A Judgment Against Health-related Bias

June 17, 2009|By Christopher D. Saudek

One hundred years ago, Judge Sonia Sotomayor would not have reached her 10th birthday. Now she is nominated to sit on the Supreme Court of the United States, with every expectation that she will influence the court for decades to come. Her life with type 1 diabetes is an under-told story, not only for the medical advances that made it possible but also for what it says about our society's approach to disabilities.

Since the discovery of insulin in 1921, diabetes is no longer fatal. It is, instead, an incurable but manageable chronic disease. Judge Sotomayor proves that people with diabetes can now contribute and excel in the workplace.

As a child she loved Nancy Drew mysteries, only to be counseled against pursuing a career in law enforcement. Not bad advice at the time, since in the 1950s and far beyond, police forces, fire departments, the military and other major employers would not hire a person with diabetes or keep employees who developed diabetes. Today, employment opportunities for people with diabetes are not so bleak. Last week, the FBI was successfully challenged in federal court for its policy against hiring people who take insulin.

To be clear, there is a vast difference between employment policies that consider the individual versus those that categorically exclude people. Individual consideration looks at each person, their strengths and limitations. It recognizes that not everyone, with diabetes or not, is suited to every job, any more than each of us can play in the National Football League, perform surgery, or be a judge. In fact, people with type 1 diabetes have performed successfully in any number of demanding professions, including, incidentally, professional football and surgery.

Progress against discrimination based solely on the presence of diabetes has been a long, hard-fought battle. In recent years, lawsuits successfully challenged discrimination not only in the FBI but in factories, trucking, police forces, school systems and the military. The issue is that each person is entitled to individual consideration and reasonable accommodation.

This is the whole point of the Americans with Disabilities Act. Ironically, the Supreme Court wrote an opinion in 1999 that limited the definition of a disability, somehow likening the management of diabetes to the correction of nearsightedness with glasses. People with diabetes were, as a result, subject to discrimination by employers, who admitted rejecting them explicitly because of their diabetes - even as courts could declare that they were not disabled and not protected by the Americans with Disabilities Act. Last year this injustice was corrected with passage of the Americans with Disabilities Act Amendments Act.

Many other disability rights issues are working their way through our courts. There is no predicting, of course, how a Justice Sotomayor would rule on issues that are not yet before the court, but at least we know that she would have a life with diabetes to inform her decisions.

Much is being written about Judge Sotomayor's legal prowess, her ethnicity and her gender, but the other story is at least as big. It is the story of medical progress that allows people with diabetes to lead full, healthy lives. It is the story of how some 24 million Americans with diabetes, more than 2 million with type 1 diabetes, are increasingly contributing in the mainstream of American life. And it is the story of the ongoing effort to snuff out the remnants of discrimination against people with chronic diseases like diabetes.

Dr. Christopher D. Saudek is a professor of medicine at the Johns Hopkins University School of Medicine and director of the Johns Hopkins Diabetes Center. His e-mail is csaudek@jhu.edu.

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