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Power and microaggressions in healthcare
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
Heather Stewart, Lauren Freeman
One place that calls for more work by feminist scholars is in the context of medicine and healthcare more broadly: specifically, understanding the ubiquitous gendered and other power dynamics in healthcare contexts and how and why they are harmful in more and less obvious ways. In this chapter, we aim to help fill this lacuna. We offer an examination of one subtle, often overlooked operation of power that is common within healthcare contexts, specifically, power in communicative interactions between physicians and patients who are members of structurally marginalized groups. One of the ways in which unequal power dynamics manifest, we argue, is through microaggressions, which can be defined as brief and commonplace verbal, behavioral or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights toward members of marginalized groups (adopted from Sue et al. 2007: 271; Sue 2010). In healthcare contexts, microaggressions occur when those with greater power (i.e. healthcare providers) exert that power, often in subtle, unintentional ways, over their patients, and particularly those who are members of one or more structurally marginalized groups (Freeman and Stewart 2018, 2019).1 Though all patients can, in theory, experience microaggressions given their diminished position of power relative to healthcare providers, we focus on patients who are members of marginalized groups since the problem is exacerbated along axes of structural oppression and marginalization.
Long and winding roads
Published in Vivienne Lo, Michael Stanley-Baker, Dolly Yang, Routledge Handbook of Chinese Medicine, 2022
The WHO’s promotion of Chinese medical practices has clearly influenced the perceived efficacy, acceptance, and adoption of Chinese practices at a multinational level. Chinese medical practices are often prioritised for integration into healthcare systems to the detriment of healthcare practices that are actually local, which ironically often leads to the marginalisation of local practices (Kadetz 2011). For example, according to one representative of the research division of the Ministry of Health of Madagascar: The WHO has suggested that to improve the primary healthcare,Malagasy must integrate traditional medicine in the primary healthcare,and so we introduced acupuncture into our traditional medicine.
Obtaining Informed Consent for Research Studies
Published in Lynne M. Bianchi, Research during Medical Residency, 2022
In addition to identified vulnerable populations (pregnant women, children, prisoners, cognitively impaired individuals), you are likely to discuss your study with members of various marginalized groups. Marginalization may stem from one's level of education, socio-economic status, disability status, race, ethnicity, gender, sexual orientation, or any other defining characteristic. Some individuals in these groups may be especially susceptible to feelings of coercion and undue influence. As with all consent and assent (Box 9.3) conversations, pay attention to how an individual reacts to your presentation and, if necessary, adapt your approach to encourage dialogue and questions.
Challenges and Benefits of Disclosure of Sex Work to Intimate Partners
Published in The Journal of Sex Research, 2023
Mikael Jansson, Michaela Smith, Cecilia Benoit, Douglas Magnuson, Priscilla Healey
In summary, our participants face several ladders of marginalization, the most prominent of which are: childhood and adult economic vulnerability, gender, race, sexuality, and legal contexts, resulting in a reluctance to seek out health and protective services (Benoit et al., 2016a, 2016b). Despite the formidable barriers to social inclusion they face, our earlier results show that participants exercise individual agency (even if at times constrained) in their work. Below we report on their exercise of agency in their personal lives. Broadly, we show that participants engage in a complex decision-making process regarding whether or not to make known their work status to romantic partners, as the consequences are unknown until the point of disclosure. Disclosing sex work to one’s intimate partner was the choice of most participants and, surprisingly, the consequences were sometimes positive. We also show some participants avoid the disclosure problem by seeking out partners from within their social and work networks, strategies similar to other marginalized groups. We begin with the topic of non-disclosure, which we predicted would be the most common response but to our surprise was the least mentioned.
Social citizenship when living with dementia: A qualitative meta-study
Published in Journal of Occupational Science, 2023
Hanne Peoples, Jakob Varming, Hanne Kaae Kristensen
The Western notion of citizenship is understood as membership of society organized as a hierarchy of status, expressed by differential legal and customary rights; a social contract that implies free and equal status among those who are accepted as members. As such, it may exclude many marginalized groups of people from benefits, rights, and responsibilities, for example due to age, race, gender, or sexual orientation (Glenn, 2000; Hilario et al., 2018). Marginalization is thus not limited to certain minority groups, but is experienced by a vast number of people who are dependent on healthcare and welfare services for various reasons (Guajardo & Mondaca, 2017). People who experience marginalization, such as PWD, often experience stigmatization due to stereotypical categorization and struggle to have their rights and social worth recognized in an era that overvalues individuality, productivity, and youth (Applewhite, 2016; Brannelly, 2016). However, although citizenship has received interest as an important cross-disciplinary concept within occupational science (ENOTHE, 2013; Hamer et al., 2017; Trentham & Neysmith, 2018), research that explores citizenship in connection with dementia from an occupational perspective, understood as “a way of looking at or thinking about human doing” (Njelesani et al., 2014, p. 233), is still limited.
Measurement Invariance of Psychological Distress, Substance Use, and Adult Social Support across Race/Ethnicity and Sex among Sexual Minority Youth
Published in The Journal of Sex Research, 2023
Although researchers have substantiated some aspects of minority stress theory, empirical evidence complicates its assumptions for some sexual minority youth. In particular, sexual minority youth with multiple minority identities do not experience more negative behavioral health outcomes than those with fewer (Bostwick et al., 2014; Russell & Truong, 2001). Further, marginalization may change the qualitative manifestation of health outcomes, rather than cause quantitative differences in risk. For example, although patriarchal systems benefit men, the dynamics of patriarchy do not preclude them from behavioral health difficulties (Rosenfield & Smith, 2012). Research has found that, among sexual minority men and women, men are more likely to experience substance use disorders as a result of sexual minority-based discrimination, while sexual minority women are more likely to experience mood and anxiety disorders (Lee et al., 2016). An intersectional framework provides the tools to empirically investigate how minority stress manifests differently for individuals at different social locations.