M5 Maintaining professional Boundaries and Institutional Self-Regulation

Review of Previous Discussions

Ethical Space, Universal Design, Lived Space Theory

Lefebvrian Model of Space

Concept Space: What is imagined or thought (e.g. the ideal classroom, healthcare facility)

Perceived Space: What is seen from outside, visual representations, or the material setup

Lived Space: The embodied experience of being in a space and receiving services (e.g., online classroom for KPE400)

Ethical Dilemmas in Healthcare Access

Political Cartoon: Hockey payer jumping an MRI queue

What does it mean?:

• Power Dynamics: Exemplifies how power operates in space (professional athletes may receive priority over others)

• Inequality: Healthcare not experienced equally; money and status influence access

• Pain Assessment: Nurses/staff often ask about pain severity (scale 1-10), but patient reports (e.g. 9,10) don’t always guarantee immediate access, depending on hospital business and staff assessment

• Structural Barriers:

  • Long wait times in Toronto emergency rooms (e.g. prof experienced 10 PM arrival; treatment at ~5-6 AM; 12-14 hours of waiting)

  • Significantly longer wait times in rural/semi-urban areas

  • Extended waits for specialized treatments (e.g. 6 months for an MRI, 5-6 months for a sleep test)

  • The system often lacks ethical and equitable solutions, making ethical space elusive

Government Regulations and Pandemic Impacts

Case Study: Governments’ response to COVID-19 highlights unequal impacts. e.g. Service Canada unemployment claims during the pandemic

• Categorization: Essential vs non-essential services affected populations differently

• Discrimination: Vaccination initially targeted affluent, non-racialized groups, with racialized groups receiving it alter

• Differential Impact: Government regulations impacted economic stability, social interaction, and access to services unequally

• Isolation: Home became a burdensome space for many due to isolation and pre-existing family tensions

• Delayed Process: Passport and citizenship applications were delayed

• Digital Exclusion: Lack of technology access or digital literacy excluded some from key online government services (e.g. passport, license, transit)

• Social Skills: Observed decrease in social skills (eye contact, spontaneous conversation). Although the prof did have some caveats to say on that

• Education: Significant educational disruption for students (e.g. online classes, leading to even more delays)

Public Space Regulation

Spaces are regulated

• Toronto Parks: Regulated behaviours (e.g. pilot program allowing beer in certain parks)

• University Campus: Regulation of protests (e.g. Palestinian support encampment) with issues of permission, police involvement, evacuation

• Recreational Spaces: Inequitable distribution of resources and access (e.g. limited soccer field time for large international student populations, while other sports like rugby get dedicated time)

• Historical Context: Indigenous land on Turtle Island decreased from 97.2% to 0.2% by 1655 to present, demonstrating the profound ethical connotation of space

Universal Design

A design approach that aims to create a space that’s accessible and usable by all people to the greatest extent possible, without the need for adaptation

• Considers multi-dimensional perspectives

if a universally designed space meets the needs of the most vulnerable, it subsequently becomes accessible for those with lesser needs

Universal Design Principles

1. Equitable

2. Flexibility in Use

3. Simple and Intuitive

4. Perceptible Information

5. Tolerance for Error

6. Low Physical Effort

7. Size and Space Appropriate

Equitable

Accessible regardless of community or economic group

Flexibility in Use

Multipurpose spaces (e.g. ice rinks used for cricket by South Asian communities)

Simple and Intuitive Use

Easy to understand regardless of experience, knowledge, or language

Perceptible Information

Information is communicated effectively to all users

Tolerance for Error

In the case of accidental actions, hazards and adverse consequences are minimized

Low Physical Effort

Can be used efficiently and comfortably with a minimum of fatigue

Size and Space Appropriate

Appropriate space for approach, reach, manipulation, and use regardless of user’s of size, posture, mobility

Universal Design Process

Involves embedding stakeholder information and testing prototypes before widespread implementation

Willie Ermine Ethical Space

A space that is honest, accessible, directed, intentional, theoretically and experientially informed, and well-designed

• Aims to reduce power imbalances which are inherent in any space

Case: Bangladeshi community playing cricket in vacant baseball diamonds at a park, leading to law enforcement intervention

Sports as an Ethical Space

Coach-athlete relationships are classic examples of unequal power dynamics

• Structural Factors: Coaches hold significant, often unquestioned power due to win-at-all cost mentality and parental trust

• Cultural Factors: Athletes (especially from low-income groups) often rely on sports for social mobility, making them vulnerable to abuse due to fear of losing their position

Ethical Space Outcomes

1. Disrupting Colonial/Neoliberal Values

2. Exclusivity

3. Design

Disrupting Colonial/Neoliberal Values

Ethical space can challenge dominant narratives (e.g. problematizing obesity as a disease, which can lead to mental trauma)

Exclusivity

While some ethical spaces (e.g. country clubs, gay bars) can be empowering for certain groups, they may exclude others (gender, sexuality)

Design

Follows from thoughtful boundaries and intentional designs that express desired values, incorporating personal subjective experiences

Hegemonic Norms

Values, beliefs, and practices imposed by a ruling class that dominate society (e.g. Christian holidays as recognized religious holidays in Canada)

Hegemonic Structure

Ruling class constructs and maintains power through negotiation of domination and consent (e.g. universities, International Olympic Committee, hospitals, FIFA)

