Affirmative action in the balance.

To provide good care, physicians must understand the communities and cultures in which they work. An important way to ensure that physicians understand the lives of their patients and to reduce health disparities is to promote racial and ethnic diversity in the physician workforce. However, a crucial tool that has made such diversity possible is currently in danger. Within the next few months, the U.S. Supreme Court will announce its decision in a case destined to chart the future of affirmative action in American higher education. The outcome in Fisher v. University of Texas at Austin1 will determine whether race may continue to be taken into account as a factor in university admissions, including admission of students to our nation’s medical schools. The plaintiff in the case, Abigail Fisher, applied for undergraduate admission to the University of Texas at Austin but was denied admission. The admission policy of the University of Texas consists of two parts. First, all applicants in the state of Texas who graduate in the top 10% of their high-school class are automatically offered admission; this policy is race-neutral and fills about four fifths of the available spaces. Second, the remaining spaces are filled according to a holistic evaluation process in which six factors are considered, one of which is race. Since the student bodies of some Texas high schools are dominated by underrepresented minority students, the top-10% policy in itself results in a substantial admission of students who are members of minority groups. Additional minority students are admitted through the holistic evaluation process. Abigail Fisher, who is not a member of an underrepresented minority group, did not graduate in the top 10% of her high-school class, and after the holistic review she was denied admission to the University of Texas at Austin. She claims that the explicit use of race as a factor in admission to the university violates the Equal Protection Clause of the 14th Amendment of the Constitution. In cases involving racial classifications, the Supreme Court invokes the standard of strict scrutiny, which requires in this case that the admission plan at the University of Texas be based on a compelling government interest and be narrowly tailored. The plaintiff claims that the plan fails on both counts. Two landmark Supreme Court cases, Regents of the University of California v. Bakke2 (1978) and Grutter v. Bollinger3 (2003), provide the legal foundation for Fisher. Allan Bakke applied for admission to the medical school of the University of California at Davis, but he was denied admission. The admission policy of the medical school included an affirmative-action plan in which 16 spots were reserved in each class for underrepresented minority students, and Bakke, who was not a minority student, challenged the constitutionality of the quota system. That challenge was upheld by the Court. In his opinion, Justice Lewis Powell wrote that the rigid quota system at the University of California violated the Equal Protection Clause of the 14th Amendment. He further contended, but was not joined by any other justice on this point, that unlike a quota, the use of race as one of several factors considered in admission would be constitutionally permissible. In his opinion, he wrote, “Physicians serve a heterogeneous population. An otherwise qualified medical student with a particular background — whether it be ethnic, geographic, culturally advantaged or disadvantaged — may bring to a professional school of medicine experiences, outlooks, and ideas that