Photo credit: Andrey Popov/Shutterstock/Paul Spella/The Atlantic
By Emma Green
Being lesbian, gay, bisexual, or transgender is not a disease. It took a long time, but nearly all medical organizations now agree that queerness is not a “sociopathic personality disturbance,” as the American Psychiatric Association once maintained.
“Nearly all” is an important caveat, though. There are still a few organizations—which most doctors and scholars would likely consider part of the fringes of medicine—that challenge this view. Some are dissenting offshoots of mainstream associations. Others are the de-fanged descendants of ex-gay-therapy groups. They’re often accused of outright bigotry, but these doctors tend to frame their dissent differently, placing an emphasis on “choice.” Patients have a right to choose a therapist who will help them with unwanted same-sex attractions or feelings of gender dysphoria, they say. And physicians and therapists have a right to choose not to provide treatments that conflict with their religious beliefs. These treatments might include sex-change operations, hormone-replacement therapy for transgender people, fertility treatments to same-sex couples, or counseling for patients who are in non-heterosexual relationships.
Some legislators agree. In the first week of April, Mississippi passed a new law making it expressly legal for doctors, psychologists, and counselors to opt out of any procedure or choose not to take on any patient if doing so would compromise their conscience. The law is specifically designed to protect medical professionals who object to gay marriage and non-marital sex. Tennessee’s general assembly just passed a similar law, which would only apply to counselors, and a now-dead Florida bill would have protected religious health-care organizations from having to “administer, recommend, or deliver a medical treatment or procedure that would be contrary to the religious or moral convictions or policies of the facility.”
This legislation is part of a wave of religious-freedom bills that have been introduced and passed in the past year or so, almost all inspired by objections to homosexuality and same-sex marriage. Some of these measures are just for show—pastors could never be legally compelled to perform a gay-marriage ceremony in the way some bills have suggested, for example. But some represent a relatively novel approach to religious-freedom legislation: They offer legal cover to people of faith who don’t want to provide certain goods or services to LGBT people, especially when doing so might seem like a tacit endorsement of their relationships and sex lives.
Medical exemptions, though, deserve to be considered in a category of their own. Doctors and therapists interact with people at their most vulnerable, and their training and expertise gives them incredible power over patients. The advice they provide—or refuse to provide—to an LGBT patient could influence the treatment that person seeks. It could make that person less likely to seek primary care or identify themselves as LGBT to other doctors, which can lead to the “failure to screen, diagnose, or treat important medical problems,” according to the American Medical Association. The medical community has a problem: What should hospitals, private practices, and medical associations do about doctors and therapists who say it’s against their beliefs to provide care to LGBT patients?
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