Medical Violence Defined Cross–Culturally Through Time

Medicine: a practice centered on healing, protecting, and improving human well-being. 

However, despite intentions, medicine is far from immune from inflicting harm. Violence is often associated with physical injury, aggression, or the deliberate intention to hurt another person. Yet, violence within healthcare can morph into a vast amount of different forms, some perhaps not immediately recognizable. Medical violence extends beyond physical harm; its umbrella of possibilities includes coercion, discrimination, neglect, violations of patient autonomy, and institutional practices that compromise an individual's dignity and well-being [2, 3].

How should we define medical violence, and who gets to determine what “violence” is in the first place?

To be able to define medical violence with all its nuances is to understand how harm occurs, becomes normalized, and is perpetuated. By expanding our understanding of medical violence, we create more opportunities for patients, healthcare professionals, and the general public to recognize these experiences and take action to address them transparently. Yet, to complete such a feat is far from simple.

Violence is complicated. Its meaning is dynamic, dependent on the cultural and historical context in which it manifests. What one society considers acceptable may be viewed as harmful in another. Cultural beliefs, social expectations, and institutional norms all influence what individuals perceive as harm and thus determine which practices are considered legitimate. However, in medicine, where professional authority often intersects with cultural understandings of health and the body, this becomes complicated. Take, for instance, a medical procedure that is viewed by a healthcare provider as necessary for a patient's well-being, but that the patient experiences as coercive because their consent is disregarded.

At what point does medical intervention become medical violence?

Rather than evaluating violence exclusively through the intentions of the healthcare provider, the patient's experience, autonomy, and ability to make informed decisions about their own body must also be understood [2].

Consider the doctor-patient relationship. Medical professionals accumulate specialized knowledge and hold authority over decisions regarding patient diagnosis, treatment, and care. While this authority is necessary for effective treatment, it also creates a perceived imbalance in which the patient may feel unable to question medical decisions, thus losing the confidence to advocate for themselves. When professional authority takes precedence over patient autonomy, harmful practices may become normalized. Medical violence does not always require intentional harm; it also emerges through unequal relationships, institutional expectations, and systems that allow the continuation of harmful practices [2, 3].

Alongside the progression of history, our understanding of medical violence has evolved over time. Take forced sterilization during the eugenics movement as an example. Both institutions and the government endorsed the sterilization of individuals. These practices were accepted as “scientifically justified” or “beneficial to society,” despite the violations of bodily autonomy and reproductive rights that it induced [4, 5]. Today, forced sterilization is widely recognized as a grave violation to our innate rights. This reminds us that medical authority does not automatically make a practice ethical. Medical practices can become accepted through the cultural and institutional beliefs of a particular period, even when they, in fact, harm. 

Medical violence extends beyond individual interactions between patients and healthcare providers, it can also occur through broader social and institutional structures. The concept of structural violence helps explain how systems and inequalities expose certain demographics to completely preventable harm. Within healthcare, unequal access to treatment, discriminatory practices, and inadequate resources can contribute to suffering, even when there is no single individual directly responsible [3]. These experiences are often embedded within the everyday functioning of healthcare institutions. They demonstrate that medical violence cannot be understood solely through individual actions, for the larger systems that influence who receives care, how that care is delivered, and whose needs are prioritized must also be considered.

Reviewed by: Vedant Patel

References

[1] Occupational Safety and Health Administration. (n.d.). Healthcare: Workplace violence. U.S. Department of Labor. https://www.osha.gov/healthcare/workplace-violence

[2] "Violence" in medicine: Necessary and unnecessary, intentional and unintentional. (2018). PubMed. https://pubmed.ncbi.nlm.nih.gov/29890993/

[3] Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449. https://doi.org/10.1371/journal.pmed.0030449

[4] Reilly, P. R. (2015). Eugenics and involuntary sterilization: 1907–2015. Annual Review of Genomics and Human Genetics, 16, 351–368. https://doi.org/10.1146/annurev-genom-090314-024930

[5] Stern, A. M., et al. (2017). California's sterilization survivors: An estimate and call for redress. American Journal of Public Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC5308144/