This chapter discusses the role of men in abuse of doctors by doctors. The chapter considers the role of men at all levels including victim, bystander, perpetrator, employer or those within the regulatory and legal systems. The chapter helps us to understand and look beneath the obvious drawing on the evidence of men’s roles at all levels. It also speaks to the potential of men to positively influence for change and prevention of abuse, as well as drawing our attention to possible risks of abuse occurring. It raises our awareness of the ‘not so innocent bystander’ and the significant potential of engaging bystanders, colleagues, and system leaders into positive action.

This chapter has been written by one of the researchers from a qualitative study on sexual harassment in medicine (Louise Stone), a doctor with lived experience of sexual harassment in medicine, Yoo Young (Dominique) Lee, and a third editor, Elizabeth Waldron who is a researcher in psychology, with an interest in gender studies.

Louise Stone is a General Practitioner (family physician) and medical educator with expertise in mental health primary care, teaching, research and policy. She is a qualitative researcher and has been leading the research in sexual harassment in medicine for ten years.

Elizabeth is undertaking PhD studies in psychology at the Australian National University. They have a similar passion for equity and have been responsible for many of the co-ordinating tasks that have made this multicultural and multinational volume possible. All three authors believe deeply in the role of context, which shapes experience and understanding.

Yoo Young (Dominique) Lee is a radiation oncologist in Sydney and a survivor of sexual trauma. Her case is the only successful criminal prosecution of a doctor who has sexual assaulted another doctor. Her case is discussed in the chapter on Law. She has not only supplied the story in these chapters, but she has written the Foreword of this book. Her story was incorporated into our early studies in this area, and her wisdom has been central to our understanding. Her courage is inspiring.

This chapter explores Germany’s legal relationship with European integration, particularly the interplay between the German Constitutional Court (BVerfG) and the European Court of Justice (ECJ). It highlights the tension arising from the ECJ’s constitutional interpretation of European law and the role of the BVerfG in balancing constitutional requirements under the Basic Law. Predominant focus falls on the evolution of the Solange doctrine developed by the BVerfG, which conditionally accepts the ECJ’s primacy based on a theory of structural congruence - ensuring democratic accountability, rule of law, and rights protection in European governance comparable to Germany’s standards. The development of the structural congruence idea, how it came to inform the BVerfG, and its place in historical debates among German legal scholars all fall under the spotlight. It concludes that while the BVerfG has often admonished the ECJ, its critique aims to ensure a cohesive and democratic European constitutional order.

The Roman Empire was rooted in violent acts. The spread of Roman control over the provinces was a lengthy process, but one that fundamentally changed the nature of political relationships. Settlers extruded from Italy. Large amounts of wealth changed hands. Land tenure was reconfigured. The population was divided first into provinces, then into assize districts. Subject populations were registered, counted, and taxed. The process put immense amounts of strain on the internal structures of communities. Roman governors were tasked with administering this new political landscape, where their position was tenuous. They distrusted new local elites who, along with Roman settlers, were prone to take advantage of local people. These same people were also responsible for tax collection, which, along with keeping the peace, was the governor’s ultimate responsibility. This systemic tension opened a space for provincial legalism.

The medical profession, often seen as a bastion of healing, is itself wounded by sexual harassment and abuse. This chapter delves into the experiences of doctors who have suffered sexual trauma, highlighting the silent struggles and complex barriers that prevent them from seeking help.

Survivors often grapple with feelings of shame, fear of retaliation, and a lack of understanding of their own experiences as trauma. The chapter emphasizes the importance of breaking the silence surrounding sexual harassment and abuse in medicine. Survivors can regain agency by understanding and incorporating their trauma into their own personal and professional narrative, as long as they are supported with wise therapists who are able to help them do so. Healing not only benefits individual doctors but also improves the overall culture within the medical profession.

This chapter identifies three distinct benefits of organized sports. Basic benefits are the physical and emotional benefits of sports that flow to all participants. Special benefits are the tangible and intangible rewards that flow only to the winners. Group benefits are the self-esteem and social-status benefits that nonparticipants receive from seeing a member of their group celebrated. The chapter argues that at the recreational and early childhood levels, the values governing the basic benefits of sports should drive eligibility rules and transgender girls should be included. At the elite level of varsity high school and college sports, the values governing special and group benefits should drive eligibility rules and transgender girls should be included, except where transgender athletes dominate the winner’s circle.

Advocacy is a broad term, arising from the Latin word ‘advocare’ meaning ‘coming to the aid of someone’. Implied in this definition is the concept of lending one’s own power to the cause of another. The power to direct the goals of any advocacy effort should remain with the individual or group that will benefit from the advocacy campaign. Advocacy can be misdirected if the voices of the individuals for whom advocacy is sought do not speak, or are not sufficiently heard.

Many of the authors in this book have shared their experiences advocating for change. In this chapter, we will explore how advocacy can occur by examining where within the system advocacy efforts can be directed, the process of planning, implementing and evaluating advocacy, and how an individual can determine where to focus their efforts. We will also draw on examples from various authors, illustrating how and why they undertake their work, and the lessons they have learned through their advocacy journeys.

This chapter offers insight into some of the kinds of positions people can take in their emotional and personal journeys as advocates within medical training. It includes people in different positions in their advocacy journeys, offering their visions for the kinds of changes that need to happen to make a difference to sexual harassment in medicine. May Erlinger writes from her perspective as a medical student, describing the personal and emotional journey of becoming mobilised around sexual harassment in Australia. Becky Cox and Chelcie Jewitt are the co-founders of ‘Surviving in Scrubs’, an online campaign to tackle the problem of sexism, sexual harassment, and sexual assault in the healthcare workforce. They launched Surviving in Scrubs as doctors in training in the UK, giving a voice to women and non-binary survivors in healthcare to raise awareness of the problem, and to demonstrate the diversity of lived experience that needs to be addressed. Louise Stone and Fiona Moir are senior medical educators, who have had senior roles in medical student and GP training in Australia and New Zealand. They discuss the range of roles and challenges they have addressed in managing professionalism, wellbeing and professional identity formation in policy, teaching and leadership.

What can a premodern narrative of legal change teach us? This brief epilogue raises the more complex question of the totalizing ambitions of states that operate from the assumption that law is a specialized practice, rather than something that emerges from daily life. The existence of a black-letter law urges states towards legislation as legal utopianism: the attempt to remake subjects in an optimal fashion and to exclude those they find problematic. This tendency towards utopianism - a form of state magic - is present in both late antique and modern contexts. Understanding the roots of it urges us towards humility with respect to our own projects of legal transformation.

This chapter discusses an integrated and holistic approach to preventing, responding to and managing sexual abuse of doctors, at organisational as well as individual level. Organisational factors which can predispose to abuse are discussed, alongside opportunities to engage in work to prevent abuse. A case study illustrates themes and impacts in cases of abuse, and the holistic lens through which support can be offered. The authors are experienced across the medical career spectrum including the support and case management of a number of doctors in training affected by sexual abuse. This includes organisational level interface with employers, regulatory bodies, health and legal services in relation to matters resulting from sexual abuse of doctors.