Simone Lawson
LGBTQ+ individuals face numerous healthcare obstacles, including providers who discriminate or refuse to provide care. While federal civil rights protections in the Affordable Care Act (Section 1557) guard against discrimination based on sex, sexual orientation, and gender identity, some states have laws that allow healthcare providers to deny services to LGBTQ+ people if it conflicts with their religious beliefs. This has led to LGBTQ+ people facing barriers to healthcare, with some individuals delaying or going without treatment, which can have detrimental effects on their health and well-being. The question of whether it is constitutional for doctors to refuse LGBTQ+ patients is a complex one, involving legal, ethical, and human rights considerations, and it has been the subject of ongoing debates, lawsuits, and legislative changes.
| Characteristics | Values |
|---|---|
| LGBTQ+ patients face healthcare obstacles | X |
| Providers discriminate or refuse to provide care to LGBTQ+ patients | X |
| Providers have a hostile attitude towards LGBTQ+ patients | X |
| LGBTQ+ patients fear discrimination | X |
| LGBTQ+ patients delay or go without treatment | X |
| Federal civil rights protections in the Affordable Care Act (Section 1557) guard LGBTQ+ people from discrimination | X |
| States have anti-discrimination laws that protect LGBTQ+ people in public places, including doctors' offices and hospitals | X |
| The American Medical Association (AMA) ethics rules prohibit doctors from refusing to provide treatment based on sexual orientation or gender identity | X |
| LGBTQ+ patients can file a complaint with the Department of Health and Human Services if they face discrimination | X |
| States and cities have laws to protect LGBTQ+ patients from discrimination by healthcare providers | X |
| LGBTQ+ patients can create an advance directive or living will to protect their healthcare rights and gender expression | X |
| LGBTQ+ patients have privacy rights under the Healthcare Insurance Portability and Accountability Act (HIPAA) | X |
| LGBTQ+ patients experience healthcare refusals, discrimination, and mistreatment | X |
| Individual physicians and other health providers may refuse to provide services based on personal moral objections to serving LGBTQ+ patients | X |
| Religiously-controlled healthcare systems may have policies in place to deny care to LGBTQ+ patients | X |
| Catholic hospitals and health insurance plans may not provide coverage for gender-affirming care | X |
| Religious clinicians in some states have the right to refuse to treat LGBTQ+ patients | X |
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What You'll Learn
Religious exemptions for doctors
While the American Medical Association (AMA) ethics rules prohibit doctors from refusing to provide treatment to a patient based on their sexual orientation or gender identity, LGBTQ+ individuals still face healthcare discrimination. The federal Affordable Care Act (Section 1557) guards LGBTQ people from discrimination based on sex in any program or facility that receives federal funding for healthcare services, including Medicare. However, some states have laws that allow healthcare providers to deny services to LGBTQ people if providing those services would conflict with their religious beliefs. For example, doctors in these states may refuse to provide fertility treatments to same-sex couples or hormone replacement therapy for transgender people.
In Michigan, for instance, laws ban discrimination on the basis of religion, race, sex, and marital status, but they do not include sexual or gender orientation. As a result, a pediatrician in the state, Dr. Vesna Roi, refused to treat a six-day-old baby girl because of the child's lesbian parents, stating that she had prayed about it and decided that she could not treat the baby due to her religious beliefs. Dr. Roi may be within her legal rights to deny LGBTQ couples services due to her religious convictions.
In Indiana, religious clinicians have the right to refuse to treat LGBTQ patients, and similar laws have been enacted in Mississippi. These laws directly conflict with the AMA code of ethics. On the other hand, many states have antidiscrimination laws that protect LGBTQ people from being unfairly treated in public places, including doctors' offices and hospitals.
LGBTQ patients who experience discrimination or refusal of care based on religious or moral objections can file a complaint with the Department of Health and Human Services. They can also explain their concerns to the physician, provide the doctor with the AMA ethical rules and applicable federal and state antidiscrimination laws, and report the behavior to another physician.
