Are People With Diabetes Treated Like Criminals?

| Oct 1, 2002

Telling the world you have diabetes is not the easiest proposition. Coming "out of the closet," so to speak, could bring support or condemnation from others.

In a climate where employers and licensing agencies may exclude people with diabetes because of perceived differences that are often based on ignorance, people with diabetes may be cautious about whom they tell—and when.

While it is true that people with diabetes hold down jobs nearly as diverse as there are jobs to be held, they can frequently encounter employment difficulties and may be denied health, life and automobile insurance as well. In addition, many are ineligible to serve in the military, scuba dive, operate public transportation or engage in commercial aviation.

The ‘Diabetes’ Label

Instead of branding a person as a disease—as the label "diabetic" does—it makes more sense to focus on attributes such as "writer" or "hockey player," which define people as complex and multifaceted.

Consider some of the areas in which being labeled "diabetic" can skew others' views of us, placing us in a category, with all its attendant assumptions, rather than considering our individual abilities.

Employment Discrimination

Employers are not supposed to consider a worker's disability when they make hiring, firing, salary and other job-related decisions. But in reality they often do.

Employees with diabetes are as talented and competent as anyone else. Employers have an obligation to foster a nondiscriminatory atmosphere and should not automatically disqualify people with diabetes on the basis of their condition.

People who feel mistreated at work as a result of having diabetes may file complaints with the U.S. Equal Employment Opportunity Commission (EEOC). The Americans With Disabilities Act of 1990 (ADA) also attempts to address workplace discrimination realities. From 1992 to 2001, 158,280 charges were brought against employers. Of those, 5,959, or 3.8 percent, were diabetes-related issues.

To successfully launch a discrimination case on the basis of the ADA, a worker must first show that he or she has a disability, defined as a "physical or mental impairment that substantially limits one or more . . . major life activities." Because diabetes is treatable with medication, it is more difficult to prove this.

Ignorance and fear of diabetes, however, are the root of the problem—not how much or if a diabetes condition is improved with treatment.

Employment discrimination is a serious problem because it excludes capable people who are able to do the job. People with diabetes in fact hold down demanding jobs such as engineers and firefighters—challenging careers that are difficult to scoff at.

A solution for employers would be to treat people with diabetes on a level playing field—one that takes into consideration a sense of compassion for any employee who may experience hardship. An employer who fails to hire people with diabetes merely because of their condition is missing out on a responsible and capable group of individuals who are accustomed to the strenuous demands of juggling a schedule.

Two particular areas that may be challenging for an employee with diabetes are heavy physical labor and shift work. However, with the wide variety of insulin treatment scheduling options and the ability to test blood glucose, there should be no reason why a person with diabetes cannot follow his or her career bliss.

A solution for employees would be an openness about diabetes and a willingness to challenge employer biases about illness by illustrating competency and professionalism.

Driving Under the Influence

Driver's licensing agencies often rely on individuals to volunteer the information that they have diabetes. A medical questionnaire is then issued by the Department of Motor Vehicles, which must be completed by a doctor on behalf of the person with diabetes.

These medical certifications are ineffective because they target an often-healthy segment of the population. They also are frequently unnecessary, because the person with diabetes may be otherwise perfectly healthy, with an ability to detect episodes of low blood glucose and an understanding of how to prevent and treat them.

People with diabetes can choose not to volunteer the information, because the certification procedure unfairly discriminates against otherwise healthy people who happen to have diabetes. But if someone with diabetes fails to admit his or her condition to the Department of Motor Vehicles and is then caught driving "under the influence" of a low blood-glucose level, that individual can face legal action.

The possibility of low blood glucose while driving is a common concern of licensing officials. Having emergency glucose in the car to treat hypoglycemia is crucial.

A recent report involved Mark Halliwell, a person with diabetes who, in December 2000, caused a fatal road accident near Edinburgh, Scotland. His dangerous driving was blamed on his "hypoglycemic state" at the time. He was banned from driving for six years and was ordered to carry out 180 hours of community service.

In Halliwell's case, hypoglycemic awareness was downplayed in the media, as were the facts that his diabetes control was excellent and that nothing on the day of the accident had been cause for concern about his condition. His doctor even testified on his behalf. But that does not lessen the tragedy.

Mountain climber Katherine Brandt-Wells, who is in optimum health, tests her blood glucose before driving and has excellent diabetes control. Brandt-Wells says she must ". have a biannual driver's license medical form completed and the costs have to be covered out of my own pocket . I have also had my license canceled due to not completing [the form] on time, and that was a very frustrating and stressful experience."

Diabetes and driving will continue to be a frustrating and controversial issue as long as people with diabetes end up in serious accidents. Test before you drive to make sure your blood glucose is in an acceptable range—and have glucose in the car, just in case. It's a small price to pay and can prevent accidents.

Writing letters to your legislative representatives is important if you believe you have been discriminated against. Keeping records and having glucose tablets or gel in the car in case of low blood glucose are responsible actions.

People with diabetes who dare to drive while hypoglycemic or who have lost the ability to tell when their blood glucose is low need to make the decision my friend made—to give up his driver's license voluntarily and find alternative modes of transportation.

My friend, whose young daughter was in his car, caused a serious road accident and is lucky that he didn't kill anyone when he crossed over onto the other side of the road while hypoglycemic. The resulting accident made him face the reality of his hypoglycemic blackouts.

