An Interreligious and Multicultural Perspective on
The Nature of Medicine and the Role of Physicians
DECEMEBR 17-19, 2024
During the three days of our UNESCO Chair workshop, we will analyze and discuss “The Nature of Medicine and the Role of Physicians”. The study and conversations will focus on how different traditions understand the discipline of medicine and perceive the practitioners of the discipline. Previous workshops have successfully taken place in Rome, Hong Kong, Mexico, Houston, Casablanca, and Bangkok with the participation of more than 80 prestigious interdisciplinary scholars from around the world.
With the rapid advancement of medical science and technology, the discipline of medicine has been radically changed in recent years and the role of physicians have also been transformed accordingly. And so, it is important to discuss and to understand the redefinition of the medical field through the lens of different cultural and religious traditions.
We plan to gather bioethics experts from Buddhist, Christian, Confucian, Daoist, Hindu, Muslim, Jewish, and the secular backgrounds to discuss different papers on “The Nature of Medicine and the Role of Physicians” submitted for this occasion. Like previous workshops, the papers submitted for this workshop will be collected and published as a book.
The general theme was suggested by the experts participating in our previous workshop (Bangkok 2022). To find convergence and cooperation in the field of these crucial issues related to the nature of the medical profession and duty of medical practitioners will be the core subject matter of the papers and workshop discussions and lectures.
Hosted by the UNESCO Chair in Bioethics and Human Rights, established in two Roman universities, the Università Europea di Roma and Ateneo Pontificio Regina Apostolorum, the conferences are a first step in creating a permanent academic forum to promote dialogue and bioethical reflection in the light of human rights and duties addressed from different religious and cultural perspectives in the worlds actively advancing medical, legal and technological environment.
By gathering experts from these religions, a rare space for dialogue has been created where an atmosphere of friendship and respect reigns. Such dialogue and encounters allow us to see the other as our brothers and sisters in our common humanity. This is most urgent in our globalized reality and can eliminate suspicions that are sometimes the causes of distrust and even violence.
Our experiences enable us to share values and attitudes that facilitate dialogue and the accomplishment of UNESCO Chair goal of “Fostering the Art of Convergence and Cooperation in Global Ethics”. The Chair seeks to create a forum for diverse bioethics thought leaders. Collaborating in a spirit of respect and friendship we hope to deliver a common framework to guide the application of bioethical principles in the light of the UNESCO Declaration on Bioethics and Human Rights. In this manner we can inform and enlighten ethical, legal and public opinions, decisions, and actions relative to medicine, life sciences and human rights and responsibilities.
OPTIONAL – PUBLIC SYMPOSIUM
As means of dissemination, publicity and involvement of multiple and diverse scientific, medical and university communities and the public we suggest organizing during the week an event open to the public on topics related to bioethics issues in the light of human rights in a multicultural and interreligious environment.
In this event, experts in the workshop and other suggested by the hosting university will provide academic lectures or presentations for educational purposes and dissemination of knowledge on bioethics and human rights. We will encourage participation of the outside community including public authorities, doctors and other healthcare personnel, patients, teachers, university scholars and students, and anyone interested in these relevant topics. The workshop and conference are primarily academic and apolitical, even though we encourage participation of all.
The language for this event can be decided locally by the hosting university, providing simultaneous translation into English (for foreigner participants) if needed.
On December 1st, Prof. Fr. Joseph Tham, LC, Full Professor in Bioethics and Research Scholar of the UNESCO Chair in Bioethics and Human Rights, will present during the ‘World Medical Association’s Regional Expert Meeting in Pacific on the WMA Declaration of Helsinki’ organized by the World Medical Association.
Abstract
Ethics of research in conflict settings
Research and trials would pose a significant challenge in conflict settings due to political instability, depravations, and lack of infrastructure. Humanitarian organizations naturally prioritize aid over research and may need more expertise, resources, and infrastructure to conduct valid research. Nonetheless, some advocates see value in them as they can measure the cost of the conflicts and the feasibility and effectiveness of interventions. The ethical challenges are informed consent, research design and review, and benefits to participants and vulnerable groups. p Declaration of Helsinki has not addressed research ethics in conflict settings. However, paragraphs on the necessity of research (26-28), informed consent (25-32), vulnerability (19-20) and benefits to participants (8, 34) are pertinent to this analysis and may benefit from further reflection. The presentation will end with a virtue ethics approach that can bridge the East-West gap in addressing this topic.
On December 5th, Prof. Fr. Joseph Tham, LC, Full Professor in Bioethics and Research Scholar of the UNESCO Chair in Bioethics and Human Rights, will present during the three-day conference “Regulatory Governance of Emerging Health Technologies” in the “Reproductive Technologies” session. The conference is organized by Centre for Medical Ethics and Law, The University of Hong Kong.
Abstract
Personalist (Dignitarian) approach to the governance of reprogen medicine.
