There are a number of ethical concerns that come into play surrounding race-based choices on healthcare. In an article by Melina Kim, “Patients Choosing Healthcare Provider Based on Race: Ethical Issues and Considerations,” it is noted that patients are allowed to make racially based requests for a healthcare provider to encourage patient wellbeing (they are also allowed to make requests for their provider based on gender and religious group). Except, interestingly, some of these requests can be considered offensive depending on the scenario — where others are considered legitimate.

The American Medical Association (AMA) Code of Medical Ethics “bans doctors from refusing to treat people based on race, gender and other criteria, but there are no specific policies for handling race-based requests from patients…while it is ethical for patients to request for a physician based on gender or religious needs in some cases, it is unethical for patients to want their bigotry to be accommodated.” For reference, Oxford Languages defines bigotry as “obstinate or unreasonable attachment to a belief, opinion, or faction; in particular, prejudice against a person or people on the basis of their membership of a particular group.”

So there’s a larger problem going on here. It’s okay for patients to ask for a specific doctor based on race, in addition to gender and religion — it’s just unethical. But by AMA’s regulations, it is not okay for physicians to treat patients based on race, gender, or “other criteria.” Can doctors then treat patients that specifically asked for them based on race? They were requested by the criteria AMA specifically told them they could not differentiate patients by — and it would seem that these two cases contradict one another.

But first, let’s explore the process for such a request. There are multiple factors that come into play when a patient has issued a request for a healthcare provider based on race. The first step is establishing that there is no concrete “right” or “wrong” when a patient makes a request for a healthcare provider — it is highly case specific, and the moral value of the request must first be determined before a ruling is made. Some additional considerations include whether another healthcare provider would be available, the urgency of the patient’s treatment, and the strength at which the patient made the request.

It is also important to note that when the patient’s request is very deeply ingrained in cultural values or beliefs, their preferred doctor may provide them with higher quality healthcare. The UCLA Law Review even goes to state, “accommodating a patient’s preference for a physician of a particular race or ethnicity is consistent with most prevailing medical ethical principles, including informed consent and respect for autonomy, and that no existing civil rights legislation could be used to bar this practice.” Moreover, studies have shown that “newcomers to a country are more likely to obtain potentially life-saving health-care services – from contraception to diabetes prevention – if it is culturally sensitive.” The concluding points are that given the patient’s request is for a non-urgent medical condition, and contains a high degree of reasoning behind it, usually that request will be honored. However, most medical concerns are time-sensitive and if a delay in the requested physician threatens the patient’s welfare, the request will be rejected and the patient will be assigned another healthcare provider.

Interestingly, there is an ethical law regarding patient care. Its intention is to “protect patients against the threat of unwanted or poorly understood care by empowering them to refuse care or to refuse to be cared for by a particular physician” — but this encourages patients to discriminate against healthcare providers, because even though doctors cannot discriminate against their patients, hospitals’ regulations regarding patient care enable patients to discriminate against their doctors.

Adding another level of complexity, it can be difficult to determine when a patient request is racist. Racial discrimination violates Title II of the Civil Rights Act, and is considered unethical. The Hippocratic Oath doctors take stops doctors from rejecting patients based on their personal values, but there is not an oath or regulation that prevents doctors from refusing a patient care based on their personal discriminations. One doctor specifically commented on instances of the medical community addressing the presence of racism.

“in my seven years of training and 14 years of continuing medical education, I have never encountered a teaching module on addressing racial intolerance in my patients… [these modules should be created so physicians can] practice and model tolerance, respect, open-mindedness, and peace for each other.”

– Dr. Dorothy R. Novick, Pediatrician (Phi, USA)

Clearly, there is still a long way to go in avoiding discrimination based on race between patients and their physicians. However, it is also significant to note that hospitals and other providers of healthcare do acknowledge the benefits of patients being able to request a specific physician to see them when the claim is reasonable — which can drastically improve the patient’s treatment experience. Thanks for reading!