi-year Pennsylvania study designed to        understand how to keep women with breast cancer gene mutations healthy        reported that nearly one-third of the high-risk women invited to        participate in the study refused because they feared discrimination or a        loss of privacy. (6) 
-  Another study of 332 people who belonged to support groups for        families with genetic disorders found that fear of genetic        discrimination resulted in 17 percent of the participants not revealing        genetic information to employers. (7) 

In addition, people have hidden genetic information about themselves due      to fear of the effects of disclosure. For example, an 18-year-old man, at      risk for inheriting Huntington’s disease from one of his parents, who      wished to enlist in the Marines to serve in the Persian Gulf War, believed      that knowledge of his risk status would disqualify him from service, even      though it was unlikely that he would become symptomatic during his tour of      duty. He therefore answered “no” to questions regarding      hereditary disorders on his application and did not include Huntington’s      disease in his family medical history.(8)      Another individual whose parent died of Huntington’s disease also      chose to hide the truth from his employer. Fearing adverse consequences at      work if this cause of death was known, the individual arranged for the      diagnosis of asphyxiation to be reported as the cause of death to avoid      mention of the disease in an obituary.(9)      Fear of genetic discrimination and the consequences of this fear have been      reported in both the scientific literature and the popular press. 
Genetic Information in the Workplace
Two types of genetic testing can occur in the workplace: genetic      screening and genetic monitoring. Genetic screening examines the genetic      makeup of employees or job applicants for specific inherited      characteristics. It may be used to detect general heritable conditions      that are not associated with workplace exposures in employees or      applicants. For example, employers used genetic screening in the early      1970s to identify African Americans who carried a gene mutation for sickle      cell anemia. Those carrying the gene mutation were denied jobs—even      though many of them were healthy and would never develop the disease. ****In these cases, genetic screening to identify the sickle cell trait      often occurred without the consent of the individuals. 

Genetic screening can also be used to detect the presence of genetically      determined traits that render an employee susceptible, or “hypersusceptible,”      to a certain disease if exposed to specific environmental factors or      substances that may be present in the workplace. In theory, genetic      screening for occupationally relevant traits has the potential to be used      to assign employees who are genetically susceptible to certain      occupational diseases away from harmful exposure. However, no consensus      currently exists regarding the validity of the scientific evidence or the      usefulness of the genetic tests reported to predict an individual's      susceptibility to exposure.

Genetic monitoring, a second type of testing, ascertains whether an      individual’s genetic material has changed over time due to workplace      exposure to hazardous substances. Evidence of genetic changes in a      population of workers could be used to target work areas for increased      safety and health precautions and to indicate a need to lower exposure      levels for a group exposed to a previously unknown hazard. The ultimate      goal of genetic monitoring is to prevent or reduce the risk of disease      caused by genetic damage. 

Although genetic changes such as chromosomal damage have been associated      with exposure to radiation and some chemical mutagens or carcinogens,      little is known about which changes are predictive of subsequent disease      risk. Much more research is required to establish the relationship, if      any, between those changes and subsequent disease risk for affected      populations and individuals. For this reason, use of genetic monitoring      results to make employment decisions is rarely justifiable.

