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Transcript
ARE WOMEN MORE
COMPASSIONATE?
Joan Cassell PhD
Were the Women
Arrogant
Daring
Warlike
As the men I had studied
ten years earlier?
If The Women Were Different
How did this affect patient care?
Theorists Who Emphasize Difference
Women More
Men More
Compassionate
Independent
Nurturant
Detached
Cooperative
Hierarchical
Sociobiologists Also Emphasize
Difference
Gender as Negotiated or Constructed
Rather than examining differences
The social construction of differences
Gender is not possessed
But performed
One does not have gender
One does gender
The Embodied Nature of Identity and
Experience
The notion of habitus
Embodied social structure
Passed on from generation to generation
Not something you think
Something you are
And what you are is based on what you do
The actions and reactions of your body
“The ultimate values, as they are called, are
never anything other than the primary
primitive dispositions of the body, “visceral”
tastes and distastes in which the group’s
most vital interests are embodied.
…The sense of distinction…which demands that
certain things be brought together and others
kept apart…responds with visceral, murderous
horror, absolute disgust, metaphysical fury, to
everything which…by challenging the principles
of the incarnate social order, especially the
socially constituted principles of the sexual
division of labour and the division of sexual labor,
violates the metal order, scandalously flouting
common sense.”
Bourdieu, Distinction: A Social Critique of the Judgement of Taste
Harvard University Press, 1984
“The principles em-bodied in this way are placed
beyond the grip of consciousness, and hence
cannot be touched by voluntary deliberate
transformation, cannot even be made explicit;
nothing seems more ineffable, more
incommunicable, more inimitable, and therefore
more precious, than the values given body,
made body.”
Bourdieu Outline of a Theory of Practice
Cambridge University Press, 1977
Are Women More Compassionate?
I wish!
How Can We Examine Compassion?
Can it be measured?
Quantified?
Does it affect medical care?
What Counts As Evidence?
Medicine permeated by dualistic thinking
At the root of many of the tragic situations
observed in medicine
Especially at the end of life
In This Thinking
Scientific
evidence-based
medicine
Large
Prospective
Randomized
Double-blind
Controlled clinical
trials
Unscientific
Anecdotal
Intuition-based
Emotion-permeated
Treatment
Logical Positivism
In 1937 Rudolph Carnap
Labeled all statements to do with
metaphysics, ethics, and
epistemology “nonsense”
Unverifiable
“Logically invalid”
The “Gold Standard”
“Evidence-based medicine and
the randomized clinical trial have
become the new gold standard
in the health care field.
Timmermans and Berg, The Gold
Standard, Temple University Press,
2003
“What counts as good clinical
practice (and, more and more,
what is reimbursable) is tied
to guidelines based upon
scientific evidence derived
from randomized clinical
trials.”
“The Ultimate Standard in Medicine”
…”the measure against which
everything else will be
measured”
…”defines the truth”
When Good Clinical Practice
and Truth Itself
Defined by Evidence-Based Medicine
Facts
prized
Body dealt
with
Masculine,
active,
scientific
professions
Values
disregarded
Mind and spirit
left to others
Soft
“feminine”
professions
• Nurse
• Chaplain
• Ethicist
Doctors Do Not Lack Values
But in dichotomy
Values perceived as personal
Versus professional commitment
• To tangible
• Measurable
• Facts
Why Conceptualize An Either-Or
Dichotomy
Based on a concept of science
almost 70 years out of date?
Values
Facts
Compassion
and caring
The advances of
modern medicine
Evidence-Based Medicine
Responsible for medical “miracles” that save lives
daily
Lives that would have been lost just a few years ago
What I take exception to is dichotomous thinking
Based on positivist standards
And a view of “science”
That no longer define contemporary science
Facts Do Not Have to Extinguish
Values
The body does not have to be treated as
though disconnected from mind and person
“Evidence” in the narrow sense
Does not need to contraindicate compassion
When “state of the art” includes both
measurable and immeasurable factors
When what counts as evidence
is not just what can be counted
Then, and Only Then
Will patients and families
get the kind of care we all hope for
When we and those we love
are gravely ill