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LGBTQ+ patients' rights
LGBTQ+ patients have faced numerous healthcare obstacles and discrimination due to their sexual orientation and gender identity. While the American Medical Association (AMA) ethics rules and the Affordable Care Act (Section 1557) prohibit doctors from refusing to provide treatment based on these factors, some states have laws that allow healthcare providers to deny services to LGBTQ+ patients if it conflicts with their religious beliefs.
In some states, such as Indiana and Michigan, religious clinicians have the legal right to refuse treatment to LGBTQ+ patients, which directly conflicts with the AMA code of ethics. For example, a doctor in these states may refuse to provide fertility treatments to same-sex couples or hormone replacement therapy for transgender people. This has resulted in healthcare disparities and specific barriers to accessing healthcare for the LGBTQ+ community, including refusals of care, discrimination, and mistreatment.
To protect their healthcare rights, LGBTQ+ individuals can create an advance directive or living will, which outlines their wishes for medical care and appoints an emergency decision-maker. Additionally, if a provider refuses coverage or treatment based on gender identity or sexual orientation, this is discrimination, and a complaint can be filed with the Department of Health and Human Services.
Despite these protections, LGBTQ+ patients may still face challenges in finding inclusive healthcare providers and navigating the legal system to uphold their rights. It is important for transgender patients to feel safe disclosing their status to their doctor, as it may impact their medical care and treatment options. Overall, the healthcare rights of LGBTQ+ individuals remain a complex and evolving issue, with ongoing efforts to improve access and equality.
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Discrimination and refusal of care
In the US, federal civil rights protections in the Affordable Care Act (Section 1557) guard LGBTQ+ people from discrimination based on sex in any program or facility that receives federal funding for healthcare services, including Medicare. Section 1557 explicitly requires federally funded healthcare programs to serve eligible individuals regardless of sex, sexual orientation, and gender identity. It also enhances hospital visitation rights for same-sex couples and prohibits unfair treatment of HHS employees and applicants based on gender identity. Many states also have anti-discrimination laws that protect LGBTQ+ people from being unfairly treated in public places, including doctors' offices and hospitals.
However, some states have laws that allow businesses and government officials to deny services, including healthcare (except in emergency situations), to LGBTQ+ people if providing such services would conflict with sincerely held religious beliefs. For example, in Indiana, religious clinicians have the right to refuse to treat patients based on their sexual orientation or gender identity, which directly conflicts with the AMA code of ethics. In Michigan, while the law bans discrimination based on religion, race, sex, and marital status, it does not include sexual or gender orientation, and a doctor in the state refused to treat a lesbian couple's baby due to her religious beliefs.
The American Medical Association (AMA) ethics rules prohibit doctors from refusing to provide treatment to a patient based on their sexual orientation or gender identity. The AMA has also adopted dozens of rules and opinions calling for the equal treatment of LGBTQ+ patients, doctors, and medical students, and supports access to gender-affirming care. Despite these rules and opinions, and the federal and state anti-discrimination laws, LGBTQ+ people continue to face discrimination and refusal of care from healthcare providers, which can lead to a lower quality of life, contribute to disabling illness, or lead to premature death.
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Healthcare access and insurance rates
While the American Medical Association's (AMA) ethical rules prohibit doctors from refusing to provide treatment to patients based on their sexual orientation or gender identity, LGBTQ+ individuals face numerous healthcare obstacles. Discrimination and refusal of care based on religious and moral objections to their LGBTQ status are common. LGBTQ+ patients may experience healthcare refusals, discrimination, and mistreatment from individual physicians or religiously-controlled health care systems.
Federal antidiscrimination protections in the Affordable Care Act (Section 1557) guard LGBTQ people from discrimination based on sex, sexual orientation, and gender identity in any program or facility that receives federal funding for healthcare services, including Medicare. This has increased LGBTQ+ access to healthcare and services by requiring federally funded healthcare programs to serve eligible individuals, enhancing hospital visitation rights for same-sex couples, and ensuring equal treatment in advance healthcare directives.