In addition, some employers may seek to use genetic tests to      discriminate against workers—even those who have not yet or who may      never show signs of disease—because the employers fear the cost      consequences. Based on genetic information, employers may try to avoid      hiring workers who they believe are likely to take sick leave, resign, or      retire early for health reasons (creating extra costs in recruiting and      training new staff), file for workers’ compensation, or use health      care benefits excessively. A 1989 survey of large businesses, private      utilities, and labor unions found that 5 percent of the 330 organizations      responding conducted genetic screening or monitoring of its workers.(10)      Another 1989 survey of 400 firms, conducted by Northwestern National Life      Insurance, found that 15 percent of the companies planned, by the year      2000, to check the genetic status of prospective employees and their      dependents before making employment offers.(11)      Thus, there is evidence that genetic information continues to be used to      discriminate against qualified workers. The economic incentive to      discriminate based on genetic information is likely to increase as genetic      research advances and the costs of genetic testing decrease.
Real People—Real Discrimination
Genetic predisposition or conditions can lead to workplace      discrimination, even in cases where workers are healthy and unlikely to      develop disease or where the genetic condition has no effect on the      ability to perform work. As a result, real people are denied employment      opportunities. 
-  One individual was screened and learned he was a carrier of a single        mutation for Gaucher’s disease. (12)         His carrier status indicates that he might pass this mutation to his        children, but not that he would develop Gaucher’s disease himself.        He revealed this information when applying for a job and was denied the        job because of his genetic mutation, even though it had no bearing on        his present or future ability to perform a job. (13) 
-  A 53-year-old man at a job interview with an insurance company        revealed that he had hemochromatosis but was asymptomatic. During the        second interview, he was told that the company was interested in hiring        him but would not be able to offer him health insurance because of his        genetic condition. He agreed to this arrangement. During his third        interview, the company representative told him that they would like to        hire him, but were unable to do so because of his genetic condition. (14) 
-  An employee’s parent developed Huntington’s disease—indicating        that the employee had a 50 percent chance of inheriting the mutated gene        that would cause her to develop the disease. She decided to be tested. A        genetic counselor advised her to secure life and health insurance before        testing, because a positive test result would not only mean that she        would get the disease but would probably prevent her from obtaining        insurance as well. A co-worker who overheard her making arrangements to        be tested reported the employee’s conversations to their boss.        Initially, the boss seemed empathetic and offered to help. When the        employee eventually shared the news that her test results indicated that        she did carry the mutated gene, she was fired from her job. In the        8-month period prior to her termination, she had received three        promotions and outstanding performance reviews. Frightened by their        sister’s experience, none of her siblings are willing to undergo        genetic testing for fear of losing health insurance or jobs.        Consequently, they must live with the uncertainty of not knowing whether        they have inherited the genetic trait that leads to Huntington’s        disease. (15) 
Efforts to Restrict Use of Genetic Information in the    Workplace 
There is no scientific evidence to substantiate a relationship between      unexpressed genetic factors and an individual’s ability to perform      his or her job. Thus, most expert groups recommend prohibiting or severely      restricting the use of genetic testing and access to genetic information      in the workplace. The American Medical Association’s (AMA) Council on      Ethical and Judicial Affairs concludes that it is inappropriate to exclude      workers with genetic risks for disease from the workplace because of that      risk.(16) In the future, however, the AMA      Council acknowledges there may be an appropriate but limited role for      genetic testing in certain situations to protect workers who have a      genetic susceptibility to occupational illness when health risks can be      accurately predicted by the test.

The National Action Plan on Breast Cancer (NAPBC) and the National      Institutes of Health—Department of Energy Working Group on Ethical,      Legal and Social Implications of Human Genome Research also has drafted      recommendations for state and federal policy makers to protect against      genetic discrimination in the workplace. Generally, the recommendations      limit the collection, disclosure, and use of genetic information and      support strong enforcement of these limitations through governmental      agencies or private right of action. Exceptions are made for possible       situations in the future that may arise if testing is shown to be      scientifically valid to predict occupational risk and situations where an      individual is unable to meet the performance requirements of a job.(17)
Existing Protections are Limited
There are no federal laws that directly and comprehensively protect      against abuses in the gathering or use of genetic information in the      workplace. A few protections exist incidentally under federal laws enacted      to address other types of workplace discrimination. The incidental federal      protections against workplace discrimination based on genetic information      that do exist are narrow in scope and, in large measure, not well      established. They are not sufficient to provide Americans with adequate      protection against genetic discrimination in the workplace. States      continue to enact legislation in response to growing concern over the      specter of genetic discrimination in the workplace. Existing state laws,      however, differ in coverage, protections afforded, and enforcement      schemes. Federal leadership is necessary to ensure that all workers are      protected against discrimination based on genetic information.

**Federal Laws**

The only federal law that directly addresses the issue of genetic      discrimination is the 1996 Health Insurance Portability and Accountability      Act (HIPAA). HIPAA prohibits group health plans from using any health      status-related factor, including genetic information, as a basis for      denying or limiting eligibility for coverage or for charging an individual      more for coverage. In addition, the Administration has worked closely with      Congress on legislation that would prevent an insurance company or HMO      from disclosing genetic information or charging an entire plan or group      more for health insurance on the basis of genetic information. These      efforts, however, do not address the larger problems of the gathering or      use of genetic information in the workplace outside of the health      insurance context. 

