A Feminist Approach to the Opioid Epidemic

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    Nonmedical prescription opioid abuse is an ongoing problem in America, with data showing an increase in this phenomenon in every state. This phenomenon found its genesis and growth within the masculine context of care. As this epidemic continues its threat on public health, it is time to consider alternative approaches to its treatment. One such approach is to implement a feminist ethic of care to improve the patient-provider relationship, foster autonomy, and to nurture national milieu

    A Feminist Approach to the Opioid Epidemic

    Nonmedical prescription opioid abuse (NPOA) is an ongoing problem in America, with data showing an increase in this phenomenon in every state (Paulozzi & Xi, 2008). This phenomenon found its genesis and growth within the masculine context of care. As this epidemic continues its threat on public health, it is time to consider alternative approaches to its treatment. One such approach is to implement a feminist ethic of care to improve the patient-provider relationship, foster autonomy, and nurture the national milieu through interdependence. The means to this end may vary, but the nature of this perspective demands effective communication. Motivational interviewing represents a consistent, evidence-based means for exercising this approach to care.

    The current perspective in treating the rising threat of NPOA relies on the masculine ethic of care. This view derives its treatment approach from the obligation of justice. That is to say, the masculine ethic of care is strongly concerned a more "hands off" approach to treatment. This duty of justice considers the patient as the sole, responsible party and, therefore, the fundamental agent of change and wellness. The way in which this is carried out is via a power dynamic in which the provider maintains an omniscient, fatherly role that emphasizes provider knowledge and patient obedience. Put another way, the masculine view stresses the notion that strong willpower and knowledge give rise to success. This method routinely omits empathy and patience from treatment and discounts the addiction research demonstrating impaired freedom of will (Vohs & Baumesiter, 2009). The result is a sense of failure and hopelessness felt by the patient.

    The feminist approach highlights the importance of the patient-provider relationship through the exercise of empathy. Central to this perspective is interdependence and the balance of power between the provider and the patient. By maintaining this symmetry, then the provider may foster open-communication, elicit change-talk, and identify barriers and strengths to recovery. Furthermore, the nurse and patient can work together to use those factors to tailor the treatment plan and evoke patient autonomy in a way that increases the chance of positive health outcomes. This framework arises from a fundamental philosophy demonstrated throughout feminist history in which the marginalized provide the best insight into the provision of care within a society (Green, 2012).

    In this model, the provider lessens the burden of responsibility by sharing that weight with the patient through a feminist ethic of care. That is not to imply that the provider strips the patient of power, but, instead, nurtures that power within the patient. This "motherly" role stands in strong contrast to the masculinity of the "fatherly" role. In this way, the provider-patient relationship takes a similar shape as a mother-child relationship, in which the provider guides the patient through treatment, fostering more and more autonomy along the way, until the patient ultimately becomes the sole decision-maker. This enables coping mechanisms and caregiving that equip the patient with the necessary skills to maintain wellness, rather than metaphorically kicking the patient from the nest. This feminist lens sets up the philosophy of care, but practice must align with this framework.

    Ultimately, there are many ways to implement this approach. No matter the means in which one seeks to do so, the most important factor will be communication. Communication remains a tool in which the provider can cultivate relationships, derive patient-centered data, and tailor the plan of care. One method for communication is motivational interviewing. This form of counseling has demonstrated success in addiction treatment and in agreement with the feminist perspective. Motivational interviewing is a goal-oriented method that facilitates change by provoking intrinsic motivation from the patient, preserving patient-centered care (Miller, 1996). The practitioner remains nonjudgmental and maintains an open, equal relationship with the patient. As the provider paces with the patient, then the provider consistent demonstrates empathy, and allows the patient to argue for behavioral change. This provides the same level of autonomy and interdependence relative to feminist care models and, therefore, a practical match in implementing such models.

    In conclusion, the feminist perspective of care in the treatment of NPOA offers an approach predictive of success. This ethic focuses on the patient-provider relationship to foster patient autonomy. By exercising empathy, then the caregiving, interdependent nature of feminism is preserved in a way that is congruent with the most recent research into addiction. Although there are many ways in which one can implement the feminist model, communication must remain a central component. Because of the caring, empathetic nature of this perspective, a nonjudgmental approach is paramount. Motivational interviewing is consistent with feminist approaches to care and, therefore, can be a valuable tool in effective communication.




    References
    Green B (2012) Applying Feminist Ethics of Care to Nursing Practice. J Nurs Care 1:111. doi:10.4172/2167-1168.1000111


    Miller, W. R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behaviors, 21, 835–842. doi:10.1016/0306-4603(96)00044-5.


    Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban–rural status and by drug type. Pharmacoepidemiol Drug Saf. 2008;17(10):997–1005.


    Vohs, K. D., & Baumeister, R. F. (2009). Addiction and free will. Addiction Research & Theory, 17(3), 231–235. Error: DOI Not Found
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    About Issaiah1332

    Psychiatric nurse and PMHNP student.

