Is there sexism in lifesaving?

A study reveals a gender bias in intensive care treatment.

Published November 15, 2007 10:10PM (EST)

Want a surefire prescription for dreading old age? Delve into every study that explores the gender gap in medical care. I do it, compulsively, but rarely do I feel like the studies are worth exploring here because they just seem repetitive after a while. Research has shown that women are less likely to receive lipid-lowering medication after a heart attack, less likely to see cardiologists, less likely to be prescribed thrombolytic agents, beta blockers and aspirin after a heart incident, and less likely to be treated for pain ... and so bloody forth. But a new study published yesterday in the Canadian Medical Association Journal was so, well, disturbing, I just had to share.

According to a retrospective study of 24,778 critically ill adults admitted to Ontario hospitals in 2001 and 2002, women over the age of 50 are one-third less likely to be admitted to ICUs, and then once in ICUs are far less likely to received lifesaving medical interventions like mechanical ventilation and pulmonary artery catheterization than their male counterparts. Even when women are admitted to the ICU, they spend less time there (where the nurse-patient ratio is one-to-one) and more time in the hospital overall. The unhappy outcome? The study found that critically ill women were 20 percent more likely to die in the ICU than critically ill men.

The intriguing thing about this study is that it comes closer to gleaning bias in the medical treatment of women. Past studies have noted differences in the treatment of men and women, but it's hard to know to what extent patient behavior and individual diagnosis played into the differences. But since the admission to the ICU is supposed to be a matter of medical necessity, it's a particularly interesting area of inquiry. Still, the origin of the differences in treatment remains a mystery. One of the researchers, Dr. Robert Fowler, told National Post that he suspected bias in treatment springs from healthcare workers viewing elderly women as frail and elderly men as fighters: "You don't hear 'frail' and 'man' in the same sentence nearly as much."

The study didn't try to parse the possible influences: the patient's attitudes toward life-extending procedures and the presence or absence of "do-not-resuscitate" statements, the preferences of family members and the bias of healthcare professionals. This subject cuts deep for me, since I feel like I've watched the medical gender gap play out in my own family. My mother got a lackadaisical response to her heart palpitations only to die a day later, while my father's back pains were met with armies of specialists who diagnosed a heart attack and eventually saved his life. But though I feel like my mother did get inadequate care, I don't feel like it was the only factor against her. Deeper gender biases came into play. She was the one used to being the caretaker and when the roles were reversed and she became sick, neither she nor my father played their parts well. One possible factor that hasn't been explored is the influence of advocacy on healthcare and the possibility that when the shit hits the fibulator, women may have weaker advocates -- either because they've outlived their spouses or their spouses are less accustomed to playing the role of caretaker. No matter why, it's unlikely that, as some of the male Globe and Mail commenters theorize, elderly women would rather die than burden anyone.

By Carol Lloyd

Carol Lloyd is currently at work on a book about the gentrification wars in San Francisco's Mission District.

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