1. ARE WOMEN MORE COMPASSIONATE? Joan Cassell PhD

3. Were the Women Arrogant Daring Warlike As the men I had studied ten years earlier?

4. If The Women Were Different How did this affect patient care?

5. Theorists Who Emphasize Difference Women More Compassionate Nurturant Cooperative Men More Independent Detached Hierarchical

6. Sociobiologists Also Emphasize Difference

7. Gender as Negotiated or Constructed Rather than examining differences The social construction of differences Gender is not possessed But performed One does not have gender One does gender

8. The Embodied Nature of Identity and Experience The notion of habitus Embodied social structure Passed on from generation to generation Not something you think Something you are And what you are is based on what you do The actions and reactions of your body

9. “The ultimate values, as they are called, are never anything other than the primary primitive dispositions of the body, “visceral” tastes and distastes in which the group’s most vital interests are embodied.

10. …The sense of distinction…which demands that certain things be brought together and others kept apart…responds with visceral, murderous horror, absolute disgust, metaphysical fury, to everything which…by challenging the principles of the incarnate social order, especially the socially constituted principles of the sexual division of labour and the division of sexual labor, violates the metal order, scandalously flouting common sense.” Bourdieu, Distinction: A Social Critique of the Judgement of Taste Harvard University Press, 1984

11. “The principles em-bodied in this way are placed beyond the grip of consciousness, and hence cannot be touched by voluntary deliberate transformation, cannot even be made explicit; nothing seems more ineffable, more incommunicable, more inimitable, and therefore more precious, than the values given body, made body.” Bourdieu Outline of a Theory of Practice Cambridge University Press, 1977

12. Are Women More Compassionate? I wish!

13. How Can We Examine Compassion? Can it be measured? Quantified? Does it affect medical care?

14. What Counts As Evidence? Medicine permeated by dualistic thinking At the root of many of the tragic situations observed in medicine Especially at the end of life

16. In This Thinking Scientific evidence-based medicine Large Prospective Randomized Double-blind Controlled clinical trials Unscientific Anecdotal Intuition-based Emotion-permeated Treatment

17. Logical Positivism In 1937 Rudolph Carnap Labeled all statements to do with metaphysics, ethics, and epistemology “nonsense” Unverifiable “Logically invalid”

18. The “Gold Standard” “Evidence-based medicine and the randomized clinical trial have become the new gold standard in the health care field. Timmermans and Berg, The Gold Standard, Temple University Press, 2003

19. “What counts as good clinical practice (and, more and more, what is reimbursable) is tied to guidelines based upon scientific evidence derived from randomized clinical trials.”

20. “The Ultimate Standard in Medicine” …”the measure against which everything else will be measured” …”defines the truth”

21. When Good Clinical Practice and Truth Itself Defined by Evidence-Based Medicine Facts prized Values disregarded Body dealt with Mind and spirit left to others Masculine, active, scientific professions Soft “feminine” professions Nurse Chaplain Ethicist

22. Doctors Do Not Lack Values But in dichotomy Values perceived as personal Versus professional commitment To tangible Measurable Facts

23. Why Conceptualize An Either-Or Dichotomy Based on a concept of science almost 70 years out of date? ValuesFacts Compassion and caring The advances of modern medicine

24. Evidence-Based Medicine Responsible for medical “miracles” that save lives daily Lives that would have been lost just a few years ago What I take exception to is dichotomous thinking Based on positivist standards And a view of “science” That no longer define contemporary science

25. Facts Do Not Have to Extinguish Values The body does not have to be treated as though disconnected from mind and person “Evidence” in the narrow sense Does not need to contraindicate compassion

26. When “state of the art” includes both measurable and immeasurable factors When what counts as evidence is not just what can be counted

27. Then, and Only Then Will patients and families get the kind of care we all hope for When we and those we love are gravely ill