Jun 28, 2023 | News
MD Barrio-Rentería M. T, Galván-López J. M., MD Hernández-Fernández D., Maldonado-Moreno K. A.
Despite more than 40 years of human rights and feminist advocacy, gender equality still has a long way to go and remains a complex issue; specially in health and science environments. The central matter in this essay is gender-based discrimination in medicine, more specifically against women, nonetheless the concept of gender needs to be defined: “Gender” is an evolving social construct that refers to the sociological and cultural behaviours, attitudes or feelings associated with masculinity or femininity (Brown, 2021). The WHO Global Health Workforce Network Gender Equity Hub, reports that women in the health and social care workforce are under-represented in management, leadership, and governance. Gender-based discrimination is present in every level and includes, belittling remarks, inappropriate jokes, denial of opportunities, behaviours or conducts (Brown, 2021).
Approximately 75% of the global health workforce is female but they only hold a small fraction of leadership positions. Women remain a minority in surgical specialties and the wage gap is reported through all specialties (Shannon, 2019). The UN Educational, Scientific and Cultural Organization’s Women in Science data shows that less than 30% of the world´s researchers are women, comprising 45% in Latin America and 32% in North America, even though the proportion of female researchers is increasing worldwide, women still publish fewer research papers than men and are less likely to collaborate internationally (Shannon, 2019).
In medicine, women are paid 8% less, this being attributed to “domestic responsibilities” given that female physicians take lighter schedule because they tend to be the primary caregivers of their children, they´re also less likely to hold positions of power, and when they achieve those positions, they are paid less than the men in equivalent roles due to implicit biases that result from gender schemas that are culturally ingrained (Kowalski, 2020 & Kuo, 2020). Unconscious biases are also present, a study conducted by the University of Nebraska examined linguistic choice and gender disparities in letters of recommendation for surgery residents; where men tend to be described as future leaders using terms such as dominant, confident and intelligent whereas women tend to be described as compassionate, calm and family centered (Hoffman, 2019 & Brown 2021). In 2015, 85% of females in surgical fields recall having suffered at least one form of gender-based discrimination throughout medical school, residency and professional practice, not only from colleagues and superiors. The two more common sources reported were patients and nursing staff; the majority of the participants reported having to work “twice as hard” to earn the respect their male counterparts automatically receive from nurses and patients (Brown, 2021).
Differences between male and female practitioners have been well established; female practitioners are more likely to follow guidelines, use more patient-centered communication, provide psychosocial counselling and preventive care more often than male counterparts (BDJ, 2017). A study investigating mortality rates in women with acute myocardial infarction found that there were higher mortality rates in women treated by male doctors than in the group of females treated by female doctors. Also, several studies have shown that patients treated by female physicians have lower rates of complications, ER department visits, lower rates of morbidity and mortality, stating that gender is an important asset in healthcare, and these differences found between male and female physicians should be investigated to replicate positive behaviour that leads to better outcomes in patient care, medical training, etc. (Tsugawa, 2017)[4]
It is important to mention that many individuals, men and women; including those in power or leadership positions don´t consider this to be an ongoing issue in the residency training programmes or a problem worth improving, yet in a study including 7 surgical programmes in Calgary, 55% of women and 40% of men agreed that it is an issue in residency training programmes. Identification of gender-biased behaviours is the first step towards its eradication (Brown, 2021).
In the article “Nevertheless they persisted: how women experience gender-based discrimination during postgraduate surgical training”, Brown suggests that women become desensitized to gendered-biased behaviours by using coping strategies involving denial and minimization of these experiences which leads to underreporting the frequency and severity of discrimination contrary to the one experienced by men that tends to be more memorable due to its infrequency. Immediate action, such as the continuous investigation on the topic, promoting collection of empirical and objective data, the promotion of institutional-level discussions between teachers and administrators, examining the local culture and climate for students and faculty members, as well as allyship and anti-oppression training in the core curriculum is needed.
