Open Peer Commentaries Lack of Access to Genetic-Relative Family Health History: A Health Disparity for Adoptees? 5 Inmaculada de Melo-Martı ´n , Weill Cornell Medicine–Cornell University In their article May and colleagues (2016) call attention to a feature shared by most adoptees: their lack of access to genetic-relative family health history (GRFHx). They argue 10 that such lack of access represents an unjust health disparity 1. for adoptees and suggest that it could be rem- edied by emerging genomic technologies. That genomic technologies could be helpful to adoptees—or anyone else, for that matter—seems uncontroversial, so I would put 15 this aside. 2. That lack of access to GRFHx constitutes a health disparity for adoptees is, however, a more conten- tious position, one that May and colleagues fail to support adequately. In the rest of this commentary, I defend this claim. My purpose, nonetheless, is not to argue that such 20 disparity does not exist; rather, it is to point out that May and colleagues have not offered compelling arguments or evidence for it and that at least some evidence exists that calls that conclusion into question. The first reason why May and colleagues have failed to 25 defend their position adequately is that their claim, that is, that lack of access to GRFHx constitutes a health disparity for adoptees, is ambiguous and May and colleagues’ argu- ments further contribute to the ambiguity. Such claim could be understood in two, perhaps interrelated but 30 clearly distinct, ways: (A) that lack of access to GRFHx rep- resents a health disparity for adoptees, and (B) that adopt- ees are at a disadvantage regarding their health—in comparison with non-adoptees—because they lack access to information about their GRFHx. As should be clear, 35 both the evidence and arguments that one can offer in sup- port of these two claims, as well as the potential solutions to the disparities alleged in each of them, are different. Moreover, one might find one of these claims persuasive while, without inconsistency, finding the other one uncon- 40 vincing. Indeed, claim (A) seems quite implausible, 3. while claim (B) appears reasonable in principle—though, as I argue in the following, it is also questionable. That May and colleagues are mixing these two distinct claims is evidenced in their discussion about the essential 45 elements of health disparities. For instance, when discus- sing the “underlying disadvantage” element, May and col- leagues argue that “In the context of GRFHx for adoptees, a disadvantage might be identified in two ways: by refer- ence to adoptees lacking access to important, recognized 50 components of health care management available to most non-adoptees; and as identified by the preferences, desires, and needs expressed by adoptees themselves” (XX). Now, that adoptees desire access to GRFHx might constitute evi- dence for claim (A) just described, but it arguably provides 55 no evidence for claim (B). When addressing the systematic nature of health disparities, May and colleagues maintain that “The systematic nature of the GRFHx gap for adoptees is a function of the nature of adoption itself” (XX). This again could provide evidence for (A) but no evidence 60 whatsoever for (B). Similarly, when discussing the issue of avoidability they contend that two strategies might be used to address lack of GRFHx for adoptees. One would be to ensure a move toward open adoptions, and another one would be to use genetic testing. But arguably genetic 65 testing would fail to address (A), even if it could contribute to solving (B). Given May and colleagues’ emphasis on genetic testing as a potential solution, then, I take it that what they are Address correspondence to Inmaculada de Melo-Mart  ın, Division of Medical Ethics, Weill Cornell Medicine–Cornell University, 402 E. 67th St., New York, NY 10065, USA. E-mail: imd2001@med.cornell.edu 1. For simplicity I simply talk of “health disparity,” as May and colleagues are appropriately concerned with a normative conception of disparity. 2. It seems worth pointing out, however, that given May and colleagues’ contention that a health disparity is at stake in this case, their conclusion is quite weak. If, indeed, adoptees suffer a health disparity that could be reduced by the use of genetic testing, one would have expected a more forceful conclusion about someone—presumably the state—having a duty to provide such testing. I do not deal with this issue here. 3. Due to space limitations, I will not defend this claim. ajob 1 The American Journal of Bioethics, 16(12): 1–3, 2016 Copyright © Taylor & Francis Group, LLC ISSN: 1526-5161 print / 1536-0075 online DOI: 10.1080/15265161.2016.1240257 Uncorrected Proof