By Maura Priest
Historically speaking, medical experts have dismissed, downplayed, and doubted, LGBT testimony. Along these lines, it was just a short time ago that the medical community understood LGBT identities as illnesses to be treated and cured. While both societal acceptance of the LGBT community, and also LGBT healthcare, have improved over time, even today scholarly studies show that LGBT patients have warranted fears about medical discrimination. Hence, concern for, and focus centered toward, the treatment of queer patients remains an ethical need. Nothing just said carries much controversy. However, there remains a controversial elephant in the room that poses serious ethical dilemmas for LGBT healthcare.
On the one hand, it does seem that medical professionals trust LGBT testimony more than before. However, we perhaps should worry that this trust extends only insofar as LGBT patients are making decisions that the medical community deems reasonable, relatable, or simply decisions that avoid the label “extreme.” We might even worry that what the medical community deems reasonable aligns much too closely with popular social sentiments.
Members of the LGBT community are ever aware that not everyone “approves” of their sexual orientation and/or gender identity; they are aware that this lack of approval all too often results in unjustified discrimination. When entering healthcare facilities, LGBT patients must trust that the standards are different, i.e., that they will be shown the same respect, and that their words will be taken as seriously, as cisgender and heterosexual patients. Without this assurance, fear of stigmatization might result in care avoidance (seeking limited care, or not any care at all.)
Let us consider a hypothetical example involving a non-binary identified patient, “Chicago.” Imagine that Chicago started puberty-blocking treatment at 12, and at 19, decides that they would like to continue this indefinitely (this is sometimes called “on going puberty suppression,” or “OPS.”) Chicago is aware of OPS’s (not so extreme) risks, and they are confident that physically conforming to their identity is, (1) essential to their well-being, and, (2) justifies the relatively minor physical risks.
In the case just described, we can imagine some, perhaps many, physicians approving OPS for Chicago without ethical qualms. After all, respecting autonomy means respecting choice. Moreover, the minor risks posed by OPS means that physicians can safely avoid accusations of “doing harm”. OPS is also promoting Chicago’s good (beneficence) by promoting comfort with their non-binary identity.
Ethical scholars have analyzed cases like the one just described, and some bioethicists confidently defend physicians’ approving and administrating OPS in all similar scenarios. However, here is a twist: let’s change the risk picture. Imagine that instead of minor or unclear physical risks, imagine that OPS had a well-documented 90% risk of osteoporosis. Suppose that Chicago, like before, fully understands the risks. And like before, Chicago insists that OPS is necessary for their wellness. Does the osteopetrosis risk justify changes in how physicians should respond? For example, does this risk justify a physician refusing treatment? Some might think so; after all, the odds of causing (physical) harm are high. Notwithstanding, if physicians are truly trusting patient testimony, different treatment is difficult to justify. In both examples, Chicago is communicating the importance of OPS in helping them feel comfortable in their non-binary identity. Assume that in both cases, Chicago had previously been judged capable of making rational, autonomous decisions. And in both cases, Chicago is confident the benefits of OPS justify the risks.
There is nothing that makes it impossible that Chicago might sincerely decide that the comfort from OPS is worth osteoporosis. This might not be something that physicians would choose themselves, nor even something that they can fully understand. However, this choice might be exactly what aligns with an LGBT patient’s personal values (which are the values of an autonomous, rational, adult,).
Regardless of whether a preference like Chicago’s (in the second example) might seem unusual, we must remember that judging norm deviant preferences as ‘misguided’ (without further reason) is intellectually suspect and violates patients’ right to autonomy. We must not be rash in deeming norm-deviant decisions, behaviors, and values as uninformed or unreasonable. Homosexual orientation and trans-identities are also norm deviant. Disbelief directed toward queer persons who prioritize identify-affirming treatment over main-stream conceptions of wellness is not only unfounded disbelief, it is disbelief that threatens the relationship between the LGBT community and medical professionals.
Paper title: LGBT testimony and the limits of trust
Author: Maura Priest
Affiliations: Department of Philosophy, Arizona State University and CONCEPT -Cologne Center for Contemporary Epistemology and the Kantian Tradition, University of Cologne.
Competing interests: The author has no competing interests to declare.