Although the American Medical Association (AMA) ethics rules prohibit doctors from refusing to provide treatment to a patient based on his or her sexual orientation or gender identity, LGBTQ individuals face numerous healthcare obstacles. Among these obstacles are providers who discriminate or refuse to provide care to LGBTQ patients, or provide care but with a hostile attitude that makes an LGBTQ patient feel unsafe and unwilling to disclose information that could affect healthcare recommendations. Gender identity, in particular, may require a different set of screenings in some circumstances, making it important that a transgender patient feels safe disclosing their transgender status to a doctor.
The federal Affordable Care Act and the Supreme Court’s decision in Obergefell v. Hodges are expected to help improve healthcare access and insurance rates for the LGBTQ community. (The ACA remains in effect at the time of this writing, despite concerns over its future in the current political climate.) If a provider refuses you coverage or treatment based on gender identity or sexual orientation, this amounts to discrimination and you may be able to file a complaint with the Department of Health and Human Services. Some states and cities also have laws to protect LGBTQ patients from discrimination by healthcare providers. In some cases, a state’s Office of Civil Rights can pursue a discrimination claim against a healthcare provider
Advance Directives and Living Wills
Creating an advance directive (also known as a healthcare power of attorney) and a living will can also help you protect your healthcare rights and your gender expression. An advance directive is a legal document that gives your doctors certain orders in case of an emergency and advises doctors of the identity of the person you want to make emergency decisions on your behalf if you are incapacitated. For example, if you slip into a coma during surgery, the advance directive will let your doctors know who can make decisions while you are in a coma. You can choose whoever you want to be the decision-maker, but you should choose someone you trust who knows your wishes.
Hospitals are required to give you information about how to create your advance directive so that it complies with state laws. The rules on these legal documents vary from state to state. Advance directives are particularly significant for LGBTQ patients because without a legal document, healthcare providers may not recognize a partner or spouse as the right decision-maker. In some cases, LGBTQ patients do not want their parents or adult children to be their decision-maker due to estrangement, and the advance directive is the only way to ensure that your romantic partner or spouse will have the authority to advise the doctor.
A living will is a legal document that instructs your doctor on what type of care you want to receive. For example, it can state that you don’t want to be kept alive using a feeding tube or extraordinary measures and would like to simply be allowed to pass away naturally using only comfort measures.
Under federal law, patients have the right to be visited by individuals of their choice at a reasonable time. All spouses and domestic partners are included, regardless of whether they are same sex partners. Hospitals and nursing homes are not permitted to discriminate against visitors based on their sexual orientation, gender identity, or HIV status. If opposite sex partners or cisgender visitors can visit at a particular time, same sex partners and transgender visitors should be entitled to the same privilege. If your hospital or provider doesn’t have a public nondiscrimination policy, it may be appropriate to file a complaint with the Joint Commission, which accredits healthcare providers.
All patients have privacy rights under the Healthcare Insurance Portability and Accountability Act (HIPAA). Privacy can be especially important for transgender patients. If you believe your HIPAA privacy rights have been violated, you can file a complaint with the Department of Health and Human Service.