Posted: 1 Aug 2011 Last revised: 20 Sep 2014
Date Written: 2008
Shifting population demographics and a dramatic rise in obesity are fueling an epidemic of Type II diabetes in the United States. In 2002, it was estimated that diabetes cost approximately $132 billion in the United States, with $92 billion in direct costs and $40 billion in indirect costs, such as lost workdays and permanent disability.
These costs will increase with time, as the prevalence of diabetes increases. The number of individuals with diagnosed diabetes in the United States has more than doubled in the last 15 years, reaching 14.6 million in 2005, with an estimated 6.2 million additional undiagnosed cases. Beyond the financial impact of diabetes on the health care system, diabetes leads to suffering, disability, and premature death. Diabetes is a lifelong, chronic illness that requires significant behavior modification for proper management. These behavioral changes, which include the regularization of diet, routine exercise, control of stress, and pharmacological treatment, must be followed 24 hours per day. Such behavioral changes can significantly ameliorate the effects of the disease and can slow or arrest its progression. This article focuses on the management of diabetes in the workplace. Most Americans spend a significant part of their day at work, and for many these days are long enough to account for most of the individual’s waking time. Diabetes management must be part of workplace life if affected individuals are to successfully control the disease.
The Americans with Disabilities Act of 1990 (ADA) provides a general legal framework for access of individuals with disabilities to public places and for accommodating employees with disabilities in the workplace. Although the ADA contains very specific guidance for physical accommodations, such as wheelchair access, it provides little guidance relevant to workers with diabetes. Many of the judicial rulings on diabetes under the ADA are based on simplistic or outdated understandings of the disease and do not provide useful precedent for workplace diabetes policies.
This article reviews the problems in ADA jurisprudence as it relates to diabetes. Some of these problems are common to other chronic diseases under the ADA. The article concludes that courts would reach more consistent and effective rulings if they used a more sophisticated view of diabetes.
Unfortunately, it is difficult to achieve consistent scientific fact-finding when each case depends on the preparation and resources of the attorneys representing individuals before the court and on the scientific sophistication of the particular judges and jurors. We propose that the Equal Employment Opportunity Commission (EEOC), the federal agency charged with enforcing the ADA, use its rulemaking power to clarify the conditions under which diabetes is a protected disability and to provide guidance on applying these standards in individual cases. Depending on how broadly the courts construe the EEOC’s mandate in this area, it may also be necessary for Congress to amend the ADA to better fit the growing burden of chronic diseases in the workplace, with particular attention to diabetes
Keywords: ADA, disability, diabetes, workplace, rulemaking, administrative law, chronic illness, EEOC
JEL Classification: I18, J28
Suggested Citation: Suggested Citation
Leeds, Hilary S. and Richards, Edward P., Legal Issues in Accommodating the Americans with Disabilities Act to the Diabetic Worker (2008). Journal of Legal Medicine, Vol. 29, No. 3, pp. 271-283, 2008. Available at SSRN: https://ssrn.com/abstract=1899077