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Softening the Sanctuary

  • Elizabeth Dean
    Correspondence
    Requests for reprints should be addressed to Elizabeth Dean, PhD, Faculty of Medicine, University of British Columbia, 2177 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
    Affiliations
    Professor Emeritus, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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      To the Editor:
      There is an alternate perspective to the issue of violence in health care commented on by Adashi and Cohen.

      Adashi EY, Cohen G. Mounting violence in healthcare: is it time to harden the sanctuary? [e-pub ahead of print]. Am J Med. https://doi.org/10.1016/j.amjmed.2022.07.021. Accessed October 15, 2022

      Valuable insight can be gleaned about societal issues and challenges by looking outside one's immediate time frame and examining other contexts.
      The authors’ perspective showed little reflection about the American context and why the United States has become such a violent country, both over time and in relation to other western countries. Among western countries, the United States has by far the highest incarceration rates. Compared with 25 or 50 years ago, what has happened to its people? Why have so many Americans become traumatized, disillusioned, disenfranchised, alienated, angry, and lonely? These attributes are common in those who perpetuate violent acts. These are the relevant questions.
      Rather than “hardening the sanctuary” and making health care facilities more like prisons for employees and patients, the authors’ observations could serve as a navel-gazing opportunity to reflect on the reasons why and how; in partnership with social scientists, Americans could work toward creating a kinder, gentler, calmer, and in turn, safer country, where public institutions such as schools and hospitals are open and accessible rather than places of threat and danger.
      Adashi and Cohen hail from prestigious educational institutions and both are committed to health. Physical and emotional safety are at the core of health. Creating prisons of our public institutions reinforces a sense of threat rather than safety. The suggestion of “hardening the sanctuary” is an oxymoron. This is a short-sighted solution that fails to address the root problem.
      I strongly urge bright minds such as Adashi and Cohen to go back to the drawing board alongside their social scientist colleagues. To look around the world more globally, where violence is not nearly as prevalent as in the United States and where institutions are accessible to the public and consider how might this be recreated in their own country. I challenge the authors and other bright minds to ask the question “why” and figure out ways of addressing the root causes of increasing violence in health care in the United States in the interest of “softening” rather than “hardening” access to our public institutions.

      References

      1. Adashi EY, Cohen G. Mounting violence in healthcare: is it time to harden the sanctuary? [e-pub ahead of print]. Am J Med. https://doi.org/10.1016/j.amjmed.2022.07.021. Accessed October 15, 2022