Discourses Reproducing Gender Inequities in Hospice Palliative Home Care

Abstract

Background As home is a site where gendered attitudes, beliefs, and practices are reproduced, it is imperative that policies and practices promote gender equity in end-of-life care at home. Purpose The purpose of this study was to critically analyze gender relations in the sociopolitical context of hospice palliative home care. Methods Using a critical feminist perspective, we examined gender relations between and among clients with cancer, their family caregivers, and nurses in hospice palliative home care. Ethnographic methods of in-depth interviews (n = 25), observations of home visits (n = 9), and review of documents (n = 12) were employed to expose gender (in)equities. Findings This critical analysis sheds light on institutional discourses that reproduce gender inequities: discourses of difference and denial; discourses of individuality, autonomy, and choice; and discourses of efficiency, objectivity, and rationality. Although gender was discounted, these neoliberal discourses reinforced traditional gender relations. Discussion Neoliberal discourses frame health and health-care experiences as resulting primarily from individual behaviors and biomedical factors, permitting health-care providers and policy makers to overlook power relations and the sociopolitical forces that obscure gender inequities. A critical perspective is needed to consider how social structures significantly shape everyday gendered experiences in hospice palliative home care.

Gender and palliative care: a call to arms

“… 26 Without unpacking the gendered impact of ‘duty’, which falls disproportionately on women, such caregiving ‘evidence’ reproduces gender inequities. 27 , 28 …”

“…26 Without unpacking the gendered impact of 'duty', which falls disproportionately on women, such caregiving 'evidence' reproduces gender inequities. 27,28 There is evidence that doing 'what a wife is supposed to do' can carry significant responsibilities within a heteronormative end-of-life context for some women. It is not just expected that a wife will provide care but will provide a certain type of care which will realise a husband's vision for a 'good death'.…”

Making Sense of Gender Inequities in Hospice Palliative Home Care

“…I am writing this commentary in response to the qualitative study by Sutherland, Ward-Griffin, McWilliam, and Stajduhar (2018): "Discourses Reproducing Gender Inequities in Hospice Palliative Home Care." I found the results to be striking and thought provoking, but not at all surprising.…”

“…We have internalized this practice and expect it of our female peers despite their perhaps rudimentary understanding of what it means to be a caregiver. As a young nurse, I would like to think that my generation is moving away from said virtue script in favor of a gender equity as highlighted by Sutherland et al (2018). Sadly, however, this issue is far from being resolved and proves that we have ways to go in shaking these pervasive angelic-like ties to the profession.…”

“…I am writing this commentary in response to the qualitative study by Sutherland, Ward-Griffin, McWilliam, and Stajduhar (2018): “Discourses Reproducing Gender Inequities in Hospice Palliative Home Care.” I found the results to be striking and thought provoking, but not at all surprising. Given my work experience in hospice-palliative care, I am aware that issues of gender inequity plague our health-care system (and by extension, our society at large) under the guise of necessary capitalistic, cost-reduction strategies; as it was so well articulated in Sutherland’s paper.…”