It's a sign of the times that the American College of Physicians has repeatedly been obliged to speak out of late against discrimination and hate and for diversity and respect for all persons. Here are just a few areas where ACP has taken a stand.
Hate crimes. Following the horrific events in Charlottesville, Va., in late July, ACP released a policy statement on hate crimes, adopted just a few weeks earlier by its Board of Regents. “It is imperative that physicians, and all people, speak out against hate and hate crimes and against those who foster or perpetrate it, as was seen in the tragic events that occurred in Charlottesville, Virginia,” said Jack Ende, MD, MACP, ACP's President, in a press release. The ACP policy statement “opposes prejudice, discrimination, harassment and violence against individuals based on their race, ethnic origin, ancestry, gender, gender identity, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion” and “all legislation with discriminatory intent.”
Transgender persons in the military. ACP opposes President Trump's decision to ban transgender persons from serving in the United States military and issued a statement when he first announced via Twitter his intention to do so. “We believe that gender identity should be included as part of non-discrimination and anti-harassment policies, including those meant to prevent employment discrimination. Transgender individuals are already successfully serving in our armed services and should not be denied the opportunity to continue to do so or to serve in the future,” Dr. Ende said on behalf of ACP.
Immigration ban. In June, ACP joined with the Association of American Medical Colleges and 19 other health profession, education, and practice societies in an amicus brief to the Supreme Court urging it to uphold a lower court's injunction against the president's executive order barring entry of individuals from Iran, Libya, Somalia, Sudan, Syria, and Yemen. The 4th Circuit found “that the reasonable observer would likely conclude that [the executive order's] primary purpose is to exclude persons from the United States on the basis of their religious beliefs” and therefore is unconstitutional. On June 26, the Supreme Court partially lifted the lowered court's injunction and agreed to review the case in the fall. The amicus brief argues that “the Executive Order, and similar actions barring or discouraging health professionals and scientists from coming to the United States, will reduce patient access to care, inhibit medical innovation and biomedical research, and set back efforts to prevent pandemics and other public-health threats to Americans.” The amicus brief is consistent with a comprehensive policy on immigration that was approved by the ACP Board of Regents and released on Jan. 31. ACP's policy also called for continuation of the Deferred Action for Childhood Arrivals (DACA) program initiated by President Obama and for enactment of legislation to create a pathway for citizenship for persons brought illegally into the country at a young age.
Gender pay gap and women's health. Late last year, ACP issued a policy statement stating that “physicians regardless of gender should be paid equally and fairly for their work at all stages of their professional careers and in all settings.” ACP opposes policies that would deny care to millions of women by discontinuing funding for Planned Parenthood. It has fought against legislation or regulation that would repeal provisions in the Affordable Care Act that require coverage of contraception and maternity care and prohibit insurers from charging higher premiums to women.
ACP's commitment to nondiscrimination and diversity is not new. In July 2015, ACP issued a policy paper on lesbian, gay, bisexual, and transgender health disparities, affirming that discrimination against LGBT persons is a public health issue; in 2011, ACP released a paper on national immigration policy and access to health care; and in 2010, the College released a policy paper on racial and ethnic disparities in health care, an update of a 2003 paper on the same topic.
By taking very visible positions on recent events and policies that in ACP's view are discriminatory in impact or intent, ACP invites controversy and dissent, including from within its own membership. Some ACP members argue that the College is overstepping its bounds by taking on “social” or “political” issues. Others defend specific policies ACP objects to by saying that they are necessary for national security (ban on immigration from six majority-Muslim countries) or combat readiness and unit cohesiveness (ban on transgender persons in the military), even though the evidence suggests otherwise. Others cite their own religious or moral objections to ACP's views.
But how can the College not speak out when a policy would deny basic human rights to persons because of their race, ethnic origin, ancestry, gender, gender identity, nationality, primary language, socioeconomic status, sexual orientation, cultural background, age, disability, or religion? When it finds that such policies adversely affect the health of those directly targeted and that of the broader community?
History tells us what happens when the medical profession fails to speak out against discrimination, and even worse, practices it. In 2008, the American Medical Association issued a formal apology for its role in countenancing segregation, following a review of its history by an independent body of experts convened by the AMA Board of Trustees. The investigation, published in JAMA, found that “For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation.”
While the country has surely made enormous progress in the past half-century in advancing equality and diversity, it's important to remember history when we consider the medical profession's obligation now to challenge discriminatory policies. The discriminatory policies that ACP speaks out against today do not equal the evil of segregation. Yet what they have in common is singling out a category of people for separate and unequal treatment in access to health care, employment, military service, or immigration, based on who they are.
Today's physicians must clearly state that in 2017, policies and practices that enable discrimination and hate are unacceptable and must be vigorously opposed, wherever and whenever they occur.