Question: The Supreme Court has just decided that discrimination against LBGTQ people is illegal, but the Trump administration has just withdrawn medical rights from this community. Doesn’t this violate the law?
Answer: I am not a legal expert, so I will not answer the legal question you raise, even if I think it is a good question. But I will address the medical issues.
As I have said in the past, medical care should be a right for all Americans, not a privilege. This means in part that we must fight against the biases and inequalities of our medical system. A few weeks ago, I pointed out that racism is a major public health problem in the United States. Likewise, prejudice and prejudice against the LBGTQ community is a major public health problem. The normalization of this prejudice by the current administration is a big step in the wrong direction. There is a health crisis in the LGBTQ community, similar to the way racism causes a health crisis in communities of color.
The principles of bioethics in medical practice, some of which are set out in the Hippocratic Oath and the Belmont Report (dealing with the ethics of research in human subjects), include, but are not limited to:
Beneficence: clinicians should strive to do what is in the best interests of their patients’ well-being and wishes Non-maleficence: do no harm Justice: clinicians should strive to ensure equitable distribution of benefits medical care for all individuals Respect: including respecting patient values, opinions, opinions and preferences Confidentiality and truthfulness
Nowhere does this say that it only applies if the patient’s social, political and religious beliefs are aligned with those of the treating clinician.
The LBGTQ community is a considerable percentage of our neighbors, friends and relatives. It is estimated that almost 4% of Americans identify themselves as LBGTQ. But this community is already largely underserved by our country.
It is well known that the LGBTQ community has a higher incidence of multiple medical conditions, including certain cancers, cardiovascular disease, addiction, depression, anxiety, suicide, victims of violence and others. Some of them have been linked to poorer medical care and civil rights, and some have been linked to socio-economic factors; at least in part because of social stigma, oppression, discrimination and prejudice.
The recent decision of the Supreme Court was based on the Civil Rights Law of 1964 and concluded that discrimination in employment LBGTQ violates this law because it prohibits discrimination based on race, religion, origin national and gender. The old administrations sought to bring this equality to medical care for all Americans. Section 1557 of the Affordable Care Act prohibits discrimination based on sex in federally funded health programs, and this was noted to specifically include discrimination based on gender identity and interruption of pregnancy.
Several actions must be taken immediately. First, no one, including the LBGTQ community, should be discriminated against in access to health care. Bullying in schools, for whatever reason, needs to be addressed (I wrote a column on the negative medical implications of bullying in the past). Programs aimed at supporting all vulnerable communities, particularly the LBGTQ community, must be strengthened.
Health care is a right for all Americans, as are safe schools and the basic needs to support “life, freedom and the pursuit of happiness”.
Let us remind those who govern us of the basic principles on which our country was founded.
Jeff Hersh, Ph.D., MD, can be contacted at [email protected]
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