This chapter defines sexual harassment and its key targets and perpetrators to argue that their attitudes and beliefs are the anthesis of medical values and principles – to do not harm. It identifies the costs to the organisations of this sexual harassment and abuse. Adopting a preventative medicine framework we extend the scale and focus of prior work to consider evidence-based SHA interventions. We aim to advance current understanding about SHA and its detection, deterrence and amelioration within the health workforce through a multi-level and multi-stage SHA prevention strategy that collectively impacts up- and down-stream changes for this workforce and their workplaces. We outline five levels at which awareness raising, education and intervention is required – to include primordial, primary, secondary, tertiary, and quaternary.

This chapter describes the role of medical regulators including the history of the International Association of Medical Regulatory Authorities (IAMRA). It highlights the common key processes of medical regulation agencies internationally and the standards of practice that are relevant to sexual harassment and abuse of doctors by doctors.

Examples of regulatory standards specifically relevant to sexual harassment and abuse of are drawn from the regulatory frameworks of several different countries illustrating the range which varies from specifically condemning sexual harassment to more generic requirements for good behaviour, productive and respectful collegiality and being aware of power imbalances.

In the final section the author documents typical regulatory processes that occur on receipt of a complaint of sexual harassment or abuse by a doctor as well as the range of responses that may occur if an adverse finding is made against a doctor. The advantage of involving medical regulators is that it allows communication about concern regarding perpetrators found to have failed the standard between jurisdictions and between specific clinical settings.

Provincial governance was never of great interest to Roman administrators or jurists. This begins to change only when jurists increasingly became administrators exposed to provincial claim. Jurists had to begin thinking about provincial contexts as raising important questions of governance - in particular, that key assumptions about law might be different in a world marked by extractive governance. Key among these is the late second/early third century jurist Ulpian of Tyre. Ulpian begins the process of transforming governance from an array of untheorized practices into something amenable to traditional juristic analysis. As a successful administrator, he did this knowing that such an account was otherwise lacking. His magnum opus, On the Office of the Proconsul, can be seen as an attempt to capture what was distinctly provincial about provincial governance. But Ulpian’s key text can also be read as a response to the challenge of provincial legalism.

Criminal punishment captured the imagination. It was a violent process, staged deliberately by the state to demonstrate certain truths about state power. However, these public scenes were susceptible to rewriting by provincial subjects. These subjects fixated on state attempts to define truth by means of judicial violence. Subjects insisted that violence be conditioned on its respect for provincial logos - rational discussions about the nature of any particular act of state violence. They emphasized that the courtroom (rather than the archive) was the most important locus for determining the content of laws and the boundaries of state power and insisted that the courtroom be a space not just for punishment, but communication. Most prolific on this point are early Christian writings about martyrs, which emphasized what they claimed was the Roman state’s incapacity to rationally defend the persecution of Christians. It is found among Jews and pagans as well.

The question of whether transgender girls should be permitted to participate in girls’ sports has been one of the most politically contested and socially controversial of the last decade. Neither law nor medicine provides definitive answers. This book takes on the absolutist positions staked out by both the left and the right and argues in favor of a more nuanced framework that seeks to ensure all girls and boys –both transgender and cisgender – have access to the benefits of organized sports.

This chapter examines the arguments for transgender girls’ exclusion from girls’ sports that have dominated right-leaning public and political discourse. The chapter articulates the argument for exclusion based on fairness and contends that it cannot justify total exclusion of transgender girls from girls’ sports at every age and level. The chapter next uncovers the claims about human flourishing and personal dignity that also motivate arguments for exclusion and argues that such claims are too empirically dubious and normatively controversial to drive policy decisions.

This chapter turns to the elite reaction to broader provincial claims about legality. Rather than putting the courtroom at the center of their legal imaginary, Greek elites reimagined themselves as transcending normal administrative processes. Through their physical self-presentation, through their beautiful speech, and through their ability to create particular affective states in their interlocutors, they sought to achieve thauma: a state of amazement that obviated the need for legal judgment. The Greek rhetoric of the "Second Sophistic" is, on this reading, a sort of anti-legalism: by replacing legal judgment with aesthetic evaluation, elites attempted to preserve their positions - and their physical bodies - from degradation and punishment.

This chapter is the collaborative effort of three Pakistani doctors, all of whom have worked extensively in their home country. Dr Hina is a general practitioner in the UK and clinician and academic in Pakistan. Dr Tehzeeb, a public health specialist, is currently a research fellow and senior lecturer at the Australian National University. Dr. Humaira is a UK-trained general practitioner and educator at Peshawar Medical College, Pakistan.

This case study presents the experience of an anonymous doctor employed at a prominent tertiary care hospital in Pakistan’s capital city. The study, which gained attention in local media, sheds light on how a female trainee overcame significant obstacles and navigated a system influenced by powerful individuals to achieve justice. Unfortunately, not all individuals facing similar circumstances are as fortunate. Additionally, the study underscores the societal and psychological challenges that female doctors encounter when seeking redress for workplace sexual harassment. Understanding this case is crucial for recognizing the need to enhance systemic support for reporting and addressing sexual harassment cases. In Pakistan, addressing this challenge is vital to safeguarding female healthcare workers.

Sexual harassment in medicine is a common, global problem hiding in plain sight. (1–3) It is difficult to detect, measure and eradicate, (4; 5) partly because there is a complex web of medical organisations involved in managing the doctors involved. Multiple organisations are responsible for responding to harassment, but individual policies and processes are often opaque, complex and partial. (6) Survivors describe reporting mechanisms that are difficult to navigate, and many survivors experience considerable harm arising from the reporting process. (6; 7) Few feel there was significant benefit to reporting sexual harm. (8)

At the start of this book, we wanted to ensure that readers have the opportunity to familiarise themselves with current thinking about sexual harassment, gender in medicine, and the historical context of sexual harm and its prevention, regulation and management. We are aware that readers will come to this book with particular learning needs and particular areas of expertise. We are expecting that some readers will be survivors; others will have policy responsibilities for managing sexual harms in the workplace or responsibilities. Some may have advocacy roles in teaching, research or policy, and many will come from other disciplines or contexts different to our own.

There are no natural or neutral eligibility rules for girls’ sports. All rules say something about who and what society values. Courts and policymakers will ultimately need to decide how eligibility rules should or must be drawn. In answering these questions, they will need to decide what the social goal of sex-segregated sports is, and which eligibility rules best serve this end. This book started from the premise that transgender and cisgender girls are entitled to equal concern and respect. It then offered a pragmatic and workable framework for optimizing individual and group benefits of sports for both transgender and cisgender girls.