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12/05/2017

#METOO Bioethics

by Craig Klugman, Ph.D.

In the December 4 episode of The Good Doctor, a medical resident is sexually harassed by her attending, who touches her when she is interacting with patients and asks her out to dinner. When she forcefully states that she is not interested in him, and has presented no signs that she is, he tells her to be careful because he could write her up for insubordination. Over the last month or so, women all over the country have posted #METOO on social media. This social activism is in response to very public reports coming to light of famous and powerful men with a history of sexual harassment of female co-workers and staff, or even minors (female and male) in their orbit. Charlie Rose, Roy Moore, Donald Trump, Kevin Spacey, Matt Lauer, Peter Martins, John Hockenberry, Harvey Weinstein, George H. W. Bush, John Conyers, Al Franken, James Levine, Roger Ailes and many more men have been accused of inappropriate behavior and sexual misconduct toward women (and boys/men in some cases). The release of these names points to a culture of structural harassment that has protected men who have acted inappropriately toward female (and male in some cases) “subordinates”. The issue is bigger than just power differentials between women and men (or men and men), but also begs questions about how the structure of society and institutions has permitted such behaviors among those who are members of the cis-gendered, abled, mainly white, famous, moneyed, politically-connected patriarchy to get away with it for so long? Also consider that we are only hearing about their actions against women (and in a few cases men). What about structural injustice against people of different races and ethnicities, genders and sexes, religions, sexual orientations, and abilities? Surely the list would be larger.

While this national conversation has been brewing, not much has come out of the bioethics community. Sexual harassment has a long history in the academy. A recent study found that as many as 10% of female graduate students have experienced harassment. A 2015 study reported that among all students, 11.7% experienced unwanted sexual contact, threats of physical force, or incapacitation with that percent rising to 23.1% among female respondents. Despite the high number of victims, many have not reported out of fear of consequences and because many of the perpetrators are protected by their institutions. They “have gotten away with it because of their research money, political capital, or prestige.” Medicine is renowned for its abusive culture of underlings especially in educating doctors, but also in the employment arena. Neurosurgeon Frances Conyers wrote about her experiences in structural sexual harassment while earning tenure at Stanford. Bioethics is commonly located within medical institutions and has adapted many of the cultural elements and practices of this field. Perhaps bioethicists refrain from commenting on issues outside the health fields? Perhaps we avoid taking stands on issues outside of a few narrow areas? Perhaps we have simply been silent too long on issues of social justice. Or perhaps, we simply have been unwilling to shine a light on the structural harassment that exists inside our own hallowed halls.

Bioethics is not without its own controversies and without its own harassment. For example, I have worked in two different departments where the supervisor created toxic workplaces through intimidation and harassment. In one case, the supervisor filed complaints and lawsuits against people who disagreed with their opinions, but only filed such complaints against women. In the other case, the supervisor committed multiple long-term acts of emotional and verbal abuse that led to health problems for those working alongside this perpetrator. When I went to the ombudsperson to file a complaint, I was told that even though my evidence was ironclad, the best thing I could do was find a job elsewhere because the person had friends in high places who would protect them. As a Jewish, gay man, I had no protections from someone who had a position of power and favor with those with more power.

In part, U.S. bioethics is part of the same culture with the same cis-gendered, heteronormative, ablest, Caucasian patriarchy that holds a lot of the power in American society. And in part, bioethics lacks diversity. In 2003, Cat Myser wrote about the problem of white normativity in bioethics: “I argue that because they [social scientists] fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces.” In Observing Bioethics, sociologists Renee Fox and Judith Swazey criticized the lack of diversity and hegemonic nature of U.S. bioethics.

To examine this issue, I conducted a quick, unscientific website examination of the characteristics of leaders of 50 bioethics centers and program in the U.S. Most of these programs are connected to medical schools and a few are independent of universities. Specifically, I looked at the demographic characteristics of their director or chairs. Of the 50, 32 are led by men and 18 are led by women. Concerning race/ethnicity, 48 leaders are white, 1 is Asian, and 1 is black. Taken together, this group has 31 PhDs, 18 MDs, 5 JDs, 1 RN, 1 DO, and 1 DDS. As this was not a research survey, questions about religion, sexual orientation, ability, and gender could not be answered by looking at websites.

I know I am not the only one who has had these experiences because others have been shared with me. In the arena of sexual harassment, there are several cases of faculty acting against their students, staff, or even other faculty members. Some were caught and dismissed and some were not, and others have been allowed to continue despite serial complaints against them by female colleagues, students, and staff. Another member of our field told me that her medical school dean grabbed both of her breasts after a meeting in his office, then when she politely rebuffed him, the dean apologized and said “it wasn’t sexual” as a way to protect himself and create a record of doubt if she reported him. In all cases, people were hurt. I know of one colleague who is a person of color and received a large number of job interviews, but no faculty job offers.  As it turns out, those “interview” opportunities were often so that the hiring committee could check the “diversity” box. In terms of sexual orientation, a distinguished member of our field was outed against their will in a very public and disturbing way.

Whether people should have their positions revoked and their lives destroyed over such behavior is a compelling question. But the question that concerns me here, is why these issues are rarely discussed except in rumor or in secret confessions when a victim does not know what to do or where to turn.

There have been changes in bioethics that are responsive to calls for diversity. U Penn has an LGBT bioethics initiative. We have many openly out LGB bioethicists. Ten years ago, Bioethics Summer Camp hosted a wedding shower for me and my husband-to-be. Several programs focus on women’s health and feminist perspectives. A number of recent writings have focused on disability ethics. And there are a very small number of openly trans-gendered bioethicists.

I am aware of the problem that this article is being scripted by a cis-gendered, abled, Jewish, tenured, gay male. That status lends me some privilege. While we should not usurp the stories of others, those in positions of privilege must speak out against these acts and must be part of the solution.

Even with a greater focus in bioethics on our diversity and a social emphasis in the moment on issues of structural harassment, we too need to self-reflect on cultures and structural barriers in bioethics that continue to cause significant harms to people who cannot speak out from positions of powerlessness and even fear. Just as harassment has no place in politics and the media, it has no place in bioethics and medicine.

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