Friday, October 11, 2013

Starved for content...

In case anyone was wondering what I've been up to, (what's she DOING?!), I am currently finishing up my Counselling Women and undergrad degree. It's been a long time coming. Like many women, I wasn't able to finish or further my studies when I was younger, so I'm finally rectifying that sad situation later in life. I never stopped my research, and I have some fabulous developments that I will be publishing later, and was in fact able to teach much of it in less academic settings. But that only goes so far, and to take my work to the next level, it's necessary to have the paperwork and degrees to back it up.

So, much of my current writing and research has gone into essays and such. For your edification, this is one of the short pieces I presented to my Issues in Women's Health prof. Mostly, the mechanics were not to her liking, rather than the content. I hope I have corrected enough of those mistakes for her to see my true brilliance shine through... Heh.

Statement 1:
Based on and using examples from your required readings, critically discuss notions of autonomy as they relate to women’s health care. Include some discussion of the conflicts that arise from ideal and actual conditions defining patient autonomy.

Patient autonomy has not always been of primary concern in conventional health care, but is now seen to play a vital role in outcomes and quality of care. Sherwin (1998) gives a comprehensive four point definition used to determine ideal autonomy in health care. The patient 1) must be sufficiently competent, 2) makes a reasonable choice from available options, 3) has adequate information and understanding of the choices, and 4) is free of coercion (p. 26).[1] However, these definitions are problematic in practice when examined in the context of classist or sexist institutional constructs.

For the first condition, competency is often defined by the dominant power group. Language and cultural barriers for example are often considered reason enough to question a patient’s competency or understanding when considering their care.  Rationality in particular is considered the usual yardstick of competency, especially, as Genevieve Lloyd (1984) shows, that that the agent demonstrate objectivity and emotional distance. However, since those traits are “constructed in opposition [to those] stereotypically assigned to women..[they] are often seen as simply incapable of rationality” (as cited by Sherman, p. 26)  Competency, therefore, is often already defined as outside a woman’s capabilities, and autonomy becomes an impossibility.

The ideal for condition two, or reasonable selection of offered choices, appears straightforward enough. However, “the set of available options is constructed in ways that may already seriously limit the patient’s autonomy by prematurely excluding option the patient might have preferred.” (Sherwin, p.26) From dominant viewpoints to researchers to funding to primary care providers, pre-selection reducing women’s preferences occur at every significant point in the shaping process of offering health care options.

The third condition of patient autonomy, that of adequate information to understand the choices, ties in with the choices available.  In “the information that has been deemed worthy of study…and, significantly, what questions are neglected; systemic bias unquestionably influences these polices.” (Sherman, p. 27). Patients most often do not have the expertise to question providers to gain the information they need, and providers often do not have the perspective as a member of that group or experience treating those members, and in many cases, the time available, to be able to volunteer the information relevant to the patient’s situation.

The fourth condition, in such a dominant patriarchal culture, is the most obviously problematic. Oppression permeates almost every aspect of a woman’s choice and agency. No matter how liberated a woman has worked to become, “[i]t’s hard to fight an enemy who has outposts in your head.” (Sally Kempton, Esquire, 1970)  Every choice, therefore, can be subconsciously influenced by the culture around her, and those decisions reinforced. Standards of beauty, self-worth related to fertility, and negative views of aging for example can all influence treatment choices, including the desirability and presentations of those treatments and the risks involved.

For women especially, the challenges of navigating and expressing autonomy in a system where they are overtly and subtly coerced, with stereotyped beliefs that reinforce their lack of competency, and with choices designed by those who do not consider women’s preferences, makes accessing health care a frustrating and often dangerous journey.

Statement 2:
Based on and using examples from your required readings, critically discuss how gender expectations affect both paid and unpaid providers of health care. Include some analysis of ways in which the needs of women health care providers can be met.

