Physicians and Touching the Human Body: Coming to Terms with Moral Codes and Temptations in the Workplace

The power of implicit (situational) and explicit (written) ‘codes’ about who can touch whom, and when, where and how, in society, extends particularly to healthcare institutions in which certain professionals are granted the right to touch patients in ways not afforded to other people. These are regulated norms, unlike lovers for example, who can make their own on a daily basis. Parents of newborns and young children are expected to have these ‘rights to touch’ as part of proper child-rearing. And physicians are expected to have similar rights as part of their professional role, circumscribed by explicit codes.

Not so for the rest of us. Permission must be given either orally or in writing by post-pubescent children and adults, to allow others to touch them. Even with prepubescent children, teachers for example, cannot touch students outside of school-board regulations that may permit “limited” forms of contact, e.g., hand on the back or shoulder. Male teachers especially cannot hug girl students, and female teachers cannot hug boy students, at least by code. Same-sex hugging is also proscribed, especially towards male-to-male in educational settings. There are clear rules about what constitutes ‘appropriate’ and ‘inappropriate’ touching and sexual harassment within most public institutions and industrial organizations. This extends generally to public open areas as well, but varies by culture.

Anthony Synnott (1993) has charted cultures which are “contact” cultures and “non-contact” cultures according to degrees of ‘tactility’, following from earlier research that showed many people suffer from physical deprivation during their adult lives. He found, along with Argyle, Mead and Montagu, that there are specific cultures which have very low levels of tactility and those which have very high levels of tactility. These he summarized as follows:

Contact                                                                              Non-contact

South Europeans                                                            North Europeans                                           Greeks                                                                                Scandinavians                                               Turks                                                                                   North Americans                                         Latin Americans                                                              Indians                                                           Some African cultures                                                   Pakistanis

New Guineans                                                                  Japanese                                                                                                                                                                Chinese                                                                                                                                                                  Upper-class British

Synnott admitted however, that within any of these cultural areas “there is a wide range of individual and sub-cultural variation.” He found that for example, “Californians and Southerners are often more tactile than New Englanders, and francophone Quebecers , than English Canadians. Similarly in Latin America, women in Costa Rica interact closer and touch each other much more often than Columbia and Panama.” This finding, among others, points to how cross-cultural communication can be difficult in a hospital setting. And we have to remember that variations exist according to variables such as age, sex, social class, and religion, regardless of culture of origin.

So how does all this relate to physicians and touching?

Physicians, particularly surgeons, touch people, either with their hands (palpate), a stethoscope (heartbeat), or surgical tools (scalpel, sutures). They understand codes because they, like all physicians in Canada, take the Hippocratic Oath (to practice professional behaviour), and have to submit to ethical standards found within their own professional associations, plus adhere to local hospital policies, etc. They are expected to take the moral high-ground. And they are taught at schools of medicine about liability insurance insofar as it affects their private practice, especially in this case, the “non-qualifiable claims” clauses that may relate to inappropriate touching of patients and possible resulting law suits.

So this seems clear enough. But what about other factors that come into play in the physician-patient relationship? For example, the age, sex, ethnicity, socioeconomic status, situational power/authority, physical appearance, type of illness, patient mobility/immobility, and religion. How do these variables influence how, when, where, and why, patients are touched? Would the fact that the physician was a Latin male, fifty-years-old, single, Catholic, and Chair of the Oncology Department, play a role if the patient was a twenty-eight-year-old female, attractive, single, Muslim, and former beauty pageant winner, with a diagnosed breast cyst? What if the patient was a 92-year-old white British war Veteran, with dementia and severe psoriasis in his groin area, and the physician was a 30-year-old black Lesbian from southern France, and resident dermatologist? Would that have an effect on their interactions re touching of his body?

In either case, who would touch who, where, when, how and why? The possible combinations of ‘causal’ variables appears endless, especially in diverse culures.

Or, would none of these sociological factors have an effect on how the physician treated the patient? How would being a member of a “low contact” or “high contact” touching culture mitigate patient-physician relations?

