Thecaseforaccommodationcanbeunderstoodtorestonseveralcoreempir- icalinsights,includingresearchshowingthatpatientswhoseracialpreferencesare respectedregardingtheirchoiceofphysicianshowhigherlevelsofsatisfactionin theirclinicalencountersandthatforsomepatientshavingaphysicianofthesame racialbackgroundconferssubstantialhealthbenefits.158
Indeed,severalrecent
studiesonthehealthbenefitsofphysician–patientraceconcordanceshowthat suchconcordanceisassociatedwithhigherlevelsofpatient-centeredcommunica- tion.159 Andevenafteradjustingforpatientage,gender,education,maritalstatus, healthstatus,andthelengthofthephysician–patientrelationship,researchershave foundthatrace-concordantphysician–patientrelationshipstendtopromotemore participatorydecisionmaking.160
Onestudyfoundthatrace-concordanthealthcarevisitsarelongerthandis- concordantvisits,andthisheldtrueevenwhenresearchersaccountedforcriteria associatedwithlongerpatientvisits,suchasolderage,highersocioeconomicsta- tus,andinferiorhealthstatus.161 Thedurationofapatient’svisitwithaprovideris consideredanimportantindicatorofthequalityofcare,162andpatientsreportthat duringtheselongervisitstheyexperiencegreatereasediscussingproblemsand
158. SeeCooperetal.,supranote20,at913tbl.3;LaVeistetal.,supranote106,at146;vanRyn&Burke,
supranote106,at823. ButseeMeghanietal.,supranote22(arguingthattheresultsofrace-concordance studiesareinconclusive).
159. SeeCooperetal.,supranote20,at911.
160. Cooper-Patricketal.,supranote143,at586–87;seeCooperetal.,supranote20,at910.
161. SeeCooperetal.,supranote20,at911.
162. SeeJohnH.Wiggers&RobSanson-Fisher,DurationofGeneralPracticeConsultations:Association WithPatientOccupationalandEducationalStatus,44SOC.SCI.MED.925,926(1997).
makingdecisions.163
Notably,blackpatientsinaraciallyconcordantrelationship withtheirphysiciansaremorelikelytoviewtheirhealthcarevisitsashighlypartic- ipatory,tobemoresatisfiedwiththeirtreatment,andtoreceivepreventivecareand necessarymedicalinterventions.164
Inadifferentstudy,nearlyone-quarterofAfricanAmericansandone-third ofLatinosreportedapreferenceforsame-racehealthcareproviders,165andmost choseraciallyconcordantphysiciansbecauseofpersonalpreferencesnotsolely becauseofreasonsofgeographicaccessibility.166
Studiessuggestthatforthese
patientsphysician–patientraceconcordancenotonlyaffectsthequalityofthein- teractionsbutcanalsoimprovehealthoutcomes.167
Inadditiontotheseresearchfindings,EMTALA,medicalethicsprinciples, andthedoctrinesofinformedconsentandbatteryareconsistentwiththeaccom- modationofpatients’racialpreferenceseveniftheydonotrequireit. Furthermore, asIhaveargued,thepatchworkofcivilrightslawsthataddressracediscrimination cannotbereadtobarthispractice.168
Underthesecircumstances,inordertoadvanceantidiscriminationnorms meaningfully—insubstanceratherthanjustinform—Iarguethatweshouldcon- ceptualizetheissueofaccommodatingpatients’racialpreferencesnotintermsof therigidapplicationofformalantidiscriminationprinciplesbutratherthroughan antisubordinationlens. BythisImeanthatweshouldaddressthenegativeimpact
thatcenturiesofracediscriminationhavehadonmembersofdisadvantagedgroups byallowingfortheconsiderationofraceinsomecircumstancesratherthanadopt aformalistapproachthatwouldviewanyconsiderationofraceasproblematic.169
163. SeeJ.G.R.Howieetal.,LongtoShortConsultationRatio:AProxyMeasureofQualityofCareforGeneral Practice,41BRIT.J.GEN.PRAC.48,48(1991);D.C.Morrelletal.,The“FiveMinute”Consultation: EffectofTimeConstraintonClinicalContentandPatientSatisfaction,292BRIT.MED.J.870,872 (1986).
164. SeeJerseyChenetal.,RacialDifferencesintheUseofCardiacCatheterizationAfterAcuteMyocardial Infarction,344NEWENG.J.MED.1443,1447–48(2001);Sahaetal.,supranote143,at998.
165. SeePadela&Punekar,supranote68,at69.
166. SeeSahaetal.,supranote21,at76–83.
167. SeesupraPartIII.C.
168. SeesupraPartII.
169. Severalconstitutionallawscholarsconceptualizetheroleofraceingovernmentdecisionmakingas cleavingaccordingtotheanticlassificationandantisubordinationinterests. See,e.g.,JackM.Balkin &RevaB.Siegel,TheAmericanCivilRightsTradition:AnticlassificationorAntisubordination?,58U. MIAMIL.REV.9,9(2003)(attributingtheantisubordinationideatoOwenFissandexplainingthat “[a]ntisubordinationtheoristscontendthatguaranteesofequalcitizenshipcannotberealizedunder conditionsofpervasivesocialstratificationandarguethatlawshouldreforminstitutionsandprac- ticesthatenforcethesecondarysocialstatusofhistoricallyoppressedgroups”);CharlesR.Lawrence III,ForbiddenConversations:OnRace,Privacy,andCommunity(AContinuingConversationWithJohn ElyonRacismandDemocracy),114YALEL.J.1353,1382(2004)(assertingthattheEqualProtection
AsnotedinPartII,EMTALAandthemoderndoctrinesofbatteryandinformed consentemergedinparttoprotectpoorandracial-minoritypatientsfrompatient dumping,nonconsensualtreatment,andbatteryinmedicalpracticeandclinical research. Prohibitingtheaccommodationofpatients’racialpreferencesinlightof
recentevidenceofpervasivephysicianbiasmay,ironically,jeopardizethehealth ofracialminoritypatientsbyrenderingthemvulnerabletothekindsofabuses againstwhichtheselawsandlegaldoctrineswereestablishedtoguard.