Ethics of identity concordance requests in patient-clinician encounters

Abstract

Systemic injustice has resulted in significant baseline inequality amongst populations according to gradients of privilege. What is the ethical approach to situations wherein equity may require differential treatment to correct for baseline disadvantages as a necessary means to its attainment?We explore this concept through the issue of patient requests for clinician identity concordance, when patients request a clinician who matches their race, ethnicity, or gender. Firstly, we discuss ethical grounds for refusing requests by exploring the balance between patient autonomy, a physician's obligation to not abandon one's patients, and the right of a clinician to be free from violence of any form. Next, we explore the ethics surrounding conditional acceptance through the frames of intent and clinical outcomes. We note the legacy of trauma experienced by marginalized patients at the hands of medicine and the abundance of data suggesting that identity concordance can mitigate disparities.