The urgency to conclude that simply being a professional ‘protects’ you from inappropriate touching, is offset unfortunately, by actual cases of malpractice involving inappropriate touching/sexual harassment (lower rates in Canada, much higher rates in the US). Going to Google Scholar will show the reader examples of Canadian infractions of touching code infractions. See also: April 29, 2016. ‘Sexual touching’ case highlights a loophole for doctors guilty of abuse… ‘Disciplined doctors’ often given 2nd chance to practise…

Written and implicit codes do work the vast majority of the time. Tort law, costs, hospital ethics committees, and codes of conduct extract compliant,  and it yet should be firmly stated that no profession (medicine, teaching, police, military, accounting, real estate, engineering, and so forth) is post facto exempt from behaviour sanctions. Nor are private citizens, exempt from the laws of the land.

But the context of traditional medical care (and physiotherapy or chiropractic), in which patients have to take their clothes off either in part or totally, and dress in a flimsy gown in order to be examined more thoroughly, transforms the prior dressed, more egalitarian state, into a state of complete subservience, body vulneability, and expected conformity. The power balance shifts to ‘doing what the doctor asks’ (or nurse) and defers to his or her expertise. The patient by definiion, becomes a temporary social ‘deviant’, and is expected to play the ‘sick role’ (Parsons). This state of dependency makes the patient vulnerable, protected situationally by an often non-visual or buried-in-adminstration “Patient’ Rights” code. This doctor-patient situation can be made worse when medical ethics and organizational ethics come into conflict (Hall). Or especially when there are multiple physicians attending to one patient, not to mention the whole corps of ‘ancillary staff’ behind the scenes -which multiplies the possibilities of things going wrong (as well as going right). Illegitimate touching can be like background noise at a rock concert; no one notices.

As the main communication of reassurance and healing, touch can be central to a physician’s role. But it can be controlled beyond codes immediately known to the physician, as in the case where a husband unexpectedly accompanies his wife into the examining room, where religious values of modesty and/or patriarchy override the physician’s usual degrees of freedom.

Western society suffers from a lack of tactility. We don’t touch each other enough in a non-sexual way. Older people for example, who are isolated from the community or live alone, particularly are susceptible to the mental and physical health hazards from not being touched. Physicians readily have this opportunity of redress with the elderly. Nonetheless, this patient group is not where most problems occur, when they do occur. It most often occurs in situations where there is opportunity and motive for sexual assault involving younger patients. Following moral codes every day, and while being vigilant about liability, is the bane of physicians’ modus operandi. Being careful can haunt one, to the point of much raised anxiety, especially as often found in recent medical school graduates. More normalized touching in society that is free from sexual implications, may reduce among everyone, inappropriate touching, simply through body acceptance and familiarity.

“Touch is many things, and has many meanings; it is magical and cosmic, healing and therapeutic, a product of merchandising technique, a prime mode of communication, soothing or arousing, loving or murderous, creative, polluting, energizing, an expression of power, and also occasionally a problem in individual, cross-gender and cross-cultural communication. It is essential for human physical, emotional and intellectual development, yet also strangely taboo.” (Synnott: 180)

Finally “We need to understand that we have for too long neglected and overlooked the importance of tactile communication not alone in the development of the infant and child, but also in the development of the adult” (Montagu, 1979: 335)

Perhaps it’s time we all incorporated more touching into our lives, but within the margins of legality, respect, need, and care.

TL Hill, PhD                                                                                                                                                         Medical Sociologist


Argyle, Michael. (1978). The Psychology of Interpersonal Behaviour. 3rd edn. Harmondsworth: Penguin Books

Hall, Robert T. (2000). An Introduction to Healthcare Organization Ethics. New York: Oxford

Mead, Margaret. (1956). Sex and Temperament in Three Pimitive Societies. New York: New American Library/Mentor Books

Montagu, Ashley. (1978). Touching: The Human Significance of the Skin. 2nd edn. New York: Harper Colophon Books

Parson, Talcott. ((1975). “The sick role and the role of the physician reconsidered.” Milbank Memorial Fund Quarterly, 53: 257-278

Synnott, Anthony. (1993). The Body Social: Symbolism, Self and Society. London: Routledge



Guns as Stupidly Normal

As a kid from 4 to 10 years of age, I was Gene Autrey, Roy Rogers, Lash Larue, Daniel Boone, Davey Crockett, and Hop-Along-Cassidy. Jeff was always Cochise, Red Cloud or Sitting Bull because of his black hair and darker skin. After playing Cowboys & Indians three times a week for 7 years, Jeff always died.

