What’s Up Doc?: LGBTQ health care

Question: The Supreme Court just ruled that discrimination against LBGTQ individuals is illegal, but the Trump administration just pulled medical rights from this community. Doesn't this violate the law?

Answer: I am not a legal expert, so I will not address the legal question you raise, even though I think it is a good one. But I will address the medical issues.

As I have stated in the past, medical care should be a right for all Americans, not a privilege. Part of this means we need to address the biases and inequity in our medical system. A couple of weeks ago I pointed out that racism is a major public health issue in the U.S. Similarly, prejudice and bias against the LBGTQ community is a major public health issue. The normalization of this prejudice by the present administration is a huge step in the wrong direction. There is a health crisis in the LGBTQ community, similar to how racism is causing a health crisis in communities of color.

The principals of the bioethics of medical practice, some of which are called out in the Hippocratic Oath and the Belmont Report (addressing the ethics of human subject research), include but are not limited to:

Beneficence: clinicians should strive to do what is in the interest of their patient's well-being and wishes Non-maleficence: do no harm Justice: clinicians need to strive to ensure fair distribution of the benefits of medical care to all people Respect: specifically including respecting the values, views, opinions and preferences of the patient Confidentiality, and Veracity Nowhere does it say these only apply if the patient's social, political and religious beliefs happen to align with those of the treating clinician.

The LBGTQ community is a sizable percentage of our neighbors, friends and loved ones. It is estimated that almost 4% of Americans identify as LBGTQ. But this community is already significantly underserved by our country.

It is well known that the LGBTQ community has a higher incidence of multiple medical issues, including certain cancers, cardiovascular disease, substance abuse, depression, anxiety, suicide, being victims of violence and others. Some of these have been linked to poorer medical care and civil rights received, and some of these have been linked to socioeconomic factors; all at least in part driven by social stigma, oppression, discrimination and bias.

The recent Supreme Court ruling relied on the Civil Rights Act of 1964 and concluded that LBGTQ employment discrimination violates this law since it bars discrimination based on race, religion, national origin and sex. Former administrations sought to bring this equality to medical care for all Americans. Section 1557 of the Affordable Care Act prohibits sex discrimination in federally funded health programs, and this has been noted to specifically include discrimination based on gender identity and termination of pregnancy.

There are several actions that need to be taken immediately. First of all, no one, including the LBGTQ community, should be subject to discrimination in access to health care. Bullying in schools, for any reason, needs to be addressed (I have written a column on the negative medical implications of bullying in the past). Programs to support all vulnerable communities, specifically including the LBGTQ community, need to be increased.

Health care is a right of all Americans, as are safe schools and the basic needs to support "life, liberty and the pursuit of happiness."

Let's remind those who govern us of the basic principles on which our country was founded.

Jeff Hersh, Ph.D., M.D., can be reached at [email protected].

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