Hegemony in FIFA

FIFA World Cup in Toronto:

• Prioritization of hosting six matches led to clearing spaces used by homeless people near BMO Field, without addressing their displacement

• Raises questions about who is prioritized and who is excluded

Hegemony and Agency and Resistance

Crucial for challenging existing inequality and promoting social justice

Microaggression

Subtle, indirect, or unintentional expressions of prejudice. They make spaces unethical

Microaggression Types

1. Microassault

2. Microinsult

3. Microinvalidation

4. Epistemic Microaggression

5. Emotional Violence

6. Existential Violence

Microassault

Explicit, verbal, or non-verbal attack meant to hurt (e.g. name-calling, avoidance, discriminatory action)

Microinsult

Non-verbal expression demeaning a person’s identity (e.g. facial expressions, body langauge)

Microinvalidatoin

Negating or nullifying a person’s thoughts, feelings, or reality (e.g. “Where are you really from”)

Epistemic Microaggressoin

Ignoring a patient’s knowledge about their own body or stories in healthcare settings; making patients doubt their judgment

Emotional Violence

Ignoring patient’s emotions, gaslighting (labeling static behaviour as “crazy”)

Existential Violence

Ignoring significance of illness or identity through gestures/words; treating illness as a number rather than a person

Micro Supports

Intentional communication and actions to elevate situations and promote inclusion

Micro Support Types

1. Intentional Communication

2. Promoting Inclusion

3. Validation

Intentional Communication

Providing feedback, giving compliments

Promoting Inclusion

Showing respect, admiring certain people with a focus on identity

Validation

Appreciating and acknowledging others’ feelings; a simple smile can make invisible individuals feel acknowledged and safe

Microaggression Student Experiences

Microaggressions often experienced based on social identities (e.g. gender, race, religion, language, economic class)

• Stereotypes exist against both racialized and non-racialized individuals (e.g. assuming all white people are rich, all Asian students are smart)

Hockey Coach Mike Gilbert and Microaggressions

Case: Coach Mike Gilbert boycotted a match because his diverse team (14 of 16 players South Asian) experienced racist slurs

Outcome: Gilbert suspended for 30 days and his contract was not renewed (officially, for team performance, not the boycott) The opposition denied allegations

Issue: Demonstrates that resistance to hegemonic practices, even when creating a safe space, can lead to negative consequences for those challenging the status quo

Space Analysis

Space is a product, reflection, and enactment of values; it communicates accessibility, exclusion, and power dynamics

• Goal is to understand, analyze, and reimagine/reconstruct space to be more equitable, accessible, honest, ethical, and culturally informed

Funding Allocations and Power Dynamics

Police Funding: Enormous amounts are invested in police services (e.g. NYPD is the 20th best-funded army globally; Toronto allocates the highest budget to police services, while other areas like children’s services and housing receive minimal funding)

Ineffectiveness: High police spending does not guarantee safety (e.g. Toronto subway stations remain unsafe despite high allocation)

Narrative Control: Powerful institutions (media, state, politicians, corporations) control narratives, maintain the status quo, and deny inequities. Investigations are often led by the same departments, creating conflicts on interest

EDI: Critical for challenging marginalization by placing marginalized people in positions of power to break existing barriers

Response to Unfairness: Powerful institutions often resort to military force, while communities mobilize through peaceful demonstrations and collective pressure

Austin et al. Ethical Boundaries in Professional Relationships

Boundary Metaphor (Austin et al.): Can be problematic as it may diminish humanness and therapeutic effectiveness in care-based relationships

Boundary Crossing: Differs from boundary violation; not harmful or exploitative, potentially therapeutic (e.g. a nurse taking a patient for a walk). However, unregulated crossings can precede violations

Austin et al. Alternative Metaphors

Highway: Therapy as a journey, with guidelines to help professionals navigate service delivery

Beach: Building therapeutic connection, an approach where practitioners and patients form a relationship that, if unregulated, has potential for harm

Territory (Preferred): Emphasizes mutuality of therapy, where both parties are aware of rights/needs and accountable for actions, balancing empathy and boundaries in healthcare

Institutional Self-Regulation and Professional Boundaries

Case: Coach Dave Scott Thomas, despite clear allegations of sexual, mental, and physical abuse, retained his job for 13 years at the university due to his success (bringing money, producing Olympic athletes)

Issue: Highlights how hegemonic structures and focus on win-at-all-costs can produce power imbalances and abuse

Application of Feminist Theory:

• Centralizes Women: Focuses on “herstory” (e.g. Megan Brown’s case) rather than the male produced “history”

• Multi-Dimensional perspective: Examines social, emotional, biological, and physical experiences of women in society

• Challenges Patriarchy: Addresses powerlessness, oppression, ignored claims, and labeling of rebellious women (e.g. “crazy Megan Brown”) in a male-dominated society where women lack equal pay and leadership

Ethical Space Creation

Requires balancing professional boundaries with institutional self-regulation to prevent inequitable or unsafe environments

Addressing Levels:

1. Structural: Create equitable institutions through impactful policy

2. Professional: Nurture the human aspect in health services beyond deontological (duty-based) ethics, humanizing patients from neoliberal considerations

3. Individual: Health practitioners must navigate boundaries, moral compass, and human obligations in service delivery