Gender This or Gender That

Recently, on the Bioethics Discussion Blog, Dr. Maurice Bernstein asked the question:

The Other View: "Gender This or Gender That" but one (the medical system) may argue, it is not about patient gender but it is all about "Disease and Disorder: Diagnosis and Treatment". It's all about skill by physicians and nursing staff. Shouldn't that be what patients are looking for? 


JR who runs the blog Issues 4 Though, had the best response (she beat me to it):

While what you said may be justified in a medical setting but medicine needs to recognize there are other components that make up how to successfully treat a patient. Mental needs have to be met or else the physical treatment will not be successful or will fail. Cured the ailment but killed the patient because they neglected the mental health of a patient. No patient should come out of hospitalization with PTSD. The physical treatment of the patient by staff should not be so abusive and horrific that the patient is forever mentally injured. Is that not a failed treatment and a side effect that is not mentioned? Even RXs mention some potential side effects. Procedures mention some possible side effects. However, they do not mention that because they may treat you less than humanely you may suffer from PTSD.

For some it is not that some female nurse sees their penis or a male nurse sees the breast(s) of a female patient. It is the manner in which it is done-with permission, for a valid medical purpose, & done with the patient's dignity & respect in mind. It is the ambushing of male patients of having an audience during an intimate exam of 2 or more females (some chose a female dr. & are fine with her but not with the nurse, MA, etc.), it is not having the same choice as female patients do in ultrasounds or even ward care, it is about how callously the exposure of a male patient is done & oftentimes done excessively or unnecessarily, it is being told it doesn't matter if we see you naked but society and religion teaches it does matter, it is made to feel you have no choice.

Why it is Patient DIGNITY and NOT patient modesty.

First let us establish some definitions.

mod·es·ty / ˈmädəstē /

noun Behaviour, manner, or appearance intended to avoid impropriety or indecency. 

Source: Oxford Dictionaries

dig·ni·ty / ˈdiɡnədē /

noun The state or quality of being worthy of honour or respect. 

Source: Oxford Dictionaries

Human Dignity

The mercurial concept of human dignity features in ethical, legal, and political discourse as a foundational commitment to human value or human status. The source of that value, or the nature of that status, are contested. The normative implications of the concept are also contested, and there are two partially, or even wholly, different deontic conceptions of human dignity implying virtue-based obligations on the one hand, and justice-based rights and principles on the other. 

Source: The Internet Encyclopedia of Philosophy (IEP) (ISSN 2161-0002) (peer reviewed)

My original argument (previously) was that referring to the human condition of not wanted to have one's (the patient) body exposed (being naked) as modesty can be construed as the patient is asking for something that they are not entitled to. The phrase that most demonstrates this is You are being too modest."

Dignity on the other hand takes into account the intrinsic value of a human being that makes the person deserving of being treated in an absolute, respectful, and dignified manner that is not open to interpretation or negotiation. To treat one in this manner is often not the easiest option and can be inconvenient. 

The basis for human dignity (by non-atheists) is that we are endowed with it by our Creator (God). For Judeo-Christians (such as myself) the concept is furthered in that we believe that we were "created in the image of God."

This was rejected because the thread has been titled "Patient Modesty" and a change would some how create a disconnect. This is nothing more than marketing fluff. I will expand on this. 

The word doctor (Latin, an agentive noun of the Latin verb docere 'to teach') medical doctors teach their patients and students to use correct terminology, especially in regards to human anatomy. Not only does this keep the procedure medical in nature (as opposed to being sexual), but it also denotes the professionalism of the physician (provider) by showing that they are (properly) educated in the correct terminology. 

One example of this is the use of the terms anus (the opening at the end of the alimentary canal through which solid waste matter leaves the body.), rectum (the final section of the large intestine, terminating at the anus.), and the colon (the part of the large intestine that extends from the cecum to the rectum). 

By using the term modesty instead of dignity, it is making one look less professional and less educated. 

The patient can be accused of being too modest. 

Modesty is taught to girls at some of the youngest stages of their lives. Modesty as projected by the person (patient) is t different levels. (Read about how New Jersey 'Mormon Prom' Draws Hundreds Of Teens For Celebration Of Modesty.) Modesty is about one choosing to be modest. 

Teens were required to sign a pact agreeing to dress and behave modestly, to dance “appropriately” and to abstain from using alcohol or drugs...

The nearly 300 students abandoned several conventional prom practices — including arriving in limousines and wearing expensive outfits. (Organizers encourage attendees to be modest in their spending as well.) Most were dropped off by their parents, and some of the girls swapped or borrowed dresses to keep down the cost...

The problem in healthcare is that providers are taught to respect patient modesty and NOT patient (human) dignity. Let me expand...

An anesthetized patient (technically) has no modesty. (Everybody line up to practice rectal exams on the anesthetized patient.) An anesthetized patient DOES HAVE dignity. The lack of consciousness negates the presence of modesty being practiced, requested, or displayed.

I bet everyone knows where I am going next...

