In January 2025, the Trump Administration issued executive orders asserting opposition to diversity, equity, and inclusion (DEI) programs on the federal level1,2 and rescinding Biden Administration orders that emphasized the importance of these efforts to promote equal opportunity across government programs. This oppositional stance parallels steps taken in many states to restrict or oppose DEI policies in educational and other settings. This column examines the implications of the recent federal reversal of DEI efforts on oncology care.
Hampering DEI Programs in the Private Sector
Opposition to diversity, equity, and inclusion initiatives has primarily involved three levers of governmental power. First, the Trump Administration has sought to block the disbursement of federal grants earmarked for DEI purposes. Second, it has sought to close federal programs that pursue diversity, equity, and inclusion goals or to remove references to diversity, equity, and inclusion in these programs’ public statements.3 Third, the administration has threatened to investigate private sector diversity, equity, and inclusion programs. Such programs, they aver, themselves constitute discrimination and may run afoul of federal law.
Govind Persad, JD, PhD
These developments build on prior opposition to DEI initiatives in some states. Before 2025, several states ordered the closure of diversity, equity, and inclusion offices at state universities or took other steps to hamper these efforts. To the extent that these orders go beyond legislation or prior court decisions, several have been preliminarily enjoined by the courts.4 One judge who paused an injunction noted her approval of a pause was conditional on the government’s representation that the orders “apply only to conduct that violates existing federal antidiscrimination law.5
Understanding the Implications for Oncology Care
Restrictions on diversity, equity, and inclusion programming in lieu of the administration’s stated priorities to no longer consider DEI factors and instead focus on individual performance and merit present challenges for effective oncology care. One major challenge is the wording of these executive orders is vague and confusing, including which forms of diversity, equity, or inclusion are unacceptable.
Much of the rhetoric around DEI programs has centered on concerns that they seek to unfairly assist racial minority Americans and constitute legally impermissible forms of affirmative action. But many programs currently facing opposition are designed to prevent discriminatory practices against racial minorities as well as other minority groups, including women; people with disabilities; lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals; and those who are economically disadvantaged. There is also growing evidence that keyword searches by political appointees on words such as “diversity” and “equity” are impacting initiatives that have nothing to do with DEI, including the cancellation of federal grants to fund such programs as research investigating the evolution of birds, for example.6
In addition, many of the efforts that have come under attack existed long before “diversity, equity, and inclusion” became a common term. Programs such as Black History Month and Women’s History Month have been around for decades, and efforts to ensure representation of women and racial minority patients in clinical trials date back to at least the 1990s. The National Institute on Minority Health and Health Disparities dates back to 2000.
At the level of care for patients with cancer, governmental opposition to DEI initiatives could harm the quality of oncology care they receive by impeding professionals’ efforts to gain cultural competency in treating a wide range of patients, a crucial component in ensuring high-quality care for all patients. Many medical schools emphasize cultural competency training, which is essential for effective patient-physician communication, treatment adherence, and patient trust. Without adequate training, oncology professionals may struggle to address patients’ needs, leading to poorer outcomes.
Assessing the Effects of Eliminating DEI Programs
Access to health care for underserved communities could also be hindered if restrictions on DEI programs lead to mistrust among patients, resulting in delayed diagnoses, which have especially dire consequences for patients with cancer in whom early diagnosis is critical and may lead to worse outcomes. For example, if visible signs of inclusion, such as brochures and posters, expressing support of LGBTQ or racial and ethnic minority patients are removed from the clinical setting, these individuals may feel unwelcome, impacting their ability to communicate effectively with their oncologist and leading to avoidance of needed cancer screenings and treatments.
In addition to creating a significant barrier to accessing effective cancer care for patients, eliminating diversity, equity, and inclusion programs may also damage the professional environment, decreasing workplace morale and hindering collaboration and teamwork among colleagues. In cancer research and innovation, restrictions on these programs could undermine once bipartisan efforts to address significant cancer disparities in diverse populations.
