Post-Mortem Dignity in Mexico

Jul 20, 2023 | News

By Analuisa Ahumada Madrigal, Student, Law School – Universidad Anahuac Queretaro

In Mexico there is a great problem with violence, connected to homicides. Mexico has registered around 91 deaths per day^[1]; in the 7 entities which reported such statistics, it is said that 71% of the bodies are set to be unidentified^[2]. However, there is an enormous problem concerning the dignity of unrecognized bodies, mainly because a dead person does not have the possibility of expressing wishes, purposes, suffering, or any type of resistance to the violence to which their body may be subjected^[3]. In 2019 Mexico had a forensic crisis due to the war against drug trafficking during the six-year term of former President Felipe Calderon. The Forensic Medical Service (SEMEFO), registered the largest number of unidentified corpses ever seen. There were so many that no effort was even made to identify all of them. A study that was carried out on the forensic crisis found that 27,271 unrecognized bodies were taken to the “common grave”, 5,446 remain in SEMEFO and most impressively was that 2,589 bodies were donated to universities for experimentation^[4]. Here is where the problem begins.

The law establishes that for the use of corpses of unknown persons, educational institutions may obtain them from establishments that provide medical care or social assistance services, but this becomes a problem for the dignity of the unidentified body, as well as causing violence to the family of the deceased person. Before death, the person did not consent to having his body donated to educational institutions where he could be subjected to experiments and various situations. In addition to that, his family will definitely no longer have the opportunity to find their relative. In Mexico, there is a “General Law of Victims” which establishes that victims have the right to know the truth and to receive specific information about crimes and violations of rights that had directly affected them^[5]. If the corpse did not have post-mortem dignity, the law would not have to legislate against incorrect use of corpses. In the Mexican Federal Penal Code, it speaks about violations of rights in the privacy of the body, its image and its honor. In 2009 in Mexico, one of the largest cases of femicide – the campo algodonero case, which had occurred in 2001, was brought to the Inter-American Court of Human Rights. In this case 8 women were found dead, but only three were identified^[6]. No effort was made to identify the other five bodies. The authorities dealt out the remaining bodies to the families with no assurance that they were actually members of those families. Another clear example of the lack of dignity accorded to unidentified bodies and the seriousness of donating unidentified corpses to educational institutions is that in 2014, Mexico once again suffered one of the most controversial cases it has ever seen, the disappearance of 43 students from Ayotzinapa, Guerrero.

Another very important issue that must be touched on is organ or tissue donation, whether a body is identified or not, it could be the victim of organ extractions for donation or sale. In Mexico this arises from a socio-cultural issue. Even despite having holidays like the Day of the Dead, death is not really something accepted and above all it may be felt to be terrifying. Organ donation can occur from brain death, which will include head trauma from a motor vehicle accident, falls, gunshot wounds, haemorrhages in the brain from aneurysms and seizures, drug overdose, drowning, and poisoning. among others^[7]. Therefore, if the cause of death was a homicide by gunshot wound, people will be able to organ-poaching or illegally sell these organs. For such reasons, there is a brisk market in illegal organ sales on the part of organised crime in Mexico. Besides selling organs, these criminals go to extreme lengths to erase any link to the people that have been kidnapped and murder to obtain these organs. Sick people and their relatives do not readily accept death. This fear is often due to not knowing what happens after death, worry about surviving loved ones and the fact of not knowing if the process will be painful or not. I previously mentioned that a person is most vulnerable at the moment of death, since he can be the object of violence, modifications and extractions perpetrated on his body, and above all his last wishes regarding his body are not really fulfilled by the simple fact that he is no longer able to protest. Many people come to use the corpse as a mere object without that being the true desire of the person. Post-mortem dignity includes the times when the media take and use photos of the body and use them in publications, since they should not be exposed to the public. What we really need to consider is that even though the person has already died, their body still has dignity, and the family should be given respect and support. Finally, I believe that it is important to establish new regulations regarding unidentified bodies and, above all, to train the SEMEFO authorities so that they can have sufficient means to identify the massive number of bodies that need to be

^[1] Deutsche Welle (www.dw.com). (n.d.). México registró menos homicidios en 2022. DW.COM. https://www.dw.com/es/m%C3%A9xico-registr%C3%B3-menos-homicidios-en-2022/a-64430440

^[2] El Economista. (2022, December 1). En siete entidades, 71% de los cuerpos sin identificar. https://www.eleconomista.com.mx/politica/En-siete-entidades-71-de-los-cuerpos-sin-identificar-20221201-0004.html

^[3] La Dignidad Post-Mortem en el Sistema Jurídico Mexicano. (2022). Comisión Estatal De Derechos Humanos Jalisco. Retrieved March 26, 2023, from https://cedhj.org.mx/revista%20DF%20Debate/articulos/revista_No18/ADEBATE-18-art2.pdf

^[4] Tzuc, E. (2020, September 25). Crisis forense en México: un país rebasado por sus muertos. CIPER Chile. https://www.ciperchile.cl/2020/09/25/crisis-forense-en-mexico-un-pais-rebasado-por-sus-muertos/

^[5] Ley general de víctimas. (2013, January 9). https://www.diputados.gob.mx/LeyesBiblio/pdf/LGV.pdf. Retrieved July 9, 2023, from https://www.diputados.gob.mx/LeyesBiblio/pdf/LGV.pdf

^[6] “Campo Algodonero”: Caso González y otras vs. México | Comisión Nacional de los Derechos Humanos – México. (n.d.). https://www.cndh.org.mx/noticia/campo-algodonero-caso-gonzalez-y-otras-vs-mexico

^[7] Muerte Cerebral. (2021). The National Kidney Foundation. Retrieved March 26, 2023, from https://www.kidney.org/sites/default/files/docs/braindeath_sp.pdf

Gender-Based Discrimination in Medicine: A General Survey

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