My six-guns could always beat a bow and arrow. And I learned to be fast on the draw too, and how to twirl my pistol around my finger right into its holster. The girls on our street loved it. Especially when I could fend off six Indians circling around my cardboard wagon. Life was nasty, brutish, and short for Jeff, Larry, Jan Eric and Danny who wore eagle (chicken) feathers in their hair. They were no match for my twin and studded black leather holster set -the best that $8.95 could buy in 1953.

My father and his two brothers were of course, avid hunters. That’s what many post-war husbands and fathers did to be able to put extra food on the table, besides building their own houses. Dad, his friends and my uncles, always set out in the Fall to hunt deer up near Algonquin Park. Most of the time they brought home enough venison for all the families to share.

But Dad taught me and my brother to shoot a real rifle at an early age. I was 13 when I bagged my first rabbit with a Coey .22. Then we got our own air-rifles, .177 calibre, and for the next 2 years my brother and I hunted starlings just for ‘fun’. We also shot (or at) other unwanted creatures, like squirels and skunks.

However, when I was 15 I went to Army Cadet Camp at Ipperwash, Ontario, for 3 months in the summer of 1959. All boys at our high school had to attend regular military drill practice (Lorne Scots) during the years preceeding 1961, after which high school cadets was abolished. At Camp Ipperwash, along with about 800 other cadets from across Ontario, I got to shoot the Lee Enfield Mark IV, Sten Gun, Bren Gun, 3.5 Rocket Launcher (“Bazooka”), and to throw grenades. Really. At age 16 (I had lied about my age so I could go).

In 1960 to 1962 I joined the Argyle & Sutherland Scottish Regiment (Reserves) in Brampton, and got to not only march my boots off again but also fire the Belgian FN gas operated semi-automatic assault rifle. At the butts, in Winona. Wow! What a treat that was! I earned my cross-rifle badge for marksmanship at 200 yards.

So with all that behind me, I joined the Royal Canadian Air Force in 1964, and learned again how to kill people, but with an Officer’s Browning automatic pistol; plus, later, with rockets and wing-mounted machine guns.

From a 5 year-old cowboy to a 19 year-old pilot, guns were normal for me. I realize now how normal it was – and still is – for average people or families in North America, and soldiers, and TV stars, to live and work with guns. I still have a rifle I never use, and most of my country neighbours all have one or more guns in their homes. Some of them use them for moose hunting but mostly they collect closet dust.

These days, the normalization of carrying or owning guns has made the United States for example, one of the most dangerous countries in which to live. “The rate for gun deaths in the United States is 14.24 per 100,000 people, compared to Japan at 0.05 deaths per 100,000. Canada ranked around the middle of the pack at 4.31 gun deaths per 100,000, while England/Wales bottomed out at 0.41 per 100,000.” (Fleuras, p.140) How stupidly normal is this US statistic in comparison. How sadly, stupidly normal.

There appears to be weak correlation between adult homicides and being brought up in a household in which gun safety was stressed and practised. There is a strong correlation however, between povety and guns and homicide, and apparently between untrained police officers and guns and ethnicity (race) and homicide. Guns aren’t stupid. Gun laws may be stupid, and gun owners with drug addictions especially may be really stupid, and trigger-happy police officers who fire on unarmed victims may be really really stupid. You get the idea here.

How does the media play along with this picture? As Fleuras (2001:218) has pointed out, “Violence for the sake of violence no longer has shock value, but simply encourages people to see more without experiencing more…Thus, violence what would by all accounts be a sordid and grisly event is transformed into something relatively painless or of little consequence, even ennobling, thus promoting its usefulness for solving interpersonal problems. Negotiation and compromise tend to be time-consuming and inconclusive; by contrast, violent solutions are clear-cut and unambiguous.” People flock to the cinema or buys DVDs to see violence, mostly of the guns, knives and bombs types. It is ‘normal’ to watch this; it is ‘normal’ to virtually experience death and dying; it is ‘normal’ to kill others for no valid reason. Life is cheap. Gun ownership is obviously cheap.







