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14829 Sept 15/97 CMAJ /Page 640


major national priority. However, we

doubt that even the best palliative
care would eliminate all requests for
I read the article by Zelek and col-
leagues with what I felt was gen-
uine sensitivity. I have been educating
as educational. I hesitate to open a
can of nonmedical worms but hasten
to state that I am entirely sympathetic
euthanasia or assisted suicide. young women and men to become to the concerns of the authors, but
Kreyes appeal to common physicians for the past 30 years and not to their methodology. Simply
sense, no matter how attractive, is have been conscious for most of that stated, both genders should be
unlikely to provide a solution to the time of the problems facing both treated equally, fairly and with respect
complex and pressing social prob- sexes. I do not believe the problem to in every way. However, promotion of
lems of euthanasia and assisted sui- be as complex as the authors suggest. the misuse of words and syntax de-
cide. This is an issue on which peo- It is real but it is also simple: it is a stroys much of what is good by level-
ple of common sense disagree. matter of choosing the right words. ling everything in reaction to a his-
In health care we are notorious for tory of gender inequality, which a
James V. Lavery, MSc creating new words and giving old decreasing minority of both sexes
PhD Candidate ones new meanings. A lot of our perceives to still exist.
University of Toronto Joint Centre
problems would be solved if instead If we need to alternate men and
for Bioethics
University of Toronto of creating new words we made use women with women and men,
Coordinator of well-established ones. The article we will need to do a count to en-
HIV Ontario Observational Database asks us to be sensitive to gender- sure equal use. We will then be un-
Sunnybrook Health Science Centre izing medical curricula. Gender is able to concentrate on the merit of
North York, Ont. defined in this paper as both the real a medical article. What education!
Peter A. Singer, MD, MPH relations between the sexes and the What syntax!
Sun Life Chair in Bioethics
cultural renderings of those rela- The principle of equality of the
University of Toronto Joint Centre
tions. I do not agree. The word gen- genders is unquestioned, and some
for Bioethics der refers to a grammatical classifi- suggestions in the article have merit.
Toronto, Ont. cation of objects roughly correspon- For example, if only the title Mr. is
ding to the two sexes and sexlessness to be used for men, then Ms. should
Reference (for example, masculine, feminine, be used for women. Age and marital
1. Special Senate Committee on Euthanasia and neuter). Ships are a good example: for status are personal and irrelevant.
Assisted Suicide. Of life and death. Report of
the Ottawa: Supply and Services Canada; eons they have been of the feminine
1995:A80-3. Cat no YC2-351/1-OIE. gender. Leslie (Gender?) S. Glass, MD
Gender has nothing to do with North Vancouver, BC
real relations between the sexes or
Gender sensitivity
a sensitive issue
their cultural renderings. Two sim-
ple words are enough to define this:
respect and equality. And what this
I believe this is a timely and valuable
article and particularly appreciate
the advice for medical educators that

O ne of the excellent reviews con-

cerning gender sensitivity,
Gender sensitivity in medical cur-
requires is the right attitude. The
creation of new words and the mis-
understandings of old ones are not
will help us to avoid creating difficul-
ties unwittingly. That one can easily
be gender insensitive during a med-
ricula (Can Med Assoc J 1997;156: the answer. ical communication is exemplified in
1297-1300), by Barbara Zelek and the last paragraph of the section on
associates, neglected very important Lawrence J. Clein, MB guidelines relating to language. The
terminology that has been used in Professor authors suggest changing a 23-year-
Division of Neurosurgery
the US but was not included in this old woman who works as a medical
Royal University Hospital
article. University of Saskatchewan secretary to a 23-year-old medical
The term seminar should be re- Saskatoon, Sask. secretary. While this change might
served for teaching presentations in- place equal emphasis on this persons
volving male faculty members, with occupation, compared with the previ-
ovular being used for presenta-
tions by female faculty members. I read this article with dismay, and I
am concerned that there is a ten-
dency for our prestigious journal to
ous example of a 40-year-old profes-
sional man, it has become totally in-
sensitive to gender. The authors are
Jack H. Walters, MD be involved in subject matter best re- presuming that all medical secretaries
St. Louis, Mo. served for newspapers. I am also con- are women. If this was the only men-
Received via email cerned that the article was classified tion of the secretarys sex in this med-