Identifying, dismantling and restructuring the system along with increasing the number of women in medicine will change the environment, given that an imbalance in sex representation promotes a culture where women are unlikely to pursue academic and personal goals, damaging well-being, medical training and ultimately healthcare.
Reflecting on strategies to promote change, medical schools and training hospitals could benefit from examining their local culture and climate as well as student, teachers, and faculty members’ perspectives. All individuals must be encouraged to be allies who continuously advocate for an inclusive environment and zero tolerance against gender discrimination and harassment policies. It is crucial that implemented strategies allow the report of inappropriate behaviour with confidence and without fear of consequences, and that those will be adequately addressed. This is an era of gender reckoning, challenging and changing times, there is no doubt that gender equality is a human right. Gender equality in healthcare and science holds the promise and potential to lead to economic, scientific, and social transformation.
Bibliography
Brown, A., Bonneville, G., & Glaze, S. (2021). Nevertheless, they persisted: How women experience gender-based discrimination during postgraduate surgical training. Journal of Surgical Education, 78(1), 17–34. https://doi.org/10.1016/j.jsurg.2020.06.027
Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. (2017). British Dental Journal, 222(3), 170–170. https://doi.org/10.1038/sj.bdj.2017.116
Hoffman, A., Grant, W., McCormick, M., Jezewski, E., Matemavi, P., & Langnas, A. (2019). Gendered differences in letters of recommendation for transplant surgery fellowship applicants. Journal of Surgical Education, 76(2), 427–432. https://doi.org/10.1016/j.jsurg.2018.08.021
Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria. (n.d.).
Jena, A. B., Olenski, A. R., & Blumenthal, D. M. (2016). Sex differences in physician salary in US public medical schools. JAMA Internal Medicine, 176(9), 1294. https://doi.org/10.1001/jamainternmed.2016.3284
Kowalski, A. (2020). The impacts of gender disparity in residency matching. JAMA Network Open, 3(11), e2028161. https://doi.org/10.1001/jamanetworkopen.2020.28161
Kuo, L. E., Lyu, H. G., Jarman, M. P., Melnitchouk, N., Doherty, G. M., Smink, D. S., & Cho, N. L. (2020). Gender disparity in awards in general surgery residency programs. JAMA Surgery. https://doi.org/10.1001/jamasurg.2020.3518
Ruzycki, S. M., Freeman, G., Bharwani, A., & Brown, A. (2019). Association of physician characteristics with perceptions and experiences of gender equity in an academic internal medicine department. JAMA Network Open, 2(11), e1915165. https://doi.org/10.1001/jamanetworkopen.2019.15165
Shannon, G., Jansen, M., Williams, K., Cáceres, C., Motta, A., Odhiambo, A., Eleveld, A., & Mannell, J. (2019). Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet, 393(10171), 560–569. https://doi.org/10.1016/S0140-6736(18)33135-0
Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2017). Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Internal Medicine, 177(2), 206–213. https://doi.org/10.1001/jamainternmed.2016.7875
May 29, 2023 | Bioethics, Multiculturalism, and Religion
by Allister Lee, licentiate student in bioethics.
In his 2020 encyclical, Fratelli Tutti, Pope Francis points out the many social issues of the contemporary age which could be characterised by the absence of communal and social purpose and selfish indifference towards the common good. However, the Holy Father also offers a hopeful message and suggests that the world should encounter itself through renewed dialogue and friendship. The last chapter of the encyclical examined the role of religions in fostering fraternity instead of polarization. As a response to the Pope’s call to dialogue, the UNESCO Chair in Bioethics and Human Rights, established at Faculty of Bioethics of the Pontifical Athenaeum Regina Apostolorum and Faculty of Law of Università Europea di Roma, organised a two-day workshop to study the document in light of other different traditions, including Islam, Judaism, Greek Orthodoxy, Buddhism, Confucianism, and Hinduism.