Applying Applicable Law to DEI Programs
A few restrictions on diversity, equity, and inclusion programs genuinely reflect relevant legal precedents adopted by the courts. The clearest examples involve programs that treat individuals differently based on their race. For example, preferentially treating patients of certain races would be subject to strict legal scrutiny. The same is also generally true for preferentially hiring professionals based on their race. Such programs, however, are rare. Moreover, even these programs can sometimes be legally acceptable. For example, the U.S. Supreme Court has indicated that the use of race as a factor in deciding whom to screen for sickle cell trait can be legally acceptable.7
By contrast, programs that seek to address racial disparities without treating anyone differently based on their race have not generally been subject to strict legal scrutiny. Examples include long-standing Congressionally authorized programs that seek to address racial health disparities in areas including cancer care and outcomes, such as the National Institute on Minority Health and Health Disparities.
“Fears of funding disruption and of investigations—even baseless ones—may nonetheless chill the operation of DEI programs in oncology. Such chilling effects risk negative consequences for clinical care, biomedical innovation, and patient trust in oncology care.”— GOVIND PERSAD, JD, PhD
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In addition, programs organized around categories other than race face fewer legal barriers. For example, there is no legal barrier to designing programs that assist patients with disabilities or preferentially accept economically disadvantaged patients. Although governmental objections to diversity, equity, and inclusion initiatives have recently extended to these categories as well, there is no legal precedent holding these programs unlawful. Indeed, legal enactments, including Medicaid, which provides health coverage for people with low incomes, and the Americans with Disabilities Act, specifically mandate assistance to and fair treatment of these patient populations.
Conclusion
Recent challenges to diversity, equity, and inclusion efforts have raised concerns for medical practice, including the field of oncology. These challenges have so far generally taken the form of presidential executive orders rather than legislation, court decisions, or administrative regulations.
In the absence of changes to the laws governing DEI programs, oncology practices’ legal obligations to adhere to these executive orders are no different than they were prior to these directives. Differential treatment based on race is legally fraught, whereas programs assisting other populations or seeking to address disparities without differential individual treatment are generally unproblematic.
However, fears of funding disruption and of investigations—even baseless ones—may nonetheless chill the operation of these programs in oncology. Such chilling effects risk negative consequences for clinical care, biomedical innovation, and patient trust in oncology care.
DISCLOSURE: Dr. Persad receives grant funding from the Greenwall Foundation.
REFERENCES
1. Federal Register: Executive Order 14151, Ending Radical and Wasteful Government DEI Programs and Preferencing. January 20, 2025. Available at www.federalregister.gov/documents/2025/01/29/2025-01953/ending-radical-and-wasteful-government-dei-programs-and-preferencing. Accessed April 2, 2025.
2. Federal Register: Executive Order 14148, Initial Rescissions of Harmful Executive Orders and Actions. January 28, 2025. Available at https://public-inspection.federalregister.gov/2025-01901.pdf. Accessed April 2, 2025.
3. Johnson CY, Dance S, Achenbach J: Here are the words putting science in the crosshairs of Trump’s orders. The Washington Post, February 4, 2025. Available at www.washingtonpost.com/science/2025/02/04/national-science-foundation-trump-executive-orders-words/. Accessed April 2, 2025.
4. Harrington B, Fabiano A: District Court Enjoins DEI Executive Orders. Hunton Insights Legal Updates, March 4, 2025. Available at www.hunton.com/insights/legal/district-court-enjoins-dei-executive-orders. Accessed April 2, 2025.
5. National Association of Diversity Officers In Higher Education v Trump, No. 25-1189, 1:25-cv-00333-ABA (4th Cir March 14, 2025).
6. Schneider K: Indianapolis program killed by federal government sought diversity…among trees. Indianapolis Star, February 26, 2025. Available at www.indystar.com/story/news/environment/2025/02/26/feds-pull-tree-planting-grant-from-keep-indianapolis-beautiful/80473693007. Accessed April 2, 2025.
7. Bush v Vera, 517 U.S. 952 (1996). Available at https://supreme.justia.com/cases/federal/us/517/952/. Accessed April 2, 2025.
Dr. Persad is Assistant Professor at the University of Denver Sturm College of Law.
Editor’s Note: The Law and Ethics in Oncology column is meant to provide general information about legal topics, not legal advice. The law is complex, varying from state to state, and each factual situation is different. Readers are advised to seek advice from their own attorney.
Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.