A cadaver has no modesty. A cadaver DOES HAVE dignity. Increasingly, medical schools are having ceremonies honoring the sacrifice that people made leaving their body to science. This is to humanize the cadavers where traditionally (and still today) the cadavers were de-humanized. This is what happens when medical providers are taught to respect modesty and NOT taught to respect dignity:

...Last month, Stony Brook University Medical Center in Long Island announced it was developing a revised ethics policy after a student posted a photo on Facebook of a classmate posing with a thumbs up next to a cadaver. The State University of New York Upstate Medical University in Syracuse also is updating its ethics curriculum after a former resident posted a snapshot of an exposed brain on Facebook...

Let us also NOT forget the Denver 5...

By using the term modesty instead of dignity, nullifies and disregards the basic intrinsic value that human beings have and deserve being sentient beings and as endowed by our Creator. This is akin to calling an African-American man "boy."

...One, it's the ultimate sign of disrespect, and is often more offensive than calling them the N-word. For years black men were summarily dismissed and treated with disregard. It was as if their stature was diminished when someone white called them a boy...

Do you remember the images from the sanitation strike that the Rev. Dr. Martin Luther King Jr. was leading in Memphis in 1968? The most striking visual was that of the male protestors wearing signs saying, "I Am A Man!"

There was a reason they were wearing those signs...

This mirrors the profession of medicine. Just as the hidden curriculum, the use of the patient gown, and teaching the term "modesty," helps retain and the paternalistic power that physicians are desperately trying to hold on to. It makes the doctor-patient relationship resemble the parent-child relationship.

For at least 2,500 years, the doctor-patient relationship has resembled the parent-child relationship. The norms of medical ethics, codified in historic documents or perpetuated as informal traditions, encouraged doctors to shield patients from bad news and from general medical knowledge. While Western medical tradition has always included some patient protections, such as informed consent (and its antecedents), doctors have possessed broad powers to withhold treatments that patients desired and, at times, to mislead patients for what they perceived to be the patients’ own good...

Even the term "doctor-patient relationship" attempts to consolidate and preserve physician power by putting the doctor first. I prefer the term "patient-physician relationship" because it puts the patient first, and recognizes the difference between a doctor (PhD) and a physician (medical doctor). 

Dignity has 3 definitions, all with subtle nuances.

The state or quality of being worthy of honor or respect. a man of dignity and unbending principle

a composed or serious manner or style. he bowed with great dignity

a sense of pride in oneself; self-respect. it was beneath his dignity to shout

As to the person who acts as he has no dignity; it is important to realize subtle nuances. First off, he is acting in an undignified manner. The lack of dignity is this example is labelling how his actions assail the dignity of those around him and society. 

By one having dignity (worth as a human being), one will (should) act in a manner worthy of that dignity. Part of our human dignity is respecting the dignity in others (even if they do not respect others' dignity). This is the second nuance of acting with no dignity.

These definitions all involve the actions of the actor, behaving in a way that elicits respect (or disrespect) of observers. The "state or quality of being worthy of honor or respect" can be achieved by behaving in such a way, for example having good manners (saying please and thank you). 

The "state or quality of being worthy of honor or respect" as in human dignity is intrinsic, and can not be given up or taken away, only disregarded and disrespected. In fact, one giving up their dignity can lead to them creating a state of higher dignity beyond intrinsic, human dignity. Think of the Christian martyrs. 

When we speak of patient dignity, we are referring to that intrinsic, human dignity. Patient dignity is a subset of human dignity. Going back to my example, human burial rites going back to prehistoric times recognize intrinsic, human dignity in the manner that the corpse is treated. By contrast, the Nazi concentration camps failed to recognize that intrinsic, human dignity and the corpses were used as manufacturing material (lamp shades, pillows, etc.), as a source of wealth for the riches (possessions) to be mined from the victims, and as refuse to be efficiently disposed of in incinerators and mass graves. 

The true horror of the Holocaust was NOT the brutal acts committed, but how the philosophy of the Holocaust and human beings (many of them nurses and physicians) ignored that intrinsic, human dignity of the Holocaust victims. 

Just as the use of the term "patient modesty" allowed providers to use it against patients (by saying you are being too modest), patient dignity can be used against them by focussing on the dignity derived from the patients own actions (as opposed to the intrinsic, human dignity as a subset of human dignity). Providers may also say that dignity does not apply to (what has been previously called) modesty/exposure issues either from a lack of comprehension of the subject or to confuse the issue (as to deny the patients their full human rights in regards to modesty/exposure issues).

Finally providers run the risk of narcissism (such as the issue of burnout) by saying "what about my dignity?" As previously stated, surrendering one's own dignity can elevate their dignity and status. 

Another risk is the provider "crying the blues" to the patient how the hospital, healthcare system, MOC, etc., tramples the patient's dignity. Due to the power differential, the sick patient can care less. If the system changes to be dignity driven, then that prosperity will spread and the atmosphere will improve for providers as well.