The most likely current source of protection against genetic      discrimination in the workplace is provided by laws prohibiting      discrimination based on disability. Title I of the Americans with      Disabilities Act (ADA), enforced by the Equal Employment Opportunity      Commission (EEOC), and similar disability-based anti-discrimination laws,      such as the Rehabilitation Act of 1973, do not explicitly address genetic      information, but they provide some protections against disability-related      genetic discrimination in the workplace. Under the ADA, individuals with      symptomatic genetic disabilities have the same protections against      discrimination as individuals with other disabilities. However, as we make      new advances in genetics, this protection will not be sufficient. More and      more people will be vulnerable to genetic discrimination based on      unexpressed genetic conditions that do not fall within the clear      disability-based discrimination prohibitions of the ADA.

Protection against discrimination based on genetic information for those      who do not currently have a symptomatic genetic disability is not well      established. Individuals who do not currently have a symptomatic genetic      disorder and, therefore, may not be protected against discrimination as a      currently disabled person include unaffected carriers of a disease who may      never get the disease themselves, individuals with late-onset genetic      disorders who may be identified through genetic testing as being at high      risk of developing the disease, and others who are identified through      family history as being at high risk of developing the disease. 

The EEOC has tried to provide ADA protection to individuals who do not      have symptomatic genetic disabilities but who may be subject to      discrimination based on genetic information. In 1995 the EEOC issued      enforcement guidance advising that an employer who takes adverse action      against an individual on the basis of genetic information relating to      illness, disease, or other disorders regards that individual as having a      disability within the meaning of the ADA.(18)      The ADA prohibits discrimination against a person who is regarded as      having a disability. The guidance, however, is limited in scope and legal      effect. It is policy guidance that does not have the same legally binding      effect on a court as a statute or regulation and has not been tested in      court. Moreover, many cases based on the argument that an employer has      discriminated against workers by regarding them as disabled have not been      well-received by the courts.(19)

In addition, the ADA does not protect workers from requirements or      requests to provide genetic information to their employers. Under the ADA,      an employer generally may not make medical inquiries about a job applicant      prior to extending a conditional offer of employment. However, once a      conditional offer of employment has been extended, but before the      individual begins work, the employer may obtain extensive medical      information about the applicant, including genetic information. During      this period an employer could, for example, obtain and store genetic      samples of job applicants, require genetic screening as a condition of      employment, or purchase genetic information about applicants from a      genetic information data bank. In addition, once the applicant is hired      the employer may request medical information that is job related and      consistent with business necessity. 

It is difficult to ensure that medical information is not used to      discriminate. Detecting discrimination based on genetic information, which      indicates a risk rather than a manifestation of disease, is particularly      difficult. As a result, genetic information could be used to deny workers      employment or opportunities regardless of their ability to do the job.      This concern is especially significant because of the rapid advances in      genetic research. For instance, genetic information obtained today may, in      the future, be found to indicate a risk factor that could be the basis for      discrimination. Moreover, this information also could be used to predict      the health risks of an individual’s family members--creating the      potential that genetic information could be used to discriminate against      future generations of workers. 

Another federal law that may incidentally provide protection against      some forms of genetic discrimination is Title VII of the Civil Rights Act      of 1964. An argument could be made that genetic discrimination based on      racially or ethnically linked genetic disorders constitutes unlawful race      or ethnicity discrimination. Protection under Title VII, however, is only      available where an employer engages in discrimination against a particular      racial or ethnic group based on a genetic trait that is substantially      related to a race or ethnic group. Since a strong nexus between race or      national origin has been established for only a few diseases, Title VII      will not be an effective tool for combating most forms of genetic      discrimination. Thus, it is clear that current anti-discrimination laws      would not adequately address the issue of genetic-based discrimination in      employment.
State Laws
A number of states have addressed the issue of genetic discrimination in      employment through state legislation. As of October 1997, 14 states had      enacted laws to provide protections against various forms of genetic      discrimination in the workplace. There are wide variations among these      state laws. 

Some of the first state laws enacted to address this issue prohibited      discrimination against individuals with specific genetic traits or      disorders, such as the sickle-cell trait (Florida and Louisiana) or the      hemoglobin trait (North Carolina). Later laws cover broader categories of      genetic traits and disorders. For example, a 1981 New Jersey statute      (later broadened) prohibits discrimination in employment based on an “atypical      hereditary cellular or blood trait,” and a New York law prohibits      employers from denying equal employment opportunities based on “unique      genetic disorders.” 

