III. What's Wrong with Biased Medical Decisions?

Of course, even if one accepts that physician bias based on patients' non-medical characteristics sometimes influences medical decisions, one possible response is “so what?” After all, the influence of characteristics like race, gender, disability or sexual orientation on decisions in the social or economic life of our society may not always be viewed as wrong. Even when such influence is understood to be wrong or undesirable, it may not be seen as deserving legal intervention. This nonjudgmental--or at least noninterventionist--stance towards bias is most common in situations involving private or personal relationships. For example, the same civil rights laws that prohibit exclusionary policies by employers and public accommodations contain exemptions from their coverage for purely private clubs. One could argue that the physician-patient relationship is personal and confidential in nature and thus beyond the proper reach of laws addressing discrimination and bias. Strong arguments exist, however, that *239 the influence of physician bias on medical treatment decisions violates both the ethical and legal norms of the private physician-patient relationship and the public norms embodied in the civil rights laws. Let us turn to a brief articulation of those arguments.