In writing this chapter, we realise we have not produced the evidence-based guideline that many would want to see. We remember approaching a senior bureaucrat in Australia and describing what we have tried to achieve. ‘I hope it provides solutions’, she said, ‘and isn’t just another collection of complaints’. While the book is not a ‘collection of complaints’, we have not attempted to provide a solution-focused manual. In the Introduction, we wrote that this book is not a reckoning. It is also not a protocol to support specific action. The reason is simple. We do not believe there is one solution that is universally relevant.

Sexual harassment not only harms survivors; it also has impacts on the team, the organisation and the profession. Harms can include changes in the way teams and individuals interact, which can have a direct impact on the quality of patient care. It can mean survivors and witnesses are less able to be empathic and interpersonally aware, as they are focussed on defensive and protective behaviours. Sexual harassment by a senior colleague changes the way survivors and bystanders see their profession, and this can cause long-lasting harm in their own practice. Many survivors leave or change their workplace, causing workforce deficits and loss of experience and skills. Those survivors who live with intersectional disprivilege provide critical diversity in teams that need to manage a breadth of patient experience. Unfortunately, they are at higher risk of sexual harassment, and so are more likely to leave, restricting the profession’s capacity to respond to community needs across the breadth of the population. The cost is a drop in the capacity of the organisation to provide quality care.

This chapter is authored by Parisa Pakdel, who holds an M.A. in Sociology from Beheshti University in Iran. The chapter focuses on women’s issues, particularly the prevalence of sexual harassment in workplaces. Pakdel delves into the sociological dimensions of sexual harassment experienced by women employees in Tehran hospitals, drawing on extensive sociological research to provide a nuanced examination of its prevalence and dynamics within these healthcare settings. The chapter includes detailed case studies of two victims who endured harassment during their tenure. It underscores the repercussions of inadequate legal safeguards against workplace harassment and sheds light on how organizational frameworks can inadvertently facilitate such misconduct. Furthermore, it explores the challenges victims face in reporting harassment incidents and advocates for systemic reforms aimed at fostering safer and more supportive environments within healthcare settings.

One is not born, but rather becomes, a woman doctor. This chapter addresses medicine itself as a highly gendered institution, constructed around hegemonic masculinity. How a woman learns to perform gender as it is expected for a doctor involves a complex negotiation regarding her body. She must be both present in and absent from her body - one of the many features placing women doctors at increased sexual risk in the workplace. The chapter delves into the historical context of these challenges and their contemporary implications, highlighting the need for continued efforts to promote gender equity in the medical profession.

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.

Relative clauses are generally introduced in the archaic Indo-European languages by a relative pronoun. In some languages, this pronoun is descended from a form *kwí-/*kwó-, while in others it is descended from a form *yó-. This chapter surveys the syntactic and semantic behaviour of the descendants of these pronouns in the attested languages. This includes a discussion of both their relative and non-relative uses. The author concludes that neither *kwí-/*kwó- nor *yó- can be excluded as a relative pronoun in Proto-Indo- European, and that together they reflect what was a unitary syntactic category in the proto-language: *REL.

This chapter reconstructs some principal features of relative clause syntax in Proto-Indo-European. Following the methodology outlined in Chapter 2, it pays close attention to the behaviour of the reconstructed relative pronoun, *REL (Chapter 4), and its position in the PIE left periphery (Chapter 5). Moving away from *REL, it then turns to the more general structures of, and relations between, ‘plain’ relative and correlative clauses in PIE. The chapter is rounded off by a discussion regarding the semantic types of relative clauses in PIE and their syntactic form.

Introduction

The climate crisis demands that we confront the economic models and modes of production that have led us to this precipice of destruction. The concept of climate justice takes into account ‘a variety of interrelated concerns – for the inequitable impact [the climate crisis] has on a range of already vulnerable communities, for participation and procedural justice, for the basic functioning and provision of needs in vulnerable communities, including ecological communities … [for] inclusion, transparency, compensation, and sustainability’ (Schlosberg and Collins 2015).

Applying a climate justice lens therefore requires us to look at the myriad impacts that extractive economic models have on the climate, the environment, and communities’ rights, safety, and wellbeing.

While much of the critique of extractive development has been (appropriately) focused on the extraction of fossil fuels, it is essential to also consider agriculture. In its current extractivist and industrial form, agriculture accounts for an estimated 22 per cent to 23 per cent of global greenhouse gas (GHG) emissions (IPCC 2023, IPCC 2019). Industrial agriculture is also a significant contributor to the interrelated ecological crises of soil depletion, loss of biodiversity, loss of pollination, and destruction of the global water supply (Shiva 2016). Furthermore, as demonstrated in the case studies explored in this chapter, extractivist agriculture has been rooted in cycles of land grabbing and violence against local communities.

As Oxfam (2016) explains, ‘large-scale monoculture investments seek fertile land with good transport connections. In many places, this means displacing peasant, indigenous and Afro-descendant communities, depriving them of their traditional livelihoods.’

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)

Introduction

For at least two centuries, major development has integrated the island of Borneo into the international market upon which a contested socio-ecological process set forth. Evidence reveals that the increasingly global market, operating through colonial contexts, infiltrated Borneo's economy by exploiting forest products, mineral resources, and essential commodities (Phillips 2016). At issue is the suppression of ‘native’ life by controlling the population, the imposition of economic monopoly, and the exclusion of these resources. This brutal marginalization is still ongoing and marks a colonial legacy, suppressing the rights of indigenous communities.

For example, the current extractivist and modern plantation models have been shown to be racially discriminatory, as evidenced by colonial agrarian policies that have disregarded the rights of indigenous peoples and sought to assert European control over their traditional territories (McCarthy and Camb 2009). The ideas presented in this chapter are informed by my research on indigenous climate justice adaptation in Borneo. As marginalization intersects with other environmental crises occurring at the local level, this chapter focuses on how the spiritual and disenchanted perspectives of the Dayak people remain relevant to ongoing crises and injustices within the context of climate change and the global political–economic system. The United Nations Department of Economic and Social Affairs has indicated that indigenous communities exhibit a minimal level of responsibility for climate change, while simultaneously experiencing the most severe consequences of its associated hazards (United Nations Department of Economic and Social Affairs n.d.).

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.

Introduction

The United Nations Framework Convention on Climate Change (UNFCCC), signed in 1992, brings together countries in a worldwide commitment to contain global warming. With the Paris Agreement, signed in 2015, this commitment is renewed and takes on an emergency character, challenging the legal field to think of strategies that establish, in the connection of national and international spaces, the duty to act to guarantee the continuity of all forms of life on the planet. The transformations required on an emergency basis to contain the advance of global warming are structural and lead to the need to rethink the entire production process. The context used in this chapter portrays Brazilian rural development in the face of the climate emergency.

In agricultural production, there is a clear contradiction between the emergence of climate change and the continued exploitation of export-oriented monocultures, known as agribusiness. The history of the word ‘agribusiness’ began in the 1940s at the Harvard Business School, with Donald K. Davis and the intention of creating a disciplinary area of studies on agriculture and business, based on liberalism and aimed at reducing the role of the state in regulation and opening up to private initiative (Pompeia 2021, 43–46). The expression appeared in the Brazilian public arena between the 1950s and 1960s (Pompeia 2021, 87). This period was marked by the debate between conservative and progressive forces about development and was interrupted by the military coup of 1964 (Pompeia 2021, 90).