Aging and Perspective



When I think back about high school years, sporting black hair and only weighing 147 lbs, my perspective on life was to see it as wondrous, hopeful, and exciting. My project time frames were short (as far as next week), and my ideas unpredictable.

After the air force, marriage, and university, my perspective started to change considerably, to embrace mortality as a definite thing, and to accept living on an old farm and driving 47 kms twice a day to work in the city, as the way things were meant to be. The loss of our two children within about 11 years of each other, was not.

Then, in my 50s and 60s, after many jobs and more degrees, and especially after also losing friends to cancer, and my parents to a stroke and pneumonia, life seemed precious. Time began to speed up. Health issues further aggravated this encroaching “carpe deum” philosophy, and I suddenly found myself enjoying conversation like never before. Slowing down in every way was looking better. After all, I had taught university long enough, directed several colleges and departments, written over 40 articles and book chapters, and successfully (with blips) raised two healthy daughters, plus re-marrying 13 years ago.

I still live in the country though, and consult, write and cut grass. And have regular ‘happy hours’ whereby I can take a cold beer or a sherry onto the deck, look out over the river, and converse for hours with our long-time close friends who live with us. Statistically, I have 12.7 years left in this current corpus delecti, and my bucket list might be too long. But I am not caring about being dilatory, or not quick-on-the-board-game-draw; rather, I contemplate my perspective on life in hedonistic and altruistic terms. I like happiness from doing what I like doing, and I enjoy helping others who are struggling. I find I read happy books now, not tragedies or sad biographies. I hug my wife every chance I get, and hug strangers if I feel they need it.

So life perspectives change with time and experience, and the aphorism is true…life is what you make it. Mistakes and all, but keeping upbeat is crucial. At 71, I still want to climb a tree.

Living is dying and dying is living: So what’s the issue?

More body cells die after about age 30 than what are being replenished. So what sense does it make to distinguish dying from a disease and dying from normal aging?

We all die. Some take longer than others if disease is staved off. Whether it’s from an accident, a chronic or acute illness, homicide, war, or suicide, or age-related organ failure – death is inevitable.

Well, the issue of course, is dying prematurely, and the fear and/or grieving associated with it. But it’s also dying maturely, since anticipatory grieving occurs among survivors and the person as well, even if he or she is extremely old. We fear death, our own, and another’s whom we love or admire.

Society-wide fear of death and dying is endemic to all human cultures. The psychological make-up of humans makes loss an emotional experience, and this phenomenon is seen as an evolved survival mechanism. Avoidance of physical and psychological pain is primarily a human trait, although psychological reactions to loss have been attributed to higher order animals as well, as in dolphins, whales, elephants, apes and some birds.

Humans can actually suffer (crying, moaning, sleeplessness, physical distress, bad decisions, etc.) when someone dies. And can suffer or grieve for extended periods. Years, in some cases. Grieving that lasts a long time and interferes with activities of daily living, like work or social routines, may be classified as “complicated” or “pathological” grief. It may require professional intervention. In normal grieving the walls of pain get thinner and further apart with the passage of time, but may never completely go away. Nonetheless, within months from experiencing a loss the survivor usually returns to former daily activities.

The acceptance of death from aging, as part of normal life, may be better tolerated than a sudden, or unexpected loss. Or much more predictably, than the loss of a child. Or than the manner of the loss, as in a homicide or suicide.

The subjectivity of the loss varies depending on time, place, and circumstance. But humans die, however the means. Cellular death, it can be argued, is a form of dying of the whole body, and without restrictions, is seen as “normal”. The dying are still “alive’ until certain criteria are satisfied to declare them officially “dead” (although we also speak of someone suffering a ‘social’ death).

The issue is one of acceptance of death as a part of life, and education can go a long way in facilitating this acceptance.