This paper will first analyze the different notions of personhood and dignity in contemporary debates in philosophy and bioethics. These questions touch on the foundation of identity and selfhood from the viewpoints of essence, nature and metaphysics, and in contrast with those of changing human experience and existence. These two positions, or “Sources of the self” according to Charles Taylor, have great significance on the human reproductive act. The essentialist position conceives dignity as derived from the natural sex act, where love and life are intrinsically bound while rejecting physicalism. The latter existentialist position does not preclude the making of life through technology, where sexuality and gender can take on various expressions. Most traditional religions espouse the essential view of self and generation in contrast with the secular tendency towards existential or ¨liquid¨ understanding of self and reproduction. Regarding the governance of reprogen technologies, the use of embryos is politically linked to the debate on abortion, as we see in the US Hyde amendment. In terms of governance, the unsettled questions are therefore: a) embryo status, human dignity and vulnerability at the beginning of life; b) safety of reporgen technologies at the individual level and potential impact on society and future generations; c) fairness in terms of racial, geographical and economical difference affecting the access of such technologies especially in view of the distribution problem of the COVID vaccine; d) transhumanism and its endpoint in view of perfectionism and ablism; and finally e) the place of religions and traditions in a globalized bioethics. Simply put, the dignitarian approach asks: “What does it mean to be human?” and “What does it mean to love?”
The UNESCO Chair in Bioethics and Human Rights in collaboration with The University of Anáhuac (Faculty of Bioethics), and the Ateneo Pontificio Regina Apostolorum is launching the NEW Master in Global Bioethics online.
Objectives & Outcomes:
Training future university professors, health care professionals, biomedical researchers, social and political agents with high academic knowledge and skills in bioethics.
Providing an integral formation in the field of global bioethics, allowing participants to develop their professional activity, both in the private and public sphere, with social responsibility and grounded in person-center approach.
Addressed to people interested in:
Promoting human dignity, human rights and duties in the field of life sciences and medicine as well as in social, legal and political environments
Studying and researching about the biomedical, philosophical, social and legal aspects of the contemporary important and cutting-edge bioethical dilemmas
Developing capacity for interdisciplinary, international and cross-cultural dialogue to explore new solutions for the preservation of health and the improvement of individual well-being and social welfare.
Program:
Concept of Human Being in Bioethics and Global Bioethics
Trends and Currents of Thought in Bioethics
Research Techniques and Databases
Ethical Fundamentals of Bioethics
Clinical and Bioethical Aspects at the Beginning of Life
Bioethics, Sexuality and Human Reproduction
Bioethical and Clinical Aspects at the End of Life
Bioethics and Medical Act
Bioethics and Health Management/Health Care Policies
Bioethics and Biolaw
Global Bioethics
Global Bioethics and International Human Rights: The Human Right to Health
Emerging Technologies and Global Bioethics: Neuro-Nano-Info Technologies
*Validity of Studies Recognition issued by the Secretary of Public Education by means of Presidential Decree, published in the Official Journal of the Federation in November 26, 1982. SEP Approved Num. 01-0832-18
The next generation of Bioethicists
Help us support training of the next generation of bioethicists in Malawi, India, Nigeria, Philippines and other countries in need. To develop professors, health personnel, researchers to be able analyze and propose solutions to the global bioethical dilemmas.
MD Barrio-Rentería M. T, Galván-López J. M., MD Hernández-Fernández D., Maldonado-Moreno K. A.
Despite more than 40 years of human rights and feminist advocacy, gender equality still has a long way to go and remains a complex issue; specially in health and science environments. The central matter in this essay is gender-based discrimination in medicine, more specifically against women, nonetheless the concept of gender needs to be defined: “Gender” is an evolving social construct that refers to the sociological and cultural behaviours, attitudes or feelings associated with masculinity or femininity (Brown, 2021). The WHO Global Health Workforce Network Gender Equity Hub, reports that women in the health and social care workforce are under-represented in management, leadership, and governance. Gender-based discrimination is present in every level and includes, belittling remarks, inappropriate jokes, denial of opportunities, behaviours or conducts (Brown, 2021).
Approximately 75% of the global health workforce is female but they only hold a small fraction of leadership positions. Women remain a minority in surgical specialties and the wage gap is reported through all specialties (Shannon, 2019). The UN Educational, Scientific and Cultural Organization’s Women in Science data shows that less than 30% of the world´s researchers are women, comprising 45% in Latin America and 32% in North America, even though the proportion of female researchers is increasing worldwide, women still publish fewer research papers than men and are less likely to collaborate internationally (Shannon, 2019).
In medicine, women are paid 8% less, this being attributed to “domestic responsibilities” given that female physicians take lighter schedule because they tend to be the primary caregivers of their children, they´re also less likely to hold positions of power, and when they achieve those positions, they are paid less than the men in equivalent roles due to implicit biases that result from gender schemas that are culturally ingrained (Kowalski, 2020 & Kuo, 2020). Unconscious biases are also present, a study conducted by the University of Nebraska examined linguistic choice and gender disparities in letters of recommendation for surgery residents; where men tend to be described as future leaders using terms such as dominant, confident and intelligent whereas women tend to be described as compassionate, calm and family centered (Hoffman, 2019 & Brown 2021). In 2015, 85% of females in surgical fields recall having suffered at least one form of gender-based discrimination throughout medical school, residency and professional practice, not only from colleagues and superiors. The two more common sources reported were patients and nursing staff; the majority of the participants reported having to work “twice as hard” to earn the respect their male counterparts automatically receive from nurses and patients (Brown, 2021).