Other state laws regulate both the use of genetic testing in employment      decisions and the disclosure of genetic test results. These state laws      generally prohibit employers from requiring workers and applicants to      undergo genetic testing as a condition of employment. 

For example, Oregon state law prohibits employers from using genetic      information to distinguish between or discriminate against applicants and      employees and prohibits employers from subjecting applicants and employees      to genetic testing. A recently enacted Texas law prohibits employers,      labor organizations, licensing agencies, and employment agencies from      discriminating against any individual on the basis of the results of a      genetic test or because of the individual's refusal to submit to genetic      testing. 

Some states permit genetic testing when it is requested by the worker or      applicant for the purpose of investigating a worker's compensation claim      or determining the workers’ susceptibility to potentially toxic      chemicals in the workplace. These statutes often require the worker to      provide informed written consent for such testing and contain specific      restrictions governing disclosure and prevent the employer from taking      adverse action against the employee. 

Given the substantial gaps in state and federal protections against      employment discrimination based on genetic information, comprehensive      federal legislation is needed to ensure that advances in genetic      technology and research are used to address the health needs of the nation—and      not to deny individuals employment opportunities and benefits. Federal      legislation would establish minimum protections that could be supplemented      by state laws.

The need for federal protection has been recognized by Congress with the      introduction of numerous bills with bipartisan support. Three stand-alone      bills have been introduced that amend existing civil rights or labor laws      to protect workers against employment discrimination based on genetic      information (S. 1045, Sen. Daschle; H.R. 2275, Rep. Lowey; H.R. 2215, Rep.      Kennedy). Two additional bills have been introduced that include worker      protections against discrimination based on genetic information, as part      of broader proposals addressing the use of genetic information (S. 422,      Sen. Domenici; H.R. 2198, Rep. Stearns).
Guiding Principles for Federal Action
Federal legislation is needed to ensure that knowledge gained from      genetic research is fully utilized to improve the health of Americans and      not to discriminate against workers. This legislation should provide a      floor or minimum level of protection and allow existing state laws to      provide greater protection. Workers should not be forced to avoid tests      that can help prevent disease because of fear of discrimination. At the      same time, we must preserve the ability of scientists to continue the      research, including studies of occupational health and safety, that is so      vital to expanding our knowledge of genetics and health.

The Administration proposes that Congress pass a law to ensure that      discoveries made possible by the Human Genome Project are used to improve      health and not to discriminate against workers or their families.      Legislation generally should include the following basic protections      against misuse of genetic information in the workplace. 
-  Employers should not require or request that employees or potential        employees take a genetic test or provide genetic information as a        condition of employment or benefits. 
-  Employers should not use genetic information to discriminate        against, limit, segregate, or classify employees in a way that would        deprive them of employment opportunities. 
-  Employers should not obtain or disclose genetic information about        employees or potential employees under most circumstances. 

****Genetic testing and the use of genetic information by employers      should be permitted in the following situations to ensure workplace safety      and health and to preserve research opportunities. However, in all cases      where genetic information about employees is obtained, the information      should be maintained in medical files that are kept separate from      personnel files, treated as confidential medical records, and protected by      applicable state and federal laws.
-  An employer should be permitted to monitor employees for the effects        of a particular substance found in the workplace to which continued        exposure could cause genetic damage under certain circumstances.        Informed consent and assurance of confidentiality should be required. In        addition, employers may only use the results to identify and control        adverse conditions in the workplace and to take action necessary to        prevent significant risk of substantial harm to the employee or others. (20) 
-  The statutory authority of a federal agency or contractor to        promulgate regulations, enforce workplace safety and health laws, or        conduct occupational or other health research should not be limited.      
-  An employer should be able to disclose genetic information for        research and other purposes with the written, informed consent of the        individual. 

****These recommendations should apply to public and private-sector      employers, unions, and labor–management groups that conduct joint      apprenticeship and other training programs. Employment agencies and      licensing agencies that issue licenses, certificates, and other      credentials required to engage in various professions and occupations also      should be covered.