The workshop began with the keynote speaker, Prof. Edmund Kwok and Dr. Christine Lai, who focused on the encyclical’s discussion of contemporary global politics concerning integral human development and addressed the Holy Father’s vision of a “better kind of politics” through a universal fraternity that is rooted in the common good, love, mercy, and hope. This was followed by Fr. Sameer Advani, LC, who contextualised Fratelli Tutti and the Catholic Church’s commitment to interreligious dialogue as a product of the Second Vatican Council, and pointed out that such dialogue is “primarily anthropological, and only secondarily theo-logical, in nature.” He highlights that because religion is an essential part of human existence and experience, the fundamental questions that interreligious dialogue seeks to answer are consequently also deeply human, such as the nature and purpose of man, and morality. In his presentation, Fr. Adavani, LC, argues that even though the Catholic faith conceives truth as singular and absolute, it is within the human condition that our knowledge and understanding of the truth is limited; henceforth, it is only by the breaking down of one’s preconceived notions of truth through dialogue with the “other” can one attain a deeper, and often hidden truth.
The Holy Father’s concept of what could be called a universal fraternity was examined by some scholars in this workshop and brought forward the tension between particularism and universalism. In his presentation, Dr. David Heyd from the Hebrew University of Jerusalem points out that this philosophical tension is reflected socio-politically in the divide between cosmopolitanism and statism, and religiously in the way that Judaism differs from Christianity where it approaches issues from the particular to the universal, while the latter does so in a reversed manner. The idea of cosmopolitanism was also mentioned by Dr. Ellen Zhang from the University of Macau about the “ethics of hospitality” and Buddhism. The speaker presented the Buddhist idea of the interconnectedness of the world by recognizing the universality of suffering and vulnerability, which in turn creates a demand for the virtues of loving-kindness and compassion. However, as both Dr. Heyd and Dr. Zhang questioned in their presentations, “Are feelings of love and compassion sufficient enough to develop rational moral propositions in favour of global solidarity and social friendship?” Undoubtedly, these affective notions can be slightly precarious for long-lasting social cohesion and unity, but they can often be a powerful impetus for open dialogue between people to (re)discover fundamental truths that forge social friendships and fosters a sense of universal fraternity.
Dialogue – as Dr. Chris Durante from St Peter’s University in New York reminded the participants through the words of the Greek Orthodox leaders, “takes place in all our encounters, personal, social, or political, and must always be extended to those who adhere to religions different from ours” where “truth is not afraid of dialogue.” As such, Dr. Durante in his presentation stressed the importance of relationality with others in the world and avoiding bigoted forms of tribalism and exclusivism. On the other hand, Luzita Ball from the Islamic Foundation for Ecology and Environmental Science (IFEES) presented the Islamic tradition which approaches the topic of interreligious dialogue in a more legalistic manner in comparison to its Orthodox counterparts, while remaining committed to the ideals of unity and solidarity for the downtrodden. In this contemporary world, even though the East and West have been ever brought closer to each through technological means, international conflicts have created a vast space for dialogue and mutual understanding. However, in his presentation, Dr. John Lunstroth from the University of Houston brought to attention the historical relationship between the two hemispheres that were characterized by admiration and a call to “rectify each other’s errors and supplement mutual deficiencies” by learning from each other. And concerning the dialogue between East and West, Dr. Ruiping Fan from the City University of Hong Kong added that to conduct authentic social dialogue and foster fraternity, there is an imperative to first acknowledge the differences of “people’s particular cultural rituals and practices”.
On a final note, the “fruitful exchange” that occurred throughout this workshop inevitably involved contentions of an intellectual nature at times. However, they were always denoted by the underlying friendship that was built through shared moments such as the day trip to Assisi on the last day of the workshop, and a deep desire to seek the truth that unites rather than divides. And as such, I firmly believe that the Pope’s encyclical is a reaffirmation and encouragement to the continuous efforts of the UNESCO Chair in Bioethics and Human Rights to foster constructive interreligious dialogue which would bring the universal fraternity closer to each other.
