Freeman FINAL Paper

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Health Science

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Dec 6, 2023

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Student ID: 5347188 Word Count: 2,253 (Comments and feedback are appreciated) 1 Intersectionality in Feminist and Healthcare Frameworks: A Critical Analysis Intersectionality is a crucial framework in both feminist philosophy and healthcare ethics. The term intersectionality provides a comprehensive understanding of the complex intersections of social identities and how they impact individuals in our society. Applying intersectional frameworks to healthcare offers strategies for addressing staunch health disparities and promotes equitable healthcare for all individuals. Through a critical examination of the application of intersectionality in feminist and healthcare frameworks, this paper will explore the theoretical underpinnings of intersectionality, its strengths and limitations, and how it can be applied in practice to improve healthcare experiences and outcomes for marginalized individuals. Three pieces of literature will be used as preliminary examples, some based on feminist theory and others focusing on intersectionality. I intend to show that while these are successful in showing an intersectional view of healthcare, there is more literature to expand the limits of what intersectionality is and what marginalized identities it reaches. Ultimately, no paper can be perfect and include every aspect of an intersectional medical framework, but it is still important that our idea of inclusivity in healthcare is always being challenged and expanded. The context that this paper examines intersectionality in is healthcare with a feminist bioethics perspective. Feminist bioethics differs from traditional bioethics in the sense that it offers a critique of the tenets of bioethics, as it applies the problematization to the belief that our society is built on equity. It is the work of feminist bioethicists to fight oppressive systems in social constructs outside of the patriarchy and gendered experiences. Within bioethics itself, feminist bioethics recognizes that oppressive systems such as patriarchy, racism, and ableism are deeply entrenched in the field of bioethics itself and aims to challenge and transform these systems. This is where intersectionality comes into the equation, with the ability to apply a

2 holistic patient view in healthcare institutions so that inequities in health outcomes are minimized. In the article by Wilson et al. (2019) the concept of intersectionality is applied to healthcare contexts to highlight how patients bring their various social identities into the doctor’s office and how clinicians have the responsibility to recognize structural factors that contribute to the issue the patient is dealing with. Wilson et al. makes the case for intersectionality by explaining how healthcare interactions do not occur in a vacuum. If intersectionality was not used, clinicians would use a single-axis methodology that would only see the patient's race or gender, and we know that is failing to recognize the unique convergence of oppression that a person faces. Something that this article pushes back against is the notion that members of a marginalized identity should just go to a doctor that matches that identity. While this may lead to better health outcomes due to a better clinician-patient understanding, this is not a feasible solution as it negates the idea that every clinician should be examining and removing their biases. While in a perfect world the idea of having specialized care from a physician that has lived the same experience as the patient sounds great, it is just not realistic to the world that we live in. This belief also takes a privileged stance, since not everyone with unique health conditions and social determinants can even find a clinician who could match them. This does not even include the fact that many people do not even have the financial privilege to choose a doctor of their liking, with inadequate (or no) insurance coverage dictating where they can go. We can also turn to Wilson et al. (2019) to examine some shortcomings of intersectionality, and what they mean for the advancement of equitable healthcare. Three main critiques are offered: that intersectionality is equal to cultural competence, the rejection of intersectionality altogether, and that intersectionality is not clear in its methodology. The first of these critiques stems from the idea that the cultural competency model is sufficient to resolve

3 inequities in healthcare. This is simply not the case, since cultural competency is more of a skill for clinicians to interact with people of diverse backgrounds and less about understanding. Even if this critique was true, Wilson et al. argues, “As an analytical method, intersectionality adds scholarship and analysis that can inform cultural competence” (15). This shows that intersectional frameworks are more than just a skill set like cultural competency. In the critique against intersectionality itself, it is argued that intersectionality needs to be replaced entirely with something different. In the article, a relational model is proposed, with the argument that intersectionality only leads to social fragmentation (Wilson et al. 15). In response to this, it is important to note that the entrenchment of bigotry leads to fragmentation, and intersectionality attempts to rectify this. With the critique that the tenets of intersectionality are unclear, that is a valid critique but that leaves the conversation open for how scholars and activists can work together to clear these misconceptions up. Something that should not be misconstrued is that while the practical implementations of intersectionality may be unclear, the bounds of what intersectionality includes should be unclear and ever-expanding. When the term intersectionality was first coined by Kimberlé Crenshaw, only the axis of race and gender was mentioned. It is important for those engaged in feminist medical ethics to keep an open mind and be willing to expand what it means to be intersectional. These ideas are furthered in Grzanka et al. (2016) with the central claim that the absence of intersectional thought in healthcare contexts ignores the complex identities and struggles people face, thereby furthering systems of inequity that have been around since the dawn of medicine. Racism, as an example, is something this article suggests feminist scholars and activists have the duty to disrupt. A central claim in this work is that feminists in bioethics have the onus of fighting systemic racism and that simply advocating for white feminism is a form of privilege that ignores the struggles Black women and women of color face. Advocating against

4 all hegemonic regimes is the reason why intersectionality is so important, we cannot simply address patriarchy without mentioning how race creates another layer of oppression. A glaring example of the need for intersectionality in healthcare was the United States ’ response to the Covid pandemic. In Pirtle & Wright’s article (2021), the issue of data reporting was discussed with the concern that with no federally funded database that was reporting disaggregated only furthers historical disparities. The central claim is made that women of color occupy lower positions of power in households, workplaces, and institutional settings. An intersectional analysis of Covid is necessary to see why this is simply just not a coincidence. As Pirtle & Wright point out, “nurses of Filipino descent account for a shocking 31.5 percent of the workforce’s COVID - 19 deaths, yet they make up only 4 percent of the workforce” (173). This example highlights that certain people’s l ives are viewed as disposable in society, even in healthcare. Furthermore, an intersectional lens shows how these individuals are also often paid less, thereby less protected from the virus. The pandemic also highlights the need to broaden what we understand as being intersectional. In Doebrich et al. (2020) it is argued that the pandemic did not take PWD 1 into account when making decisions and policies about public health. The model of disability competence that is the standard does not take into account the systemic obstacles PWD face. It is argued that the competency model fails to account for systemic barriers to equity and limits the scope of advocacy to the individual level. This, coupled with the history of eugenics in medicine, only furthers distrust of medicine from PWD (Doebrich et al. 395). The solution to this needs to be a more intersectional model, as the authors argue there needs to be a shift to disability- conscious medicine, a framework that prioritizes the voices of disabled people and advocates for 1 People with disabilities

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