Responsible Discrimination

As a physician, if I was presented with a child having back or bone pain and shortness of breath, and both parents were of African descent, one of the first tests I would order would be a test for sickle cell disease. If both parents were of Mediterranean descent, I might not initially order a sickle cell test, but it would certainly be in order if my initial testing proved fruitless. If one of the parents were white, I would not order a sickle cell test at all.

Is this discriminatory? Absolutely. My patients expect me to discriminate between diseases that they are likely to have versus diseases that they are unlikely to have, based on my knowledge and experience. To do anything less would be abrogation of my responsibility as a physician. If I indiscriminately order tests that have little or no possibility of being positive, it wastes critical health care dollars, can delay the diagnosis, and clogs up the system for everyone else. Believe it or not, in some quarters, this is controversial. Just Google “race-based medicine” for a number of opinions on why this is so. But I believe that most of us would agree that this type of discrimination is entirely justified. It is evidence based and non-malignant. It ensures that medical care is tailored to benefit the patient and society at large.

On New Year’s Eve, one of my Facebook friends posted the following status:

"Protecting the rights of terrorists has been more important than protecting the lives of Americans. That must now change decisively. It is time to know more about would-be terrorists, to profile for terrorists and to actively discriminate based on suspicious terrorist information." -Newt Gingrich. Disgusting; I do not see how this is morally defensible...

I admire my friend’s passion for social justice, but I disagree with his conclusion. I believe that it is not only morally defensible to actively discriminate based on suspicious terrorist information, but that it is morally indefensible not to do so.

A government’s first responsibility is the protection of its citizens. To endanger its citizens for the purpose of ensuring that someone’s feelings are not hurt is an abrogation of the mandate of a government. The preamble of the United States Constitution explicitly states this purpose of establishing the government:

We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.

In the case of terrorism, the government has not only the right, but also the responsibility to be prejudicial against citizens of other countries, if necessary to protect its own citizens. This is not to say that we should intentionally harass non-citizens without cause, but that is not what Newt said. He specifically said that we must “actively discriminate based on suspicious terrorist information.” [italics mine.] No one who is not a citizen of the United States has a right to enter our country without permission. If we have the slightest reason to believe that someone may have terrorist connections or sympathies, it is essential that those suspicions be totally allayed before that person is allowed entrance into the United States.

These protective measures may necessarily include profiling. There is no question that over the last decade, the vast majority of terrorist incidents in the world, and against the United States, have been conduction by young Muslim men. That is not to say that women or members of other religions cannot conduct terrorist activity, but it is irresponsible for the government not to concentrate its attention on the group that is most likely to conduct a terrorist act. To do otherwise diverts resources and tells our enemies that we are not serious about combating terrorism.

This is not just an Obama administration issue. It started during the Bush administration, after 9/11, when we saw Norwegian grandmothers going through intrusive screening at the same rate as young, Middle Eastern men – maybe more in our attempt not to appear discriminatory – and we all had our fingernail clippers confiscated. Since the Richard Reid shoe-bombing incident, we all have to take off our shoes to go through security. Now, since the panty-bombing attempt, we can’t go to the restroom or have a blanket or a book on or laps during the last hour of a flight. The TSA under the Obama administration is merely continuing the dangerous policies of the Bush administration.

As Christopher Hitchens said, “Why are we so bad at detecting the guilty and so good at collectively punishing the innocent?” I think the reason is that we are unwilling to use our collective knowledge and experience to do those things that are necessary to effectively and efficiently use the information available to concentrate on those few people who are the risk. Instead, in our politically correct society, we are more concerned with sparing feelings than saving lives.

Why this is so controversial, I don’t know. In medicine, we know that to discriminate based on knowledge and evidence is essential in order to save lives. Why should we be so reluctant to do the same when it comes to air safety and national security?