Freeman FINAL Paper
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University of Louisville *
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Date
Dec 6, 2023
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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
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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
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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
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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
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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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justice. Disability justice works reframes a person with disabilities as a teacher instead of a
problem for a doctor to treat through collective efforts.
The authors state, “Incorporating
disability justice and intersectionality throughout medical education, training, and practice will
promo
te the art of enabling as well as healing that should be inherent in the practice of medicine”
(Doebrich et al. 401). Broadening the collective understanding of intersectionality from race and
gender to now disability shows the need for intersectionality in healthcare. (add to this)
As shown in Stevens et al. (2018) intersectional approaches to medicine are possible, and
doing so brings positive health outcomes to marginalized people of color. In this example, a
treatment model was synthesized to combat mental health issues around the time before and after
childbirth. This was done through a coordinated care plan with a team of medical experts, with
the treatments happening in the same facility as their primary care provider. This was all to
ensure lowered stigma and obstacles for these patients to receive care. Pregnant people have a
vulnerability in social dynamics of power, with many experiencing barriers to adequate
healthcare and resources to have a successful pregnancy. In modeling this treatment plan under
the guidance of intersectionality the aim was for “patients to feel more in control of their mental
health treatment, to feel empowered rather than stigmatized or judged, and to create a healthcare
experience that attempts to minimize the many forms of racism encountered by ethno-racial
minority women in their everyday lives” (Stevens et al. 631).
This approach shifts the paradigm
of our for-profit healthcare system to a system that sees patients intersectionally and holistically
to maximize the quality of treatment.
Intersectionality is without its critiques and shortcomings in healthcare settings. As
discussed above, there have been numerous objections to the notion of intersectional
frameworks, and these leave room for growth in the future. Common critiques of
intersectionality are that it may be too complex and difficult to operationalize in clinical settings,
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leading to a lack of practical guidance for healthcare providers. Additionally, some argue that
intersectionality can be used to essentialize or prioritize certain identities over others, potentially
leading to a form o
f “oppression Olympics” where different marginalized groups compete for
recognition. In
“
Addressing the Practical Implications of Intersectionality
...”
by Barned et al.
(2019), critiques are made against proposed implementations of intersectional healthcare in our
capitalistic healthcare complex. One of these critiques is the juxtaposition of institutional
features that hinder equitable healthcare along with proposed models of intersectional care. This
means that while there are efforts to make the doctor’s office more inclusive, there are certain
things rooted in medicine that are the antithesis of intersectional care. An example of this is how
most medical consultations are kept below a half hour, leaving many patients feeling excluded
from feeling truly seen in their care. A common critique that comes from this is that the onus of
responsibility is often placed on the individual level of the physician-patient encounter, instead
of larger medical institutions. Many individuals with complex chronic conditions create a sort of
‘elevator pitch’ in order to receive adequate care.
A proposal to solve this has been virtual
appointments to further build care, but this seems to be offering relief to a secondary issue, rather
than the way our healthcare system is structured. Going back to the example of appointment
lengths, it is important to question whether the clinician should be responsible for realizing a
patient’s social factors
, or if this is a symptom of the status quo entrenched by institutions. These
critiques do not deliver a death sentence to the prospect of intersectional healthcare practices,
but
it just shows that the individual practitioner can only do so much in their own practice to
promote intersectionality, and they must play their part.
These proposed shortcomings of intersectionality have the ability to be improved upon
for the advancement of healthcare under a feminist ethic framework. It is important to note that
people's social categories can change over time. Genders change, sexualities can be fluid, and
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7
people can be rendered with a disability. Everyone has a unique set of circumstances that they
walk into a clinician's office with, and it is pertinent that it is taken into consideration along with
societal factors that precede them. An intersectional feminist bioethics framework can help to
restructure power dynamics and center social justice work in healthcare. It empowers patients
and healthcare providers to recognize and address the multiple identities and experiences that
intersect to shape a person's health outcomes. It also promotes a more collaborative and equitable
approach to healthcare that recognizes and values the diverse needs and experiences of patients.
It is important for those in positions of marginalization to lead the advancement of
intersectionality in healthcare. Their lived experiences provide important insights into the
challenges and barriers that exist in the healthcare system. As shown in the literature, events such
as COVID-19 can magnify social inequities that leave certain groups like people with disabilities
struggling. Advocating for systemic changes to barriers to healthcare is another positive step. An
example of this is universal health care and how equal access to a doctor’s office lessens
obstacles for everyone to get quality healthcare. Moreover, improving physical accessibility to
healthcare facilities, such as by ensuring accessible entryways and reliable public transportation,
can also help to promote equal access to healthcare for marginalized groups. Overall, by
applying an intersectional feminist ethic framework to healthcare, healthcare providers can better
understand and address the complex and intersecting factors that contribute to health disparities,
thereby advancing health equity and social justice.
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References
Barned, C., Lajoie, C., & Racine, E. (2019). Addressing the Practical Implications of
Intersectionality in Clinical Medicine: Ethical, Embodied and Institutional Dimensions. Americ-
an Journal of Bioethics, 19(2), 27
–
29.
https://doi.org/10.1080/15265161.2018.1557278
Doebrich, A., Quirici, M., Lunsford, C., McLaughlin, M., & Vercler, C. (2020). COVID-
19 and the need for disability conscious medical education, training, and practice. Journal of
Pediatric Rehabilitation Medicine, 13(3), 393
–
404.
https://doi.org/10.3233/PRM-200763
Grzanka, P. R., & Brian, J. D. (2019). Clinical Encounters: The Social Justice Question in
Intersectional Medicine. American Journal of Bioethics, 19(2), 22
–
24.
https://doi.org/10.1080/1-
5265161.2018.1557295
Laster Pirtle, W. N., & Wright, T. (2021). Structural Gendered Racism Revealed in
Pandemic Times: Intersectional Approaches to Understanding Race and Gender Health
Inequities in COVID-19. Gender & Society, 35(2), 168
–
179.
https://doi-
org.echo.louisville.edu/10.1177/08912432211001302
Patrick R. Grzanka, Jenny Dyck Brian & Janet K. Shim (2016) My Bioethics Will Be
Intersectional or It Will Be [Bleep], The American Journal of Bioethics, 16:4, 27-29, DOI:
10.1080/15265161.2016.1145289
Stevens, N. R., Heath, N. M., Lillis, T. A., McMinn, K., Tirone, V., & Sha’ini, M.
(2018). Examining the effectiveness of a coordinated perinatal mental health care model using an
intersectional-feminist perspective. Journal of Behavioral Medicine, 41(5), 627
–
640.
https://doi-
org.echo.louisville.edu/10.1007/s10865-018-9973-0
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Yolonda Wilson, Amina White, Akilah Jefferson & Marion Danis (2019)
Intersectionality in Clinical Medicine: The Need for a Conceptual Framework, The American
Journal of Bioethics, 19:2, 8-19, DOI: 10.1080/15265161.2018.1557275
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