640 CAN MED ASSOC J 15 SEPT. 1997; 157 (6)

14829 Sept 15/97 CMAJ /Page 641


ical communication, such a change in though at least 10 people read the [Dr. Guyatt and associates
text would be inappropriate. manuscript before publication, none respond:]
of us noted the error he spotted. The
P. Gerard Cox, MB
Firestone Regional Chest & Allergy Unit
St. Josephs Hospital
parallel terminology should read a
40-year-old man who works as a pro-
fessional and a 23-year-old woman
M any people, like Dr. Berger,
find it oppressive when they
encounter negative reactions to lan-
McMaster University
Hamilton, Ont. who works as a medical secretary. All guage that has been used habitually
of us hold cultural and social stereo- throughout their lives. Indeed, an
types that can limit our views and ex- overzealous insistence on using or

I am disappointed that you would

publish such a paranoid, meaning-
less article. In this era of fiscal restraint
pectations of, and our communica-
tion with, others. I hope the concepts
outlined in the article have helped
avoiding particular forms of expres-
sion can be irritating, burdensome
and unnecessarily inhibiting.
it is hard to believe that there is money some physicians recognize these ster- A problem arises, however, when
available to fund committees such eotypes and either minimize them, people find particular expressions dis-
as the one mentioned in this article. or at least acknowledge them and turbing or offensive. Most people
their effect on teaching and practice. agree that pejorative terms that refer
Kenneth L. Maudie, MD to a persons race have no place in the
Cranbrook, BC Susan Phillips, MD language, yet people who use them
Associate Professor are liable to find objections oppres-
[One of the authors responds:] Queens University
sive and will consider them an exces-
Kingston, Ont.
sively rigid application of political

I was unprepared for the level of

hostility that a discussion of the
subtle biases inherent in the language,
Brave new world of gender-
Berger may find the comparison
of this example and the use of lan-
content and process of medical educa- inclusive language guage that women find disrespectful
tion seems to have provoked among hyperbolic or even ludicrous.
CMAJ readers. Although these read-
ers agree in principle that equality
must be upheld, equitable practice is
T he articles Attitudes toward the
use of gender-inclusive lan-
guage among residency trainees
Berger, however, is not a woman and
has not been subjected to the sys-
tematic discrimination and barriers
either ridiculed or denounced as a (Can Med Assoc J 1997;156:1289-93), against advancement that women
slight to our language or our profes- by Dr. Gordon H. Guyatt and associ- continue to face.
sion. I am left wondering what a pro- ates, Medical curricula for the next We should seek an appropriate
fessed belief in equity actually means. millennium: responding to diversity balance between 2 potential prob-
In a tongue-in-cheek manner Dr. (Can Med Assoc J 1997;156:1295-6), lems. On the one hand, we should
Walters seems to be asking whether by Dr. Christiane Kuntz, and Gen- encourage gender-inclusive language
we really must launder the English der sensitivity in medical curricula and discourage language that people
language to eradicate all traces of sex- (Can Med Assoc J 1997;156:1297- find patronizing or disrespectful. On
ism. The aim of the guidelines is not 1300), by Barbara Zelek and associ- the other hand, excessively rigid ap-
to delete words from the language, ates, contain a megadose of Or- plication of language formulas can
but rather to have educators and their wellian newspeak. Gender-inclusive create an oppressive environment.
students use the meanings behind the language and sensitivity are the Data we cited in our article indi-
words to explore hidden stereotypes mantras of the 90s. We have reached cate that women avoid surgical spe-
and biases. For example, the word the stage where an inanimate object cialties, and part of the reason is that
hysteria has as its root the Greek replaces a human (oh, sorry living) they feel alienated in the surgical en-
word hyster, meaning uterus. Rather being, as when chair replaces chair- vironment. Our use of language re-
than eliminating the word from use, man. This mongrelization of the flects attitudes and contributes to
students might have an interesting English language is all but complete, their creation. The greater accept-
and useful discussion of whether the all in the name of political correctness ability of gender-exclusive language
term implies that being female is the a new form of totalitarian suppres- in surgical environments is no coinci-
cause of this psychiatric disorder. sion of free speech. dence.
Dr. Coxs point is well taken and We do not know exactly where the
illustrates how stereotypes can be Emile Berger, MD right balance lies between creating a
subtly embedded and deeply held. Al- Montreal, Que. climate in which women feel fully re-

CAN MED ASSOC J SEPT. 15, 1997; 157 (6) 641