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Are We Ready for Coed Hospital Rooms?

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Long emergency room stays are one of the most unpleasant and potentially dangerous aspects of healthcare delivery in most western nations. In recent years, Canada has addressed this problem, in part, by permitted male and female patients to share hospital rooms, separated by a privacy curtain, in the belief that most patients would gladly bunk with a person of the opposite gender in order to receive quality care as rapidly as possible. Over the past several months, however, a handful of high-profile protests by disgruntled "modesty" advocates have been pressuring Canadian providers to reconsider their policies. In one case, Deborah Smith, a physician from Sudbury, carried her outrage to authorities and to the media when she discovered that her mother-in-law had been housed at London, Ontario's University Hospital in a room with a man. Her mother-in-law, who suffered from severe dementia, likely did not even notice the male patient--but Dr. Smith did, when glancing behind his privacy curtain. In another instance, a patient at Concordia Hospital in Winnipeg, Ollie Ingram, complained that she had been housed with a male patient for three weeks in 2009 and that the man's gown accidentally fell open on several occasions, forcing her to look away. Her discomfort attracted the attention of the province's health minister, Theresa Oswald, who has launched a one-woman media blitz against such mixed-gender rooms. A similar effort is afoot in Great Britain, where after many years of controversy surrounding mixed-gender wards, hospitals will soon face stiff fines for boarding male and female patients side by side. However, having witnessed firsthand the consequences of strict sex segregation in hospital room assignment, which is generally the norm in the United States, I cannot help regarding these segregation efforts as tragic steps backward for both healthcare and gender equality.

The segregation of beds into "male" and "female" is not a problem manufactured by bioethicists or philosophers that lacks real-world consequences. Every night across the United States, hundreds--if not thousands--of patients endure extra hours, and even days, waiting in crowded emergency rooms because the hospital beds available are not "gender-appropriate." Nurses and administrators squander valuable time that could be devoted to patient-care shuffling our sick from room-to-room in order to separate the sexes. Priority is given to keeping men and women apart, rather than to minimizing the distress of uprooting and relocating the reluctant victims of this endless game of musical beds. The burden falls particularly heavily upon patients in need of specialty services, such as mental health care, and upon individuals of the gender less frequently in need of those specific services. For example, a mentally-ill female patient with a history of severe substance abuse is likely to wait for a bed on a chemical addiction unit, where the majority of patients are men, solely because she is female.

Ironically, the patients themselves are not even asked whether they would mind a roommate of the opposite gender. It is just assumed that they would--or that their wishes are irrelevant, because such mixing of the genders is inherently unsafe. As the Manitoba carper, Ms. Ingram, told the Winnipeg Free Press, "There are things men need and things women need." Fortunately, sick men and sick woman both need precisely the same thing: medical care. Even if the privacy concerns of ongoing gender segregation had merit--and I am not at all convinced that they do--the significant practical benefits of decreasing emergency room waits during periods of overcrowding outweigh these concerns. I cannot speak for Dr. Smith, but I would much rather have my mother share a room with a man than have her spend the night unattended in a hospital corridor.

The good news is that with regard to coed hospital rooms, the practical benefits dovetail neatly with the ethical ones. Whatever objections some patients may have to sharing a room with a member of the opposite sex--and it is not even clear that many people do harbor such objections--they are fundamentally irrational. Critics of coed rooms often raise the bugaboo of male patients sexually assaulting or harassing their female roommates, particularly if those women are incapacitated. This objection appeals to stereotypes about gender roles, but finds little basis in reality. In the first place, with segregated rooms, male patients can just as easily assault incapacitated male roommates. Sexual violence knows no sexual orientation. In addition, although lurid cases will always draw media attention, and I have no doubt that some cherry-picker will respond to this column with just such examples, sexual assaults have not historically been a significant problem in mixed-gender rooms in Canada or England. People who are sick enough to be hospitalized have far more pressing concerns than harassing or assaulting their fellow patients. Moreover, if our genuine goal were to reduce sexual assaults in hospitals, we would implement meaningful measures to prevent patients from wandering into each other's rooms, such as segregating patients by floors, or having all doors monitored. The same male patients who some nay-sayers are allegedly afraid may assault potential female roommates can currently slip into adjoining rooms and do exactly that with relative ease. Of course, few actually do. If anything, gender-segregated rooms provide the illusion of safety rather than real protection.

A far more plausible explanation for opposition to gender-mixed hospital rooms is old-fashioned prejudice. Because some people have been brought up to fear or dislike sharing a room with a person of the opposite sex, or blush at the prospect of catching a glimpse of an unwelcome body part when a robe slips open, we enshrine and perpetuate this prejudice in social policy. I do not particularly sympathize with such prejudices. The same perverse reasoning was used to segregate hospitals by race in this nation for much of the twentieth century. Today, no hospital would likely honor a patient's request to have a white roommate. I am optimistic that, a generation from now, requests for a male or female roommate will be similarly viewed as ignorant and anachronistic. To paraphrase Supreme Court Justice Oliver Wendell Homes, it is revolting to have no better reason for a rule of law than that it was so laid down in the time of Queen Victoria.

Of course, even if our nation does move toward acceptance of mixed-gendered hospital rooms, such change will not come overnight. Our hospitals could implement such a program slowly--first making such arrangements voluntary, and then charging an additional fee for those who persist in demanding same-sex accommodations, before ultimately eliminating the practice of segregation entirely. I can also understand allowing some flexibility to permit special accommodations for cross-gendered patients and for victims who have survived sexual trauma. But one should have a far better reason for demanding a same-sex roommate that mere personal taste, tradition or the belief that one's God wishes it so. Needless to say, those patients with a religious or cultural objection to inhabiting a mixed-gender room can always shell out for a private room, as some individuals do already to avoid sharing living quarters with members of other races, ethnicities and social backgrounds. After all, we cannot hope to quench prejudice completely. We simply should not enable it.

The most significant threat to social progress is the all-too-common mistake of confusing the familiar with the desirable. They do that in Saudi Arabia, where they have gender-segregated workplaces, and most social interactions between unrelated men and women are curtailed in the name of modesty. Civilized people find such separation not merely distasteful, but deeply immoral, and wish that those who imposed gender-segregation in the Middle East would be treated by the world community with the same contempt as those who imposed racial apartheid in South Africa. Similarly, enlightened westerners are growing increasingly suspicious of religious extremists, of all so-called faiths, who segregate men from women during worship or who prohibit one gender from equal opportunities to obtaining positions of leadership. We find these forms of prejudice intolerable, and rightly so, but largely because they are not our own prejudices. It's much easier to see your neighbors' irrationality than your own.

Fortunately, our own prejudices with regard to gender separation in public facilities and accommodations are starting to crumble. Every year, more colleges permit coed dormitory rooms, which I have little doubt will soon become the norm. Some of the most enlightened schools now also have coed restrooms--which, once our society grows accustomed to them, offer the best long-term solution to lengthy lines outside ladies' rooms at concerts and stadiums. Eventually, we will have coed locker rooms at schools and public swimming pools. When we do, people will look back with either amusement or horror--or both--at the excessive inconveniences that we imposed upon ourselves with our ill-conceived ideas about "modesty." Integrating America's hospital rooms would be a small but meaningful step toward such a gender-blind future.

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