Reasonable accommodation

Abstract: Reasonable accommodation, a provision of the 1990 Americans With Disabilities Act, directs employers to alter the workplace so that qualified workers with disabilities have equal employment opportunity. Data on employees' requests for and employers' responses to reasonable accommodation, reported by people with disabilities, demonstrate that employers are reluctant to modify the social structure of work because of their perceived need to contain the costs of reform and maintain control of the work process. Employers often discourage employees with disabilities from making requests for accommodation, and they deny one of every three requests. The authors show how organizations devalue the work of people with disabilities, and identify an array of resistance strategies employers use to preserve hierarchy and authority in organizations.

Abstract: Is an accommodation reasonable, under the Americans with Disabilities Act, if and only if the benefits are roughly proportional to the costs? How should benefits and costs be assessed? Should courts asks about how much disabled employees are willing to pay to obtain the accommodation, or instead how much they would have to be paid not to have the accommodation? How should stigmatic or expressive harms be valued? This essay, written for a symposium on the work of Judge Richard A. Posner, engages these questions in a discussion of an important opinion in which Judge Posner denied accommodations involving the lowering of a sink in a kitchenette and a request for telecommuting. The problem with the analysis in that opinion is that it does not seriously analyze either costs or benefits. A general lesson is that while cost-benefit balancing can helpfully discipline unreliable intuitions about the effects of requested accommodations, it can also incorporate those intuitions. Another lesson is that stigmatic harms and daily humiliations deserve serious attention as part of the inquiry into which accommodations are reasonable, and that the removal of those harms and humiliations can create real benefits. Adequate cost-benefit analyses must attempt to measure and include those benefits.

Abstract: This report presents (1) a brief history and summary of the Americans with Disabilities Act and (2) an extensive section of definitions and explanations of key components--such as disability, qualified individual with a disability, reasonable accommodation, and undue hardship--and their relevance to medical schools. While these definitions are numerous and somewhat technical, an understanding of them is essential for medical school faculty, staff, and administrators to assess the Act's impact on and implications for their institutions and to assure adequate and appropriate compliance. Gaining such understanding is important, for although some authorities believe that the Act will have minimal impact on most colleges and universities, the author maintains that experience at her medical school does not support this view. A companion article, published in this issue of Academic Medicine, focuses on the implications of the Act for colleges of medicine and offers suggestions for compliance.