Wednesday, July 8, 2015

ACP and the “LGBT Agenda”

When ACP came out with its position paper on access to healthcare for Lesbian, gay, bisexual, and transgender (LGBT) persons, published online by the Annals of Internal Medicine on May 12, we knew that some of our recommendations would be controversial.  Our call for civil marriage rights for same-sex couples, our opposition to conversion,” “reorientation,” or “reparative” therapy for the “treatment” of LGBT persons, our advocacy for health insurance coverage of comprehensive transgender healthcare services, and our view that the definition of “family” should be inclusive of those who maintain an ongoing emotional relationship with a person, regardless of their legal or biological relationship, were among the recommendations that we anticipated would generate objections, including from some segments of the ACP membership.

And, as we expected, we have since heard from a dozen or so ACP members who have taken issue with the paper.  (We have also heard from many members who applauded it).  Some of those who objected said that ACP shouldn’t be involved in “political” issues.  Some said they knew of patients, friends and colleagues who benefited from “reparative” or “conversion” therapies. Some cited their own religious beliefs in explaining why they object to same-sex civil marriage and the College’s support for it.  And although the Supreme Court just a few weeks later validated our view that same-sex couples should have the same civil marriage rights as heterosexual couples, a decision we applauded, the ruling has hardly settled the controversy, with many conservative states now considering laws to exempt people with religious or personal objections from providing services to same sex married couples.

ACP respects the sincerity of those who differ with us on religious or other grounds.  Yet at the same time, we remain firmly committed to our advocacy for policies that the evidence shows are necessary and appropriate for reducing healthcare disparities for LGBT persons, as we have done for other patient populations that have been discriminated against because of race, ethnicity, or gender. Our paper references studies and other  evidence-based sources that support the recommendations made in our paper, including that denial of same-sex marriage rights can result in “ongoing physical and psychological health issues” for LGBT persons, that  same-sex marriage bans (now found to be unconstitutional) result in “increases in general anxiety, mood disorders, and alcohol abuse”, that “the denial of marriage rights to LGBT persons has also been found to reinforce stigmas of the LGBT population that may undermine health and social factors, which can affect young adults,” that  “all major medical and mental health organizations do not consider homosexuality as an illness but as a variation of human sexuality, and they denounce the practice of reparative therapy for treatment of LGBT persons” and that reparative therapies “may actually cause emotional or physical harm to LGBT individuals, particularly adolescents or young persons.”

Several of the ACP members who object to our recommendations said that we were promoting what they called “the LGBT agenda.”  I’ve been thinking a lot about that, because I am not sure what the “LGBT agenda” even means.  But if it means that ACP is advocating for public policies to ensure that lesbian, gay, bisexual and transgender persons have the same civil marriage rights and legal protections as everyone else, that they can visit the hospital and make decisions for an incapacitated spouse, that they are not pressured into “therapies” that are premised on the wholly disproven idea that their sexuality and gender identity is “abnormal” and in need of treatment, that they should not be harassed or discriminated against and denied healthcare services and insurance benefits because of who they are, well then, we are guilty as charged, and proud of it.

Today’s question:  What do you think of the concerns expressed by some ACP members about the College’s recommendations on LGBT access to healthcare, and specifically, the idea that we are promoting an “LGBT agenda”?

1 comment :

Jay Larson MD said...

Time for some members to wake up and smell the professionalism. According to the ACP manual on ethics 6th edition:
"Physicians should help the community and policymakers recognize and address the social and environmental causes of disease, including human rights concerns, discrimination, poverty, and violence. They should work toward ensuring access to health care for all persons; act to eliminate discrimination in health care; and help correct deficiencies in the availability, accessibility, and quality of health services, including mental health services, in the community. The denial of appropriate care to a class of patients for any reason is unethical."
LGBT persons should have all the rights and responsibilities as any one else in our society.