Graduate School of Social Service, Fordham University, New York, NY, USA.
Wurzweiler School of Social Work, Yeshiva University, New York, NY, USA.
Palliat Support Care. 2024 Feb;22(1):3-9. doi: 10.1017/S1478951523001104.
The purpose of this study was to describe disrespectful, inadequate, and abusive care to seriously ill patients who identify as transgender and their partners.
A cross-sectional mixed methods study was conducted. The sample included 865 nurses, physicians, social workers, and chaplains. Respondents were asked whether they had observed disrespectful, inadequate, or abusive care due to the patient being transgender and to describe such care.
Of the 21.3% of participants who reported observing discriminatory care to a transgender patient, 85.3% had observed disrespectful care, 35.9% inadequate care, and 10.3% abusive care. Disrespectful care included insensitivity; rudeness, ridicule, and gossip by staff; not acknowledging or accepting the patient's gender identity or expression; privacy violations; misgendering; and using the incorrect name. Inadequate care included denying, delaying, or rushing care; ignorance of appropriate medical and other care; and marginalizing or ignoring the spouse/partner.
These findings illustrate discrimination faced by seriously ill transgender patients and their spouse/partners. Providers who are disrespectful may also deliver inadequate care to transgender patients, which may result in mistrust of providers and the health-care system. Inadequate care due to a patient's or spouse's/partner's gender identity is particularly serious. Dismissing spouses/partners as decision-makers or conferring with biological family members against the patient's wishes may result in unwanted care and constitute a Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation. Institutional policies and practices should be assessed to determine the degree to which they are affirming to both patients and staff, and revised if needed. Federal and state civil rights legislation protecting the LGBTQ+ community are needed, particularly given the rampant transphobic legislation and the majority of states lacking civil rights laws protecting LGBTQ+ people. Training healthcare professionals and staff to become competent and comfortable treating transgender patients is critical to providing optimal care for these seriously ill patients and their spouse/partner.
本研究旨在描述被认定为跨性别者的重病患者及其伴侣所遭受的不尊重、不充分和虐待性护理。
进行了一项横断面混合方法研究。样本包括 865 名护士、医生、社会工作者和牧师。受访者被问及他们是否观察到由于患者是跨性别者而导致的不尊重、不充分或虐待性护理，并描述这种护理。
在报告观察到对跨性别患者的歧视性护理的参与者中，21.3%的人表示观察到不尊重的护理，85.3%的人观察到不充分的护理，35.9%的人观察到虐待性护理。不尊重的护理包括麻木不仁；工作人员的粗鲁、嘲笑和八卦；不承认或接受患者的性别认同或表达；侵犯隐私；错误称呼；使用不正确的名字。不充分的护理包括拒绝、延迟或仓促护理；对适当的医疗和其他护理的无知；以及边缘化或忽视配偶/伴侣。
这些发现说明了重病跨性别患者及其配偶/伴侣所面临的歧视。不尊重的提供者也可能向跨性别患者提供不充分的护理，这可能导致患者和医疗保健系统对提供者的不信任。由于患者或配偶/伴侣的性别认同而导致的不充分护理尤其严重。无视配偶/伴侣作为决策者，或违背患者意愿与生物学家属协商，可能会导致不必要的护理，并构成《健康保险流通与责任法案》（HIPAA）的违规行为。需要评估机构政策和做法，以确定它们在多大程度上对患者和工作人员都是肯定的，并在必要时进行修订。需要制定保护 LGBTQ+群体的联邦和州民权立法，特别是考虑到泛滥的跨性别恐惧症立法以及大多数州缺乏保护 LGBTQ+人群的民权法律。培训医疗保健专业人员和工作人员，使其具备治疗跨性别患者的能力和舒适度，对于为这些重病患者及其配偶/伴侣提供最佳护理至关重要。
