XPost: alt.gossip.celebrities, alt.politics.democrats.d, sac.general   
   XPost: alt.rush-limbaugh   
   From: queers@alate.com   
      
   This post is part of Outward, Slate’s home for coverage of LGBTQ   
   life, thought, and culture. Read more here.   
      
   If you were hospitalized for a severe illness, would you trust   
   the ICU doctors with access to your complete medical history? In   
   theory, of course, all of us should feel able to answer yes.   
   Doctors need complete, accurate information about a patient’s   
   history to make the best possible decisions about that patient’s   
   care. But what if stigmatizing info in some charts led them to   
   deprioritize the patient because they do not value some aspect   
   of that person’s identity? For transgender patients, as well as   
   patients with other stigmatizing information in their medical   
   pasts, there’s reason to fear that an accurate medical history   
   could lead to worse treatment, not better. In fact, just this   
   week, the Trump administration’s health department is apparently   
   moving to finalize a rule that would roll back Obama-era   
   protections on LGBTQ discrimination in health care settings. In   
   the midst of the coronavirus pandemic, this has me thinking dark   
   thoughts about what I would, and would not, want a doctor   
   treating me for COVID-19 to know.   
      
   As a trans person, I’ve experienced medical discrimination   
   firsthand. After a recent move, I struggled to find a doctor   
   willing to prescribe the hormone treatments I’d already been on,   
   by then, for more than two years. For the first six months, I   
   drove three hours to a Planned Parenthood clinic to find a   
   doctor who’d prescribe my meds. Eventually I found a doctor   
   closer to home, but it’s not ideal: He regularly asks me   
   prurient, nonmedical questions about my transition, including,   
   in one instance, asking what my “cup size” was. There are far   
   worse horror stories than mine. In fact, I’ve found doctor’s   
   appointments go easier if I avoid disclosing my transition   
   history whenever possible. I get quicker, more professional care   
   if we skip the apparent distraction my transition presents.   
      
   For the most part, my experience has been one of inconvenience   
   rather than danger. But what if I was in a crowded ER filled   
   with dying patients and an overworked, traumatized staff? In an   
   emergency, you want to feel as though your medical team will do   
   everything they can to save your life. I don’t have that   
   confidence, because I’ve experienced doctors not treating me   
   equally when my life wasn’t at stake. I know there may be   
   nagging doubts and biases about my gender identity in the back   
   of my doctor’s head. These might mean they spend less of their   
   limited time on my case, or waste time being distracted by   
   irrelevancies about my transition history. At the extreme end,   
   they might send me home out of antipathy or prioritize a more   
   appealing cisgender patient for extraordinary measures such as a   
   ventilator. That’s why, if I fall ill with COVID-19, I won’t   
   volunteer the information that I’m trans. Why risk even a slight   
   possibility that someone might see me as less valuable than the   
   patient in the next bed?   
      
   Sharing health information isn’t necessarily a patient’s choice.   
   A rare point of concurrence between former Presidents George W.   
   Bush and Barack Obama was the desire for efficient, transferable   
   electronic health records throughout the U.S. Obama even put $27   
   billion into incentives for providers to adopt EHRs as part of   
   Obamacare; he’s said that the difficulties in achieving this was   
   one of his greatest disappointments with the law. Perhaps   
   because of this bipartisan support, EHRs have never been   
   controversial in theory, even though their implementation has   
   continually come up short. Criticisms have focused on lack of   
   transferability between competing systems and complexity sucking   
   up doctors’ precious time.   
      
   The concept of patient privacy, both in the system we have now   
   and in the supposedly ideal system of easily transferable EHRs,   
   has always been concerned with protecting a patient from   
   information leaking out from medical settings into personal   
   settings where it may cause embarrassment or harm. However, this   
   assumes that medical histories are always treated neutrally by   
   doctors. Doctors are human beings with human prejudices, whether   
   unconscious or otherwise. According to a 2017 NPR poll, 1 in 10   
   transgender Americans report having been discriminated against   
   in a medical setting, and a further 22 percent say they’ve   
   avoided seeking medical care out of fear they will be   
   discriminated against. Transgender people are now facing the   
   unsettling possibility that, if we contract COVID-19, the same   
   medical discrimination we’ve been facing all along could result   
   in other patients’ lives being considered more worth saving than   
   our own.   
      
   For a while, the situation for trans patients looked to be   
   improving under Obamacare, which forbade discrimination against   
   trans patients outright. However, these protections were   
   successfully delayed by the Trump administration, which is   
   seeking to go even further and enshrine a right to discriminate   
   against transgender patients in the law. We know that   
   discrimination does happen, there are no laws preventing it from   
   happening, and the current administration wants to go further in   
   ensuring it can happen without consequence. In such a climate,   
   the only refuge for a patient like me is secrecy. Keeping my   
   transition history secret might expose me to more risk, if   
   something about my hormone therapy or anatomy turns out to be   
   relevant to my case, but I believe that should be a risk I am   
   allowed to take. My trans status may turn out to be hard or   
   impossible to conceal, but I won’t volunteer it. Doctors have no   
   right to force me to share information they can, and do, proceed   
   to use against me in a discriminatory fashion.   
      
   Although gender identity has been singled out by the Trump   
   administration, it’s not solely trans people who have reason to   
   worry about doctors’ biases. A gay man on a daily HIV prevention   
   medication such as Truvada for PrEP might face discrimination,   
   as might a person with a history of mental illness treatment   
   (particularly severe mental illness or hospitalization) or a   
   person who overcame a struggle with alcoholism or addiction in   
   their past. (Of course, there are also groups who face   
   discrimination without any ability to hide—black Americans in   
   particular and also other people of color and people who are   
   overweight.) Ultimately, I believe the only solution is to give   
   individuals the opportunity to keep irrelevant parts of their   
   medical history private, even from the doctors and nurses   
   treating them.   
      
   If we agreed patients should have this right, it could be   
   achieved in different ways. We could simply enshrine the right   
   of patients to refuse to share whatever aspect of their medical   
   history they wished and be done—if the patient’s actions   
   ultimately hurt the patient, they hurt the patient, and that’s   
   OK. However, it is true that patients may not be the best judges   
   of whether it’s safe to exclude certain information. An   
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)