ARE WOMEN MORE ARE WOMEN MORE

COMPASSIONATE?COMPASSIONATE?

Joan Cassell PhD

Were the WomenWere the Women

Arrogant

Daring

Warlike

As the men I had studied

ten years earlier?

If The Women Were DifferentIf The Women Were Different

How did this affect patient care?

Theorists Who Emphasize Theorists Who Emphasize

DifferenceDifference

Women More

Compassionate

Nurturant

Cooperative

Men More

Independent

Detached

Hierarchical

Sociobiologists Also Emphasize Sociobiologists Also Emphasize

DifferenceDifference

Gender as Negotiated or Gender as Negotiated or

ConstructedConstructed

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 The Embodied Nature of Identity

and Experienceand 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 Are Women More

Compassionate?Compassionate?

I wish!

How Can We Examine How Can We Examine

Compassion?Compassion?

Can it be measured?

Quantified?

Does it affect medical care?

What Counts As Evidence?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 ThinkingIn This Thinking

Scientific evidence-based medicine

LargeProspectiveRandomizedDouble-blindControlled clinical

trials

Unscientific

Anecdotal

Intuition-based

Emotion-permeated

Treatment

Logical PositivismLogical Positivism

In 1937 Rudolph Carnap

Labeled all statements to do with metaphysics, ethics, and epistemology “nonsense”

Unverifiable

“Logically invalid”

The “Gold Standard”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 The Ultimate Standard in

Medicine”Medicine”

…”the measure against which everything else will be measured”

…”defines the truth”

When Good Clinical Practice When Good Clinical Practice

and Truth Itselfand Truth Itself

Defined by Evidence-Based MedicineDefined by Evidence-Based Medicine

Facts prized Values disregarded

Body dealt with

Mind and spirit left to others

Masculine, active,

scientific professions

Soft “feminine” professions• Nurse • Chaplain• Ethicist

Doctors Do Not Lack ValuesDoctors Do Not Lack Values

But in dichotomy

Values perceived as personal

Versus professional commitment• To tangible• Measurable• Facts

Why Conceptualize An Either-Or Why Conceptualize An Either-Or

DichotomyDichotomy

Based on a concept of science almost 70 years out of date?

Values Facts

Compassionand caring

The advances of modern medicine

Evidence-Based 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 Facts Do Not Have to

Extinguish ValuesExtinguish 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 ThenThen, 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