Domestic Partner Benefits: Where Do We Stand?

By Billy Thomas, MD, MPH
UAMS Vice Chancellor for Diversity and Inclusion
Professor, College of Medicine

Dr. Billy Thomas
Billy Thomas, MD, MPH
UAMS Vice Chancellor for
Diversity and Inclusion
Professor, College of Medicine

This spring the U.S. Supreme Court will be busy hearing three cases that focus on major social issues that are directly linked to social equity. Two of these cases – Fisher vs. the University of Texas at Austin and Schuette vs. the University of Michigan – have as their primary focus the inclusion of race as one of many factors in the undergraduate admissions process, while the third is a challenge to the Defense of Marriage Act (DOMA) that seeks to expand benefits for federal employees so that benefits available to married couples would extend to same-sex couples; these would include tax breaks, survivor benefits and health insurance for same-sex domestic partners. As part of the rapidly changing social climate in the United States, the importance of these cases cannot be overstated.

Locally, the hearing of the DOMA comes at a time in which the University of Arkansas for Medical Sciences (UAMS) is in the midst of discussions and perhaps a move towards the adoption of policy that would extend employee benefits for married spouses to domestic partners including same-sex couples.

At this point, the issue is being debated by the UAMS Academic Senate. Since a recent meeting, discussions, primarily over email, have been intense. Despite some differences of opinion, it looks like most members feel that a decision on the issue is long overdue and are supportive of domestic partner benefits. In fact, in a recent session the Academic Senate voted in favor of extending employee benefits to domestic partners. I commend and totally support the work and leadership of the Academic Senate on this important issue.

Formal academic senate adoption has already occurred at the University of Arkansas at Little Rock and the University of Arkansas at Fayetteville. Both institutions are part of the UA system, as is, of course, UAMS. However, as the sole academic health center in the UA system, UAMS has a unique role in the debate on this critical issue.

Is the push for domestic partner benefits just another political issue? Or is it a social and/or health care issue that requires that we reflect on our institutional values? The mission of UAMS is to improve the health, health care and well-being of Arkansans and of others in the region, nation and the world by the education of current and future health professionals, the provision of high quality and innovative health care, and advancing knowledge in areas affecting human health. Implicit is the recognition that UAMS has a social obligation – “social contract,” some say a “social covenant” – that obligates us to adopt policies that are fair and equitable for those we serve, including those who work here. The overall impact of such policies on the health and vigor of the community is immeasurable, creating a social good that will translate into improved health and health care within our community, state and region. This is part of our social contract with the multiple and diverse communities we serve.

Central to this debate also are two of the basic tenets of health care – humanism and professionalism. Humanism, according to scholar Joseph Cohen, MD, is “a way of being” that “comprises a set of deep-seated personal convictions about one’s obligations to others, especially others in need … [that] manifests itself by such personal attributes as altruism, duty, integrity, respect for others, and compassion.”

The value we in medicine place on humanism is exemplified by the ceremony in which students recite an oath whereby they pledge to be honest, upright, selfless, giving, and inclusive, to do no harm, and to help those that are less fortunate. In short, humanism plays a major role in our approach to and care of individual patients and communities. Professionalism, on the other hand, allows us to function within specified boundaries (observable behaviors or expectations of the patient and public) while optimizing patient care.

There is some debate about the relationship between the two. Some would say that humanism and professionalism are unrelated, and even that in some cases professionalism is more important. Most health care disciples have portions of their curricula devoted to professionalism. This is also the case at UAMS. In my opinion, humanism is the true “backbone” of professionalism, and the two are intimately linked. Without a deeply instilled, unwavering humanistic approach to individual patients and a true sense of the multiple social ills that directly affect individual and population health, we will not be able to deliver appropriate medical care in what we define as a professional manner.  It is humanism that is foremost in most questions of access to and quality of health care.

So, it is indeed our social duty to not only weigh in on, but to also be a leader on the issue of whether to extend benefits to domestic partners. We should consider the matter from the perspective of humanism, which is at the heart of good and equitable care, remembering that part of our social contract is to support and become a voice for many that do not have a voice. In this case, it is for those individuals that are denied access to their partner’s benefits and in the end denied access to quality, equitable health care.

1. High Court Skeptical of Federal Defense of Marriage Act. Chronicles of Higher Education. March 27, 2013-04-03

2. Cohen Jordan J. Viewpoint: Linking Professionalism to Humanism: What it Means, Why it Matters. Academic Medicine, Vol. 82, No.11/November 2007.