**** Individuals who believe they have been subjected to workplace      discrimination based on genetic information should be able to file a      charge with the Equal Employment Opportunity Commission, Department of      Labor, or other appropriate federal agency for investigation and      resolution. The designated agency should be authorized to bring lawsuits      in the federal courts to resolve those issues that would not settle      amicably. The courts should have the authority to halt the violations and      order relief, such as hiring, promotion, back pay, and compensatory and      punitive damages, to the individual. Alternatively, an individual should      be able to elect to bring a private lawsuit in federal or state court to      obtain the same type of relief plus reasonable costs and attorney’s      fees. In order to enforce these protections, the designated enforcement      agency must be given sufficient additional resources to investigate and      prosecute allegations of discrimination. 
ENDNOTES
1. Hemochromatosis (H.H.) is an iron storage disorder      that affects about 1 in 300 individuals of Northern European descent. The      major symptoms of H.H.—liver cirrhosis, heart deterioration, and      other organ failures—are caused by the accumulation of excess iron      and do not occur until mid-life. Left untreated, the disease causes early      death. Treatment by simple blood donation to remove excess iron allows      people with H.H. to live a normal lifespan.

2. Lisa Geller, et al., “Individual, Family and      Societal Dimensions of Genetic Discrimination: A Case Study Analysis,”      *Science and Engineering Ethics*, Volume 2-1, 71-88 (1996).

3. J.C. Fletcher and D.C. Wertz, *Refusal of      Employment or Insurance*, abstract for presentation made at the Annual      Meeting of the American Society of Human Genetics, Baltimore, November 1,      1997.

4. Harris Poll, 1995 #34.

5. National Center for Genome Resources unpublished      survey, 1997.

6. Gina Kolata, “Advent of Testing for Breast      Cancer Genes Leads to Fears of Disclosure and Discrimination,” *The      New York Times*, January 4, 1997.

7. E. Virginia Lapham, Chahira Kozma, Joan O. Weiss, “Genetic      Discrimination: Perspectives of Consumers,” *Science*, Volume      274, 621-624 (1996).

8. Geller, et al.

9. Id.

10. U.S. Congress, Office of Technology Assessment, “Genetic      Monitoring and Screening in the Workplace,” OTA-BA-455 (1990).

11. Gostin, “Genetic Discrimination: The Use of      Genetically Based Diagnostic and Prognostic Tests By Employers and      Insurers,” *American Journal of Law, Medicine, and Ethics*;      Volume 17- 1,2 (1991).

12. Gaucher’s disease is an inherited metabolic      disorder in which harmful quantities of a fatty substance called      glucocerebroside accumulate in the spleen, liver, lungs, bone marrow, and,      in rare cases, the brain. Carriers are unaffected, but the child of two      carriers has a one in four chance of being affected. Highly effective      enzyme replacement therapy (that reduces liver and spleen size and other      abnormalities and successfully reverses other manifestations of the      disorder) is available for patients with the most common form of the      disease. 

13. Paul R. Billings, et. al., “Discrimination as      a Consequence of Genetic Testing,” *American Journal of Human      Genetics*, 50:476-482, 1992.

14. Lisa Geller, et. al., “Individual, Family and      Societal Dimensions of Genetic Discrimination: A Case Study Analysis,”      *Science and Engineering Ethics*, Volume 2-1, 71-88 (1996

15.*60 Minutes*, “Genetic Discrimination”      segment, April 21, 1996.

16. Council on Ethical and Judicial Affairs, American      Medical Association, “Use of Genetic Testing by Employers,” *Journal      of the American Medical Association*-1830 (1991).

17. Karen Rothenberg, et al. “Genetic Information      and the Workplace: Legislative Approaches and Policy Challenges,”      *Science*, 1755-1757 (1997).

18. Equal Employment Opportunity Commission,      Compliance Manual, vol. 2, Section 902, Order 915.002,902-45 (1995).

19.*See* Farmland Foods, 58 F.3d 382 (8th Cir.      1995);*Dutcher v*. *Ingalls Shipbuilding,* 53 F.3d 723 (5th      Cir. 1995); *Hites v. Patriot Homes,* 904 F.Supp. 880 (N.D. Ind      1995). 

20.*See* 29 CFR 1630.2(r). Under the Americans      with Disabilities Act, the term “[d]irect threat” means “a      significant risk of substantial harm to the health or safety of the      individual or others that cannot be eliminated or reduced by reasonable      accommodation.”

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