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Ten: Patient Requests for Healthcare Providers of a Specific Race or Sex
- Indiana University Press
- Chapter
- Additional Information
One of the characteristics of an ethical manager in American society today is informed sensitivity to the ways in which attitudes toward persons of a different race, sex, nationality, culture, religion, or social/economic position can affect behavior. Chapter 7 included a brief discussion of the potential impact of these attitudes on the quality of healthcare. There the focus was on the importance of preventing unequal treatment of patients because of attitudes or biases existing among healthcare providers. In this section of the book, focused as it is on healthcare organizations as employers, it is useful to consider management ’s responsibilities to employees when patients request that they be cared for by persons of a speci¤c race or sex. When all relevant considerations are taken into account, some such requests are more legitimately honored than others. It is the purpose of this chapter to assist managers in identifying relevant considerations and in distinguishing between requests that should be accommodated and those that should not be accommodated. The Race of the Caregiver1 Case 10.1. M. J., a home care case manager, is not sure how to proceed. She has just had an extended conversation with the patient for whom she is arranging home care. All went well until the patient said that he did not want anyone who is black coming into his home. The patient is an elderly European American who said that he does not feel comfortable around black people and that he especially does not like the idea of a Ten Patient Requests for Healthcare Providers of a Speci¤c Race or Sex black person walking around in his house. “I’m a strong believer in staying with your own kind. Besides,” he continued, “I have a right to decide who comes into the privacy of my own home.” M. J. has had such requests or demands before and has wrestled with them each time. She knows that some case managers do try to provide a home worker of the race requested. They argue that personal care is intimate and private and that compatibility with the caregiver is an important dimension of a good patient experience. Patients, they conclude, should have a worker with whom they are comfortable. A second reason is sometimes given for acceding to the patient’s request for a home care worker of a particular race. To send a black worker to the home of someone who does not want such a person in the house is to place the worker at risk of racial insults or abuse. The patient in this particular case has made a major point of insisting that no black person come into his home; he might be capable of such harassment. M. J. has heard and considered these arguments before. She is also convinced, however, that there is an important fairness issue involved in not assigning someone to do a particular job simply because of his or her race. In the past, she has always refused to honor requests for home care workers of a particular race. This time she decides that she would like to clarify the policy and practice of the organization. She asks her supervisor whether she should make arrangements that specify a white worker or to tell the patient that the organization will not comply with this request. It is not surprising that M. J. and others in this situation often ¤nd it dif-¤cult to know how best to respond to a patient’s request or demand for a home health worker of a particular race. As is indicated in the case scenario, some ways of thinking about management’s responsibility to patients and employees may seem to suggest that the organization should, in fact, comply with such requests. When priority principles of ethics (Chapter 2) are kept in mind, however, it becomes clear that complying with this request would be a serious mistake. It would be a denial of a basic right in order to accommodate lower-priority interests. The determination that someone should be prevented from performing a particular job simply because of her or his race is a very harmful form of discrimination. When a factor like race, totally unrelated to the ability to do the job, is used as a basis for deciding who does what work, managers are saying that irrelevant considerations will be permitted to in®uence work assignments . While there are understandable perspectives that may lead good managers to wonder whether they should honor patient...