CULTURAL AWARENESS
The Americans with Disabilities Act in Emergency Medicine: Past, Present, and Future By Eric Kontowicz, MPH, PhD; Jason Rotoli, MD; Cori Poffenberger, MD; IV Mirus, MD, MPH; Richard Sapp, MD, MS; and Wendy C. Coates, MD, on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine
SAEM PULSE | MAY-JUNE 2025
The Road to Inclusion: Setting the Stage for Change
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The World Health Organization defines disability is an umbrella term that includes impairments, activity limitations, and participation restrictions. Disability is not only a health issue but a complex phenomenon that results from the interaction between a person’s body and the environment in which they live. In the United States, individuals with disabilities represent a significant portion of the population, with approximately one in four U.S. adults having a disability. People with disabilities are often perceived as needing to be “cured” to achieve a so-called “normal” state. This reflects an ableist mindset,
which views able-bodied individuals as the ideal. Such attitudes are likely influenced by caregivers’ inherent desire to cure disease and optimize patient well-being. However, these implicit biases can negatively affect the patient-physician relationship, leading to challenges in receiving equitable care. Many individuals with disabilities do not perceive themselves as “broken” or in need of a “cure.” People with disabilities often encounter societal, physical, communication, attitudinal, institutional, and environmental barriers to accessing healthcare. These barriers include inadequate wheelchair access, insufficient language accommodations for those who are deaf or hard of
hearing, inadequate descriptions of printed documents for people with low vision, physician bias, negative assumptions about quality of life, denial of access due to the cost of accommodations, and increased violence against people with disabilities. Such obstacles extend into healthcare settings, delaying treatment, increasing anxiety, and sometimes leading to outright denial of care. Table 1 outlines examples of barriers individuals with disabilities may face when seeking healthcare. Moreover, individuals with disabilities are more likely to underutilize primary care services continued on Page 26