Alternative transportation is certainly not as bad as it sounds—I bike to work every day, and it's a healthy, nonpolluting form of transportation.

Flying in the Face of Discrimination

Before April 1992, anyone who wanted a pilot's license had to obtain a medical certificate, which was simply not granted to people with type 1 diabetes.

On June 10, 1991, Eileen Bahlsen was told by Canadian authorities that she was "medically unfit to hold any form of flight-crew license." On November 4, 1991, she launched a federal court case against this blanket restriction, claiming that it violated her rights under Section 15 of the Canadian Charter of Rights and Freedoms.

In the lawsuit, Bahlsen said: "There are people with diabetes that probably should not be flying. There are people in the normal population that should not be flying. However, I believe that if I was considered on an individual basis, that I would be declared fit to hold a flight-crew license."

On June 30, 1995, the federal court judge declared that Bahlsen was right and the regulation was wrong. Bahlsen became the first person in the world with type 1 diabetes to be licensed to fly an aircraft solo.

It took the U.S. Federal Aviation Administration (FAA) longer.

The FAA received a petition in 1991 from the American Diabetes Assoc-iation asking that each pilot be considered as an individual. Through letter-writing campaigns, a protocol written by endocrinologists and the efforts of numerous organizations—including the Juvenile Diabetes Re-search Foundation, the Aircraft Own-ers and Pilots Association, and the American Association of Diabetes Educators—the case against FAA discrimination flew.

However, the petition was not considered seriously until medical professionals finally joined in the struggle. Stanley Mohler, MD, the former director of the FAA's Civil Aeromedical Institute and director of aerospace medicine at Wright State University School of Medicine in Dayton, Ohio, brought some weight to the petition.

"With today's pure insulins, an individual who practices good dietary habits, does regular reasonable exercise, avoids silly things like tobacco, and is careful using alcohol, if at all, generally has very predictable blood sugar levels," Mohler wrote.

In December 1996—after a full five years of convincing—the FAA conceded, and it now considers people with diabetes on an individual basis for aviation licensing.

Blanket discrimination is unacceptable. If people with diabetes are automatically excluded, there is no room for negotiation or consideration of individual qualifications. Considering each person individually is the bare minimum a licensing body—whether aviation or otherwise—can do to foster a nondiscriminatory system.

Athletes With Diabetes

Athletes with diabetes have often faced discrimination. Most National Hockey League teams, for example, avoided Bobby Clarke because he had type 1 diabetes. However, after joining the Philadelphia Flyers in 1969, Clarke missed only one game during his first four NHL seasons.

Athletes who have diabetes include basketball player Chris Dudley, baseball player Jason Johnson, Olympic swimmer Gary Hall Jr. and golfer Kelli Kuehne. They are able to take diabetes in stride, and it does not affect their athletic performance or abilities. There is even an organization for athletes with diabetes—the International Diabetic Athletes Association (on the Web at www.diabetes-exercise.org)—which is dedicated to physical fitness for individuals with diabetes.

However, not all athletes have found the acceptance achieved by Dudley, Johnson, Hall and Kuehne.

Ernest Bladé, the climbing leader for the International Diabetic Expe-dition Aconcagua 2000, received a rubber stamp across his medical chart soon after his diagnosis with diabetes: the Spanish phrase "el paciente no es apto para la practica del alpinismo"—"the patient is not fit to practice mountaineering."

Bladé was already a world-class mountaineer—an athlete at the peak of health. The phrase became the ironic inspiration for the expedition, proving that people with diabetes could actually make it to the summit of one of the most treacherous and challenging mountains in the world—Cerro Aconcagua.

Katherine Brandt-Wells, one of the seven who climbed, says how fortunate she was to have experienced little diabetes discrimination. In 1993, however, she took a solo backpacking trip in Norway, crossing the Smorstabbreen glacier with a guide who didn't understand her need to stop occasionally to test her blood glucose and eat.

"Friends well-experienced in mountaineering have advised me not to in-form trip leaders of my diabetes until I have been accepted to participate in a mountaineering trip," says Brandt-Wells.

Because of such fears of discrimination, Brandt-Wells believes that it is better to reveal her diabetes with a matter-of-fact statement to the group before the trip begins, with a quick explanation of hypoglycemia and what to do if she's acting strangely, rather than facing automatic exclusion at the beginning.

A solution to the prejudices held by other athletes and trainers against athletes with diabetes lies in education. The many successful examples of athletes who happen to have diabetes are certainly encouraging and may also change the point of view of coaches and other athletes. Bobby Clarke did not like to discuss his diabetes because it was used against him, in the form of taunts, when he played on the ice. But proving people wrong gave Clarke the last laugh.

All About Choices

Unfortunately, discrimination by em-ployers, licensing agencies and sports organizations is a reality faced by people with diabetes.

Despite this, Katherine Brandt-Wells believes that "diabetes doesn't have to set any limits. We are capable of doing anything we set our minds to."

Aside from some still-existing restrictions we continue to face, such as those affecting certain military service positions, commercial aviation and other areas, she's absolutely right.

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Categories: Blood Glucose, Blood Sugar, Diabetes, Diabetes, Discrimination, Drivers License & Pilot License, Insulin, Losing weight, Low Blood Sugar, Type 1 Issues


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