A letter to a hospital

Non-judgmentalism includes not judging when the issue is moral standards we believe in.

[I wish to raise a concern] about policy stated in a notice in the waiting room which I felt raises legitimate concerns about whether the paramount priority of patient care is being maintained.

The notice said that the hospital would not allow patients to refuse treatment from a particular member of staff on racist grounds, and that any refusal of treatment on such grounds could be considered refusal of treatment altogether.

I was horrified to find that any patient of yours refuses to be treated by a particular person for such reasons. Racism is very wrong, and its ongoing presence in our communities is rightly a deep concern.

However, I was more horrified that a hospital would consider responding to the problem in this particular way. Granted, patient care requires politeness and mutual respect, and I think it is quite reasonable to insist that no one responsible for their actions uses certain types of language within the hospital. But this is different from removing the patient’s autonomy to ask for a different doctor irrespective of whether their reason is good or bad.

For one thing, it creates a practical problem, at the minimum being a cover for incompetence, and at the worst, an abusers’ charter. Suppose a woman (or a man) believes that a doctor (or other member of staff) is using medical access to her body as a cover for groping her sexually, and that doctor is of a different race.

Such a policy puts her in a situation where if she requests to be transferred, but cannot prove a complaint, she is liable to be accused of racism if she requests to be treated by someone else. This may prevent her receiving treatment or trap her in a situation where the price of treatment is submitting to abuse. In cases where a person is not happy with the doctor’s competence, playing the race card to block their access to another doctor is likely to be even easier, as such concerns are often instinctive rather than analytical. The only way of preventing this is not to regard the patient’s possible reasons for making the request as a relevant factor.

I would also ask whether refusing someone treatment because they are being racist is really any different, in theory, from refusing a pregnant woman treatment because she refuses to marry the father of the child. The precise similarities and differences of the two cases are interesting, but the question is worth asking. It is usually argued that it is right for medical practice to aim to be non-judgemental about moral issues.

I appreciate the awfulness of racism, and the fact that the policy is a natural reaction to it. However, I think in the case of a hospital, it is necessary to stop at insisting that people must not be verbally or physically abusive, and not to reduce the autonomy of patients to make choices about who treats them.

 

Any thoughts, further arguments for this position, counter-arguments to it, or experiences of (probable or indisputable) racism in such circumstances, or of being accused of racism, or being unwilling to make a request for a different reason for fear of being accused?  It is hardly a simple question.

Cherry Foster

Asking Unaskable Questions

You volunteer as a Cathedral guide, and are standing about without very much to do. A fellow guide comes over. “Two – women – want a tour. I have to wait for the coach party at 2. Can you take them round?”

You haven’t anything else booked and there’s someone to mind the leaflet stand. “Yes”. You walk over.

The two – women – consist of a younger woman, who could in point of fact be anywhere between twelve and forty, wearing a plain green hoodie and denim skirt, sitting in an electric wheelchair with her head on a rest, faltering out highly distorted speech. With her is an older woman, with greying hair and a stylish umbrella.

This could be anything from a student who has just graduated from Cambridge, out for the day with her paid carer, to a mother with her daughter who has a permanent mental age of six. At first glance, there is no way of telling. Yet the appropriate response and appropriate tour is completely different.

I’ve been on all three sides of this: I’ve been the visibly disabled person (most common), the volunteer who has to work out how to respond, and the (perceived) carer who is liable to be treated as a machine and ignored, rather than included as a friend or relative (which was the actual truth). There are real difficulties to all three positions.

The step of dropping the blanket assumption that someone with a physical disability is necessarily mentally impaired is beginning in the UK (I think we should be careful of assuming we are the first culture or society to make that step, lest we be justly accused of arrogance).

Unfortunately, I speak advisedly when I say “beginning” – “does he take sugar” is very far from being played out. It can be seen in many things, from the typical legal warnings about the use of products (which assume disabled people lack agency and automatically aren’t responsible for their own safety) to the social tendency to ignore a disabled person’s insistence that they are able to do some ordinary activity, but to instantly believe anyone with them.

However, it isn’t enough to say what people shouldn’t assume, without offering some different norm that they can use instead.  There is a real problem of communication and etiquette. How can we tell? How can we communicate what the appropriate response is in such situations? How do we start a conversation without doing something wrong or being hopelessly awkward or embarrassed? How do we as volunteers/service personnel ask what is wanted, or give the other person the opportunity to tell us? How do we as disabled people politely indicate the other person is getting it wrong and needs to switch modes or change what they are doing?

 

Cherry Foster