Law & Medicine

How the ADA shapes health care


A “qualified individual with a disability” is an individual with a disability who, “with or without reasonable accommodation,” can perform the essential functions of the employment position in question. A person is not a qualified individual with a disability, however, if he or she cannot satisfy the basic attendance requirements of a position.

Employers are not required to offer any and all accommodations, such as those that are disruptive to the business, overly burdensome, or prohibitively expensive. Providing a clean and private area in the workplace for self-administered peritoneal dialysis fluid exchange would likely qualify as a reasonable accommodation that should be offered, absent some compelling reason not to.

The protection given by the ADA may be suspended if the condition poses a direct threat, defined as “a significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures, or by the provision of auxiliary aids or services.”4 The U.S. Supreme Court has noted that this should be assessed by the objective reasonableness of the views of health care professionals.

Dr. S.Y. Tan, emeritus professor of medicine and former adjunct professor of law at the University of Hawaii, Honolulu

Dr. S.Y. Tan

Even if patients such as those with ESRD may be eligible for Social Security disability, the National Kidney Foundation’s Employers’ Guide notes that “many of them express a strong desire to continue their jobs if they are working, or to get back to a job if they have been temporarily unemployed. In many cases, the disability payments will be less than the person’s former salary. Someone who was the ‘breadwinner’ of the family may feel a loss of purpose and accomplishment. In addition to earning money, work is a way of enhancing a person’s self-esteem. Work also gives people a chance to practice skills and abilities, and to socialize with others.”5


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