Persistent, and sometimes substantial, differences continue to exist in the quality of health among Americans. Blacks have higher infant mortality rates and shorter life expectancies than whites. Underlying the disparities in the quality of health among Americans are differences in both need and access. Moreover, recent studies have suggested that even when blacks gain access to the health care system, they are less likely than whites to receive certain surgical or other therapies. These studies have examined treatments in several areas, including cardiology and cardiac surgery, kidney transplantation, general internal medicine, and obstetrics. Whether the disparities in treatment decisions are caused by differences in income and education, sociocultural factors, or failures by the medical profession, they are unjustifiable and must be eliminated. In this report, the Council on Ethical and Judicial Affairs of the American Medical Association emphasizes the need for (1) greater access to necessary health care for black Americans, (2) greater awareness among physicians of existing and potential disparities in treatment, and (3) the continued development of practice parameters, including criteria that would preclude or diminish racial disparities in health care decisions.