The changing legal landscape of discrimination in medicine

As the case surrounding Heidi Cox progresses, Peter Taysum discusses the issues and how it could set the precedent for discrimination against disabled students in the future In 1992, Heidi Cox started her undergraduate medical education at St George’s Hospital Medical School. Unfortunately, she was seriously injured and damaged her spinal cord, and she became paraplegic. Heidi did not continue her medical studies after this, and she is currently a wheelchair user. She completed a bachelor’s degree at Reading and a master’s at City University and then decided to return to medicine: she applied and was accepted to Oxford University.

Disabled medical students in the same position as Heidi Cox face being unable to practice medicine

Oxford University contacted the General Medical Council (GMC; the regulatory body for medical education) for advice about how they could support her studies, and about tailoring their course to her different abilities. The council responded that under the Medical Education Act 1983, they are not able to recognise modified courses for undergraduate students. This act does, however, allow them to modify courses for a qualified doctor in their preregistration house officer year. Heidi decided to bring legal action against the GMC, under the Disability Discrimination Act 1995, because she thought she had been discriminated against because of her disability. She won her initial complaint in June 2000 under the legal point that the GMC is a trade organisation, and, as such, it is “unlawful to discriminate against a disabled person ... in the terms on which it is prepared to admit him to membership of the organisation.” This meant that she could take her place at Oxford University.

The GMC, however, successfully appealed against this ruling, on the grounds that, as a regulatory body, it is not a trade organisation. This legal ruling means that the first role of the GMC is towards the public and their protection, without balancing the needs of those people with disabilities. As such, it is not held responsible under the Disability Discrimination Act 1995.

Due to the timing of the case, the incorporation of Human Rights Act into member states of the European Union (which took place in 2001) was not applicable. The GMC would have a responsibility under the Human Rights Act, not to discriminate in respect of disability, or serious communicable diseases. Whether Heidi would have made a good pathologist—her chosen career path—was not discussed, and whether the GMC could, or should, modify the medical undergraduate degree course was not considered. The Human Rights Act will be incorporated in Employment Law in 2003. Students are a special breed and are not protected by employment law. Medical students are an even stranger breed, because they are automatically provisionally registered with the GMC after they graduate. Medical schools, therefore, have a responsibility to ensure that only students who can meet the rigorous demands of the preregistration house officer year are admitted onto their course. There is confusion about who exactly has a responsibility for the protection of medical students.

Given the recent changes in the law, you may wonder whether the position taken by the GMC is still tenable. Speaking on Radio Four’s You and Yours programme in May this year, Peter Rubens, Chairman of the Education Committee of the GMC, stated that the council was interested in “outcomes” of the medical curriculum, rather than the curriculum itself.

How individual medical schools ensure that their graduates achieve such outcomes is for the schools to decide, and so the issue of modified courses is irrelevant. Given the already diverse courses for undergraduate medical education, such as problem based learning, system based learning, traditional and a “mixed menu” approach, the GMC seem to be stating that courses are, by their very nature, different. If the council are interested only in the achievement of outcomes, this would appear to be different to their previous interpretation of the legal implication of the Medical Education Act.

This is cold comfort for Heidi, and the following paragraph taken from a recent GMC publication is ironic given their recent appeal:
“You must always treat your colleagues fairly. In accordance with the law, you must not discriminate against colleagues, including doctors applying for posts, on grounds of their sex, race or disability. And you must not allow your views of colleagues’ lifestyle, culture, beliefs, race, colour, gender, sexuality, or age to prejudice your professional relationship with them.”¹

The GMC have, however, commissioned a working group from their education committee to look at rewriting Student Health and Conduct. But until this brings positive affirmation from the GMC that they welcome diversity within medical schools, the wrong signal is being sent to potential entrants to medical schools with disabilities.

Peter Taysum, medical student, University of Newcastle
Email: p.n.taysum@ncl.ac.uk


studentBMJ 2002;10:171-214 June ISSN 0966-6494

1. General Medical Council. Good medical practice. London: GMC, 2001:para 34. www.gmc-uk.org/standards/good.htm#Treating colleagues fairly (accessed 14 May 2002).