Legal and Ethical Implications of HHS Investigation of DEI in Healthcare

Graphic by Alej Gonzalez-Acosta

Diversity, Equity, and Inclusion (DEI) have become central to the conversation of improving medical education and healthcare. Medical schools and healthcare institutions have adopted DEI initiatives to address racial and socioeconomic disparities, aiming to create a more representative workforce. However, these programs have sparked many controversies and the current presidential administration has taken a hard stance against these policies, arguing that they prioritize identity over merit and lead to discrimination. This tension embodies a core question: Is DEI an essential tool for equitable healthcare, or does it amount to unfair discrimination?

On March 7, 2025, the U.S. Department of Health and Human Services (HHS) announced that its Office for Civil Rights (OCR) had initiated four investigations into medical schools and hospitals over allegations that their “medical education, training, or scholarship programs for current or prospective workforce members discriminate on the basis of race, color, national origin, or sex”. [1]  This comes as a response to President Trump’s Executive Order “Ending Illegal Discrimination and Restoring Merit-Based Opportunity”, which aims to end illegal preferences and discrimination, ordering agencies to “enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities”. [2] 

Proponents for DEI initiatives in healthcare believe it is vital to “address the long-standing and well-documented inequities in our healthcare system”. [3] Diversity in healthcare workers can target the vast racial disparities in health outcomes in the U.S., particularly for Black people. According to a 2023 study published by the JAMA Network, a higher proportion of Black primary care doctors is associated with longer life expectancy and lower mortality rates among Black people. [4] DEI initiatives can help combat implicit biases in healthcare by ensuring that medical students receive training on the unique health challenges faced by different communities. Supporters of DEI argue that these policies do not constitute discrimination but rather correct historical inequities. Therefore, DEI aligns with the medical ethics principles of justice and beneficence, requiring that all individuals have equal opportunities to access and succeed in medical education and work in the best interest of diverse patient populations effectively. Without DEI, medical institutions risk perpetuating a cycle of inequality that leaves underserved communities at a disadvantage.

Critics of DEI in medical education raise ethical concerns about fairness. They argue that DEI policies may lead to reverse discrimination, where qualified candidates from non-minority backgrounds are disadvantaged in admissions and hiring. As evidenced by the recent HHS investigation, critics argue that DEI policies violate the Civil Rights Act, which prohibits racial discrimination in federally funded institutions. Jay Greene, a senior research fellow at the Heritage Foundation, claims that seeing physicians of the same race or increasing the number of doctors from any particular racial group does not improve health outcomes. [5] There are also concerns that DEI efforts could unintentionally lower academic and professional standards. Some worry that medical schools might accept students with lower qualifications, potentially impacting the quality of medical training and patient care, thereby violating the medical ethical principles of justice and beneficence by promoting unqualified students and workers. 

The ethical debate over DEI in healthcare is unlikely to be resolved soon, especially as legal and political battles continue. While DEI advocates see it as a moral imperative to correct systemic inequalities, critics warn against policies that could create new forms of discrimination. The challenge lies in finding a balance between promoting diversity and maintaining fairness in medical education and healthcare.

Reviewed by Anna Chen

Resources

 [1] Department of Health and Human Services. (2025, March 7). HHS’ Civil Rights Office Investigates Alleged Discrimination in Health Care Workforce and Training to Restore Merit-Based Opportunity. HHS.gov. https://www.hhs.gov/about/news/2025/03/07/hhs-civil-rights-office-investigates-alleged-discrimination-health-care-workforce-training-restore-merit-based-opportunity.html 

[2] The White House. (2025, January 21). Ending Illegal Discrimination And Restoring Merit-Based Opportunity – The White House. The White House. https://www.whitehouse.gov/presidential-actions/2025/01/ending-illegal-discrimination-and-restoring-merit-based-opportunity/ 

[3] American Medication Association. (2024, March 26). Statement on improving health through DEI. American Medical Association. https://www.ama-assn.org/press-center/press-releases/statement-improving-health-through-dei  

[4] Snyder, J. E., Upton, R. D., Hassett, T. C., Lee, H., Nouri, Z., & Dill, M. (2023). Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US. JAMA Network Open, 6(4), e236687. https://doi.org/10.1001/jamanetworkopen.2023.6687 

[5] Greene, J., & Kingsbury, I. (2023, December 20). Racial Concordance in Medicine: The Return of Segregation . Do No Harm. https://donoharmmedicine.org/research/2023/racial-concordance-in-medicine-the-return-of-segregation/