DeVille Kenneth, Kopelman Loretta M
Department of Medical Humanitities, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858-4354, USA.
J Med Philos. 2003 Aug;28(4):489-516. doi: 10.1076/jmep.28.4.489.15971.
The U.S. Supreme Court's seminal 1978 Bakke decision, now 25 years old, has an ambiguous and endangered legacy. Justice Lewis Powell's opinion provided a justification that allowed leaders in medical education to pursue some affirmative action policies while at the same time undermining many other potential defenses. Powell asserted that medical schools might have a "compelling interest" in the creation of a diverse student body. But Powell's compromise jeopardized affirmative action since it blocked many justifications for responding to increases in political opposition and legal challenges. The Bakke decision and its moral background and legal legacy are traced and analyzed. Despite recent legal setbacks, the framework sketched by Powell can be used to defend diversity in medical education both morally and legally as a "compelling state interest." Because trust is a central component of the physician-patient relationship and a prerequisite to the profession's ability to provide effective medical care, the state has a compelling interest in training physicians with whom patients can feel comfortable and safe if the population is (1) distrustful; (2) underserved; (3) faces significant discrimination in the allocation of benefits, goods and services and (4) affirmative action programs would be likely to promote their trust in the system. Similar narrowly-tailored arguments could be used in other professions and for other groups. Bakke is an important background for the pending Grutter case.
美国最高法院1978年具有开创性的“巴克案”裁决如今已有25年历史，其遗产模糊且岌岌可危。大法官刘易斯·鲍威尔的意见书提供了一种正当理由，使得医学教育领域的领导者能够推行一些平权行动政策，但同时也削弱了许多其他可能的辩护依据。鲍威尔断言，医学院在创建多元化学生群体方面可能有“令人信服的利益诉求”。但鲍威尔的妥协危及了平权行动，因为它堵住了应对政治反对和法律挑战增加的许多正当理由。本文追溯并分析了“巴克案”裁决及其道德背景和法律遗产。尽管最近在法律上遭遇挫折，但鲍威尔勾勒的框架可在道德和法律层面用于捍卫医学教育中的多元化，将其作为一种“令人信服的国家利益”。由于信任是医患关系的核心要素，也是该职业提供有效医疗服务能力的先决条件，如果民众（1）不信任他人；（2）医疗服务不足；（3）在福利、商品和服务分配方面面临重大歧视，且（4）平权行动计划可能会增进他们对该体系的信任，那么国家就有令人信服的利益诉求去培养能让患者感到舒适和安全的医生。类似的经过精心调整的论点可用于其他职业和其他群体。“巴克案”是悬而未决的“格鲁特案”的重要背景。