Differences between male and female practitioners have been well established; female practitioners are more likely to follow guidelines, use more patient-centered communication, provide psychosocial counselling and preventive care more often than male counterparts (BDJ, 2017). A study investigating mortality rates in women with acute myocardial infarction found that there were higher mortality rates in women treated by male doctors than in the group of females treated by female doctors. Also, several studies have shown that patients treated by female physicians have lower rates of complications, ER department visits, lower rates of morbidity and mortality, stating that gender is an important asset in healthcare, and these differences found between male and female physicians should be investigated to replicate positive behaviour that leads to better outcomes in patient care, medical training, etc. (Tsugawa, 2017)[4]
It is important to mention that many individuals, men and women; including those in power or leadership positions don´t consider this to be an ongoing issue in the residency training programmes or a problem worth improving, yet in a study including 7 surgical programmes in Calgary, 55% of women and 40% of men agreed that it is an issue in residency training programmes. Identification of gender-biased behaviours is the first step towards its eradication (Brown, 2021).
In the article “Nevertheless they persisted: how women experience gender-based discrimination during postgraduate surgical training”, Brown suggests that women become desensitized to gendered-biased behaviours by using coping strategies involving denial and minimization of these experiences which leads to underreporting the frequency and severity of discrimination contrary to the one experienced by men that tends to be more memorable due to its infrequency. Immediate action, such as the continuous investigation on the topic, promoting collection of empirical and objective data, the promotion of institutional-level discussions between teachers and administrators, examining the local culture and climate for students and faculty members, as well as allyship and anti-oppression training in the core curriculum is needed.
Identifying, dismantling and restructuring the system along with increasing the number of women in medicine will change the environment, given that an imbalance in sex representation promotes a culture where women are unlikely to pursue academic and personal goals, damaging well-being, medical training and ultimately healthcare.
Reflecting on strategies to promote change, medical schools and training hospitals could benefit from examining their local culture and climate as well as student, teachers, and faculty members’ perspectives. All individuals must be encouraged to be allies who continuously advocate for an inclusive environment and zero tolerance against gender discrimination and harassment policies. It is crucial that implemented strategies allow the report of inappropriate behaviour with confidence and without fear of consequences, and that those will be adequately addressed. This is an era of gender reckoning, challenging and changing times, there is no doubt that gender equality is a human right. Gender equality in healthcare and science holds the promise and potential to lead to economic, scientific, and social transformation.
Bibliography
Brown, A., Bonneville, G., & Glaze, S. (2021). Nevertheless, they persisted: How women experience gender-based discrimination during postgraduate surgical training. Journal of Surgical Education, 78(1), 17–34. https://doi.org/10.1016/j.jsurg.2020.06.027
Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. (2017). British Dental Journal, 222(3), 170–170. https://doi.org/10.1038/sj.bdj.2017.116
Hoffman, A., Grant, W., McCormick, M., Jezewski, E., Matemavi, P., & Langnas, A. (2019). Gendered differences in letters of recommendation for transplant surgery fellowship applicants. Journal of Surgical Education, 76(2), 427–432. https://doi.org/10.1016/j.jsurg.2018.08.021
Is there a gender disparity in the residency training programme? Perspectives of trainees from a tertiary hospital in Nigeria. (n.d.).
Jena, A. B., Olenski, A. R., & Blumenthal, D. M. (2016). Sex differences in physician salary in US public medical schools. JAMA Internal Medicine, 176(9), 1294. https://doi.org/10.1001/jamainternmed.2016.3284
Kuo, L. E., Lyu, H. G., Jarman, M. P., Melnitchouk, N., Doherty, G. M., Smink, D. S., & Cho, N. L. (2020). Gender disparity in awards in general surgery residency programs. JAMA Surgery. https://doi.org/10.1001/jamasurg.2020.3518
Ruzycki, S. M., Freeman, G., Bharwani, A., & Brown, A. (2019). Association of physician characteristics with perceptions and experiences of gender equity in an academic internal medicine department. JAMA Network Open, 2(11), e1915165. https://doi.org/10.1001/jamanetworkopen.2019.15165
Shannon, G., Jansen, M., Williams, K., Cáceres, C., Motta, A., Odhiambo, A., Eleveld, A., & Mannell, J. (2019). Gender equality in science, medicine, and global health: where are we at and why does it matter? Lancet, 393(10171), 560–569. https://doi.org/10.1016/S0140-6736(18)33135-0
Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2017). Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Internal Medicine, 177(2), 206–213. https://doi.org/10.1001/jamainternmed.2016.7875
