Abstract
Reasonable people can certainly all agree on the importance of working toward fairness and equality for all, both in medicine and beyond. There are different ways forward in this regard and in this article the authors promote EDI although it is far from clear that these policies are effective.1-3
The article raises a number of significant questions. The authors state there are “many patients and members of the medical community facing discrimination and inequities daily” but do not provide any data as to the actual magnitude of the problem.
They propose an EDI committee of 5 to 15 in order to represent “varied races, ethnicities, genders, and other demographic” categories. Given the number of identity groups (based on race, gender, sexuality, etc) in a country as pluralistic as Canada is this even possible (if it was desirable)? It becomes even more difficult when considering “intersectionality”—the combinations are endless.
They point out issues with guidelines that don’t work well for Black patients. This deficit should and will be rectified by further scientific studies; EDI policies are unnecessary. One of the article’s references defines race as “Socially constructed organization of people according to physical characteristics perceived to have biological derivation” (italics are mine). So they’re saying that the guidelines need to be adjusted—a biological statement—but at the same time that race is “socially constructed” and only “perceived” to be biologically-based. Which is it then? You can’t have it both ways.
There are examples where the application of EDI practices in healthcare has actually caused an increase in harm. When a vaccine first became available in the US during the COVID pandemic, decisions needed to be made regarding who should get it first. A complicated process ensued but ultimately “the elderly” were not prioritized as much as in other countries because “racial and ethnic minority groups are underrepresented among adults >65” (https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf). This was despite agreement that this would lead to more overall deaths. That is, life-saving decisions based on EDI principles led to a worse healthcare-related outcome.
The intention of the authors should be applauded in that their goal is to increase fairness and equality. However, EDI policies are self-defeating. They see each person in terms of their identity group and presume certain characteristics accordingly. This is prejudice. EDI sees equality when “outcomes” reflect their view of the world by favouring certain groups at decision making times. But this means that those in unfavoured groups face inequality of “opportunity” at those times. One form of injustice is just replaced by another.
The introduction of EDI policies will adversely affect radiology practice. The authors have not provided evidence of a problem to warrant the proposed changes. EDI goals to reduce inequalities are admirable but in practice their policies only swap one form of prejudice for another, swap one form of injustice for another, all leading to abandonment of merit, an increase in mediocrity and increased resentment between racial groups. 4
These guidelines should be rejected and the CAR should instead focus on enhancing opportunities for members of underrepresented groups to achieve excellence rather than obsess with achieving equality of representation according to identity group.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.