From Oct. 18 to Oct. 21, Philosophy Professor and Bioethicist Dr. Allison Reiheld attended the American Society for Bioethics and Humanities (ASBH) conference in Washington, D.C., to present her paper, “‘She Walked Out of the Room and Never Came Back’: Is provider refusal to treat transgender patients a legitimate case of conscientious objection or a fundamental betrayal of the patient-provider relationship?”
Reiheld’s new line of research involves the clinical treatment of transgendered individuals, focusing specifically on care that is unrelated to their trans status. This research is not only new for her but also a topic that has only recently received much attention from the Institute of Medicine, whose most recent report about LGBT health had a heavier focus on transgendered individuals than in the past.
In Reiheld’s own research, she has found that transgendered individuals have been largely mistreated in clinical settings often because physicians do not treat them they way they should.
“Twenty percent of transgender individuals have had physicians refuse to provide them care across a variety of different [medical] professions,” says Reiheld. “They’re not just [denied] for hormone therapy or sex reassignment surgeries to help them transition but for basic things, including preventive care.”
Reiheld is specifically examining how transgendered individuals are treated, not for the commonly associated sex reassignment surgeries and hormone therapy, but for common illnesses and injuries like pneumonia or broken bones and for preventative procedures like mammograms or prostate exams.
She began this research when she moved to the St. Louis area, when she became connected to transgendered individuals who opened up to her about their medical experiences.
“Speaking with them raised a number of issues for me. They found out I studied medical ethics, and they would tell me these horror stories,” Reiheld says.
Reiheld has found in her research that discrimination, or fear of discrimination, from doctors has played a large part in the mistreatment of transgendered individuals.
“Somewhere between one third and one half of transgendered individuals in different studies have said that they’ve put off preventive care for fear of being treated discriminatorily,” says Reiheld. “The biggest fear is that they will go to a place, be denied and then they will have to go to another place. They will have to doctor shop until they find someone who will treat them.”
Another fear that she has found has burdened transgendered individuals is that physicians will “treat them, but treat them badly, either clinically badly, as in a lower quality of care, which has been documented to happen sometimes, or just because they’re not trying as hard because they’re nervous about the person’s trans status.”
One reason that physicians may be tense or uncomfortable with treating transgendered patients is because there have not been proper institutional measures to train physicians on how to treat and respect transgendered individuals, save the Veteren’s Administration, who has recently instituted a national policy on transgender cultural competency training.
Transgender cultural competency training involves learning “how to talk to people who are transgender, how to refer to them by the pronoun of their choice, or the name with which they introduce themselves rather than the name on their driver’s license or medical record,” explains Reiheld.
Despite the Veteren’s Administration’s efforts, many other medical institutions have not adopted such policies.
“Only one third of medical schools even teach their students about gender non-conformity at all, in any kind of way, and it’s usually with respect to the procedures that trans patients undergo to transition, like sex reassignment surgery and hormone therapy,” says Reiheld.
While implementing these policies in medical institutions may help lesson the mistreatment of transgendered individuals, many doctors may bring their own personal moral beliefs or prejudices into their practice, which may also interfere with granting equal treatment to all patients. This is called conscientious objection, which is another aspect of Reiheld’s research.
Conscientious objection in the medical field allows doctors to refuse to perform certain procedures due to their morality principles. One classic example is when a Catholic doctor refuses to perform an abortion or assist in fertility measures because it goes against his/her religious beliefs.
Medical conscientious objection can complicate the patient-provider relationship because even if objections are on a “legitimate moral basis, it’s all too easy to do so in a way that disrespects, demeans, and dehumanizes the patient,” Reiheld explains.
Refusing to care for transgendered individuals is not what Reiheld finds is part of the “normal definition” of conscientious objection, as this concept revolves around refusing to perform procedures, whereas transgendered individuals are simply denied basic and preventative care.
While they can refuse to perform procedures, Reiheld has found that doctors cannot “object to providing procedures for certain persons, especially in emergency situations.”
However, it becomes complicated when the situations are not emergencies, and the doctor simply dismisses a transgendered individual seeking general care without technically violating the longstanding rule.
“This is deeply problematic because patients who have had this happen to them–and 20 percent of transgendered people have–or have heard about it–and that’s an even larger number of transgendered people–are much less likely to seek preventive care precisely for fear of the stigma,” says Reiheld.
All of these facts point Reiheld to the main point of her research, which is that when physicians refuse to treat transgendered individuals, the essential relationship between provider and patient has become broken in such a deep way that it is beyond repair.
“This [problem] breaks up the relationship between patient and provider…Not only does it break up that individual, specific patient-provider relationship, but it poisons future patient-provider relationships for that patient in a way that becomes the biggest crux of the moral problem,” Reiheld says.
Upon attending the ASBH conference, Reiheld received much feedback from its attendees, which included a wide array of professionals such as physicians, social workers, psychologists, and historians on her emerging medical topic, and using this feedback, she plans to publish on the clinical treatment of transgendered individuals soon.
Filed Under: Philosophy