Gender expectations are a vital and primary consideration in the delivery and quality of care of patients, and the working conditions of health care delivery. How could it not be? “Approximately 80% of paid health care workers in Canada are women… Women make up the overwhelming majority of hospital workers…Women are also the overwhelming majority of health care workers employed in nursing homes, residential facilities or private homes”, according to Armstrong et al. (2009b)[2] As for  unpaid workers providing health care, usually to older relatives, Letvak, S. (March 2001) reminds us that “72% of caregivers are women."[3].
Not only do these disproportionate demands on time create stress for the women caregivers, for those who have made a career out of it, the inherent sexism of their expected roles can create further difficulties. As Letvak suggests from G J Clifford, “the predominance of women in such professions as social work and nursing has led to their identification with that other domain of female exclusivity, the housewife.”[4]  Letvak also quotes from P E B Valentine, that nursing in particular, “being identified with a docile female role…has led to a ghettoization of the career field. Ghettoization segregates people by race, ethnicity, lifestyle, or socioeconomic status and reinforces negative stereotypes[5] which has made it progress against the gender expectations of the so-called nurturing professions nearly impossible, even today.

Mothers who are paid or unpaid caregivers are in the worst straits. As Letvak reports from
Faludi,70% of women with young children also participate in the labor force. Women still shoulder 70% of all household duties[6]  Women’s unpaid care hours re excluded from paid labour and other duties, however, as “Sixty percent of women caregivers work 35 or more hours per week outside of the home in addition to caring for an older adult family member”[7] as Letvak enumerates from Jenkins.  Why are women disproportionately burdened with the health care needs of patients in our culture, yet also expected to perform all their other duties as well? It is considered acceptable in a sexist social context, because “[t]he very image of nursing maintains the stereotype of nurturing, self-sacrificing females who will always meet the needs of others.”

Clearly, this is detrimental to women, and the families and patients they care for, and comprises the health of all concerned.  But what is to be done?  As Lessard et al. suggests, by fully engaging the women involved in paid and unpaid care in the policy process[8] as part of the solution, some remedies automatically present themselves.  Recognizing and valuing women’s caregiving services could reduce frustration and result in more appropriate services and programs, including possible subsidies or other support for unpaid caregivers.[9]  Letvak suggests other support suggestions for paid caregivers, such as flexible working hours, job sharing, part-time work with benefits, and other innovations on hours worked, including more flexible time off for those with kids in school or whose families become ill.[10]

As the fashion for neocon privatization of public services shows no signs of slowing down in health care, it appears that women will be forced to take on even more of the burden than they have in the past. The time for improvement is now, increasing the quality level of care, staff, and saving the system money. Without considered improvements in the conventional health delivery system, patient care and professional nursing and its quality will continue to decrease, homecare will necessarily increase, the burden shifting more to families and their women, reducing the health of all concerned, and therefore, our collective health.  With a rapidly ageing population, it is of vital importance.

[1] Sherwin, S. (!998). A relational approach to autonomy in health care. In S. Sherwin (Coord.), The politics of women’s health, Exploring agency and autonomy (pp.19-47) Philadelphia: Temple University Press.
[2] Armstrong et al (2009b). Hidden health care work and women. Canadian Women’s Health Network
[3] Letvak, S. (March 2001). Nurses as working women. AORN Journal, 73(3), 675–682.

[4] G J Clifford, "Women's liberation and women's professions reconsidering the past, present and future," in Women and Higher Education in American History: Essays from the Mount Holyoke College Sesquicentennial Symposia, ed J Faragher, F Howe (New York: W W Norton and Co, 1988) 165-182.
[5] P E B Valentine, "Nursing: A ghettoized profession relegated to women's sphere," International Journal of Nursing Studies 33 no 1 (1996) 98-106.
[6] Faludi, Backlash: The Undeclared War Against American Women.
[7] C L Jenkins, "Women, work and caregiving: How do these roles affect women's wellbeing?" Journal of Women and Aging 9 no 3 (1997) 27-45.
[9] Ibid.
[10] Letvak., S, (March, 2001)