Affirmative action in medicine

The phrase “affirmative action” implies different things to different people. To some people, it means “reverse discrimination,” “unfair advantage,” or “preferential admissions.” To other people, it may represent “overdue retribution,” a “necessary evil” or a “deserved opportunity.” The culmination of all of the different interpretations complicates the current, heated debate on the future of affirmative action. Nonetheless, 40 years after the inception of affirmative action policies, a tremendous increase in the number of women and a considerable increase in the number of minorities in most fields, including medicine, has occurred. Furthermore, studies have shown that minority doctors take care of minority patients, who constitute a disproportionate amount of the medically underserved. Unfortunately, it is well known that certain ethnic minorities are still underrepresented in medicine. Even more distressing is the preponderance of public health epidemics in minority populations. Minority women have the highest percentage of new HIV/AIDS cases, and the numbers are growing. Minorities are plagued with the lack of adequate health insurance and access to proper medical care. Many people would like to believe that the nasty “isms” are in our distant past. This illusion is kept alive to help some of us sleep better at night. Nonetheless, mass denial poses a problem because it facilitates abuse of power without requiring accountability for the consequences. Racism, sexism, and other forms of unjust discrimination still plague our country and continue to invade all aspects of public life, including medicine. Affirmative action programs ensure that an opportunity, which might be denied, is given to women and underrepresented minorities. It also upholds the importance of diversifying the entire health care system of both physicians and patients. The notion of compensatory justice is frequently appealed to as a justification of affirmative action because the injustices of the past invariably lead to present/ future injustices. According to this view, “affirmative action programs are attempts to alleviate unfair or undeserved disabilities, whatever their source, that prevent people from competing on equal terms.” For example, a man denied access to quality education, jobs, and other socioeconomic/political gains has a son. His son now has access by law to all of the things his father was formerly denied. This man’s son wants to be a doctor. How does this man ensure that the depressed property tax base of his community does not hinder his son from getting a quality elementary and secondary education that will afford him the opportunity to compete effectively for college admissions? How will this man afford to ensure his son is prepared to do well on standardized tests, which include both academic and sociocultural components? Will this man be able to prepare his son to handle his professional career in addition to the societal pressures and expectations in regard to his performance? How will this man teach his son to respect, participate in, and trust a system that denied his father basic civil rights because of his race/ethnicity? Parents of all races consider some of these questions when preparing their children for the future; however, not all parents will be facing these questions largely because of their race/ethnicity. It is important to recognize that being a member of certain minority groups can be an additional burden to the realities of life in this country. This man’s son certainly should not be another generation denied access into medicine (or any other field) because of the residual burdens of his race/ethnicity. From this perspective, compensatory justice is an attempt to neutralize the present competitive disadvantages caused by the effect that unfair burdens have had in preventing people from competing on equal terms. Furthermore, it is probably not a coincidence that the minority groups underrepresented in the medical profession are the same groups grossly underserved by the medical community. Integration of the medical school classroom represents another benefit for society. It can help provide for a diversity of ideas and values and offer a broader and more valuable educational experience. The infusion of minority members into the student bodies of professional schools and then into the professions will create more widespread awareness among professionals of the needs of the minority community. Power and greed undoubtedly fuel the social injustices that continue to plague our country, but they also persist because of ignorance and fear of the unknown. The integration of minorities into the larger economic and political framework following from their integration into the professions and skilled trades will help alter the traditional perceptions of other members of society, making them more aware and responsive to the special needs of minority communities and less apt to think in terms of unflattering stereotypes. Although *This article was inadvertently left out of the Ethics section that appeared in Current Surgery March/April 2000. Our apologies to the author. Correspondence: Inquiries to Willem A. Landman, DPhil, Dept. of Medical Humanities, Brody School of Medicine at East Carolina University, 600 Moye Blvd., Greenville, NC 27858; fax (252) 816-2319; e-mail: landman@brody.med.ecu.edu