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    86 Comments

  3. by   Emergent
    Seriously? Sorry, but this article seems like divisive, stereotyping nonsense generated by the woman's studies dept of academia.

    That bad, bad patriarchy doing everything wrong! Those uncaring men responsible for all our problems.

    Maybe a man will counter with an article claiming that female dominance of the regulatory system is what twisted the arms of the medical community to meet the pain goals of a generation of weaklings, who lacked strong male role models in their lives.
  4. by   Daisy Joyce
    I'm not entirely certain the opioid epidemic is the result of obedient and powerless patients.
    I more get the sense that these patients were not taking their meds as prescribed, and HCPs sorta shot themselves in the foot when they decided that pain is whatever the patient says it is.
  5. by   Atl-Murse
    What universe do you exist ? Real problems demands real solutions not some wishful magical thoughts. Gender wars will not help.
  6. by   KatieMI
    The author clearly never in his/her life saw a single one of those "poverless, obedient" patients who will do literally whatever it takes to wheedle more "good pills" from a provider, who is the truly powerless person in this equation, facing DEA on one side and HCAPS surveys on another.
  7. by   Jedrnurse
    I'm sensing....a future nursing theorist/professor!!

    Yay.
  8. by   ItsThatJenGirl
    There's well documented sexism in the history of medicine. Anytime women had an issue, it was dismissed as "hysteria". I mean, there are terms out there like "bikini medicine". Women have history been under-treated and dismissed. I don't see how anyone could argue that it's important for a female patient to be seen as an equal when being treated for a medical condition. I've been dismissed due to my gender plenty of times. I've been spoken to like "well I've found with women they tend to" in a derogatory way. We aren't included in medical studies at the rate men are, either - which impacts evidence based practice.

    While I'm not sure that it has anything to do with the opioid crisis, or fixing it, dismissing the problem would be a big mistake. IMO, of course.
  9. by   JKL33
    Quote from Daisy Joyce
    ... HCPs sorta shot themselves in the foot when they decided that pain is whatever the patient says it is.
    Issaiah1332:
    This phenomenon found its genesis and growth within the masculine context of care.
    OP, I'm curious how you might reconcile these two ideas. ^

    I don't agree with your thesis but I don't think you have proven it, regardless. What you have written is divisive and ultimately unhelpful .

    I hate the way we tend to use such a boxed-in definition of "caring" to begin with. There are a LOT of ways to care and to show care/concern. Definitions and generalizations like the ones in your article hurt both men and women. Boys and girls, too. Everyone, really.
    Last edit by JKL33 on Nov 24
  10. by   Julius Seizure
    OP, I had never heard of the term "feminist ethic of care" until reading your article. It is an interesting concept, even if the terminology seems to rub me the wrong way at the moment. I'll have to do some reading and think it over to decide how I feel about this. My initial reaction was similar to what JKL wrote, that men can "care" in an effective way too and that "caring" shouldn't need to be a feminist issue. I see now that the concept you are writing about is not quite what I initially understood it to be. Admittedly, I've never been one for philosophy.


    I want to commend you for taking the time to create a well-written article (with citations!). You may get some comments that disagree with the concept behind your writing, but I do hope that others recognize and appreciate that it was written in an academic and professional way.
  11. by   AJJKRN
    While I find the OPs concept on the newer end I can appreciate what is trying to be conveyed. Especially in the mental health arena. I don't think this article is solely pointing to just how women are treated in medicine but how medicine has treated everyone since it's inception...including how women are undertreated and often dismissed.

    Come on guys...give a girl a break! Sheesh...
  12. by   JKL33
    Quote from Julius Seizure
    men can "care" in an effective way too and that "caring" shouldn't need to be a feminist issue.
    And women can and do care in ways that are not "feminine" in the traditional sense.

    This piece is essentially asking people to choose a positive "female" ethic over a negative "male" ethic as if each of those don't have a respective opposite, if you will.

    Or maybe I'm just bound to disagree because I haven't noticed people fitting into boxes quite this neatly such that we could choose a philosophy of care that we agree with and simply label it masculine or feminine - and I wouldn't see the benefit of doing so.
  13. by   JKL33
    Quote from ItsThatJenGirl
    I don't see how anyone could argue that it's important for a female patient to be seen as an equal when being treated for a medical condition.
    Agree!

    I didn't get that the article had anything to do with that, but rather that a certain philosophy is feminist/motherly, etc.

    From the article:
    the provider guides the patient through treatment, fostering more and more autonomy along the way, until the patient ultimately becomes the sole decision-maker.
    I have no idea how this ^ can be labeled to be "motherly" and "in strong contrast" to being "fatherly," for example.
  14. by   klone
    Quote from JKL33
    I haven't noticed people fitting into boxes quite this neatly such that we could choose a philosophy of care that we agree with and simply label it masculine or feminine.
    Yes, this

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