Despite these protections, some states have laws that allow healthcare providers to deny services, except in emergency situations, to LGBTQ+ people if it conflicts with their religious beliefs. For example, a doctor may refuse to provide fertility treatments to same-sex couples or hormone replacement therapy for transgender people. In states with broad conscious clauses, LGBTQ+ individuals may be able to file a federal lawsuit against a doctor who refuses to provide gender-affirming care based on their sex, sexual orientation, or gender identity.
Additionally, LGBTQ+ individuals may face barriers to healthcare due to fear of discrimination, which can lead to delaying or forgoing treatment, negatively impacting their quality of life. Discrimination can take the form of healthcare providers being ill-informed, asking inappropriate questions, refusing to use preferred names, or refusing to treat LGBTQ+ patients altogether.
To protect their healthcare rights, LGBTQ+ individuals can create an advance directive or living will, which are legal documents that outline their preferred care and advise doctors of their chosen decision-maker in case of an emergency.
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Legal protections for LGBTQ+ patients
While there have been efforts to improve legal protections for LGBTQ+ patients, discrimination in healthcare remains a significant issue for this community. The Affordable Care Act Section 1557 is a federal civil rights protection that safeguards LGBTQ+ individuals from discrimination based on sex, sexual orientation, and gender identity in any healthcare program or facility that receives federal funding, including Medicare and Medicaid. This law has increased LGBTQ+ access to healthcare services and enhanced hospital visitation rights for same-sex couples.
Additionally, the American Medical Association (AMA) ethics rules explicitly prohibit doctors from refusing to treat patients based on their sexual orientation or gender identity. The OCR, a law enforcement agency, also investigates and enforces Section 1557 of the ACA, ensuring that LGBTQ+ individuals are protected from discrimination in health programs and activities that receive financial assistance from the Department of Health and Human Services.
Some states and cities have also enacted laws to specifically protect LGBTQ+ patients from discrimination by healthcare providers. These laws enable individuals to file complaints or pursue discrimination claims with the assistance of the state's Office of Civil Rights. Furthermore, advance directives, or healthcare power of attorney, are essential legal tools that LGBTQ+ individuals can use to protect their healthcare rights and gender expression. These documents allow individuals to appoint a trusted person to make emergency medical decisions on their behalf and ensure their wishes are carried out.
Despite these protections, there are still challenges. For instance, religious exemptions for healthcare providers in certain states may conflict with Section 1557, allowing them to deny services, including fertility treatments, hormone replacement therapy, and counseling, if providing them would violate their religious beliefs. The Weldon Amendment has also been cited as impacting LGBTQ+ individuals, as it allows a broader range of healthcare entities to deny care based on religious beliefs.
Ongoing legal cases, such as those involving Steven Hotze, a physician who has actively campaigned against LGBTQ+ rights, pose a significant threat to the healthcare access of the LGBTQ+ community. A ruling in his favor could result in a widespread loss of access to preventive healthcare, including HIV prevention medication.
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Frequently asked questions
It depends on the state and the doctor's religious beliefs. In some states, there are laws that allow doctors to deny healthcare services to LGBTQ+ people if providing those services conflicts with their religious beliefs. However, the American Medical Association (AMA) ethics rules prohibit doctors from refusing to provide treatment based on a patient's sexual orientation or gender identity.
LGBTQ+ people have reported doctors refusing to call them by their preferred name, being subjected to unnecessary and inappropriate exams, and facing hostile attitudes from healthcare providers.
Fear of discrimination can lead LGBTQ+ people to delay or avoid seeking treatment, which can lower their quality of life and contribute to disabling illnesses or premature death.
If you believe a doctor has refused to treat you because of your sexual orientation or gender identity, you can explain your concerns to the physician, provide them with the AMA ethical rules and applicable federal and state anti-discrimination laws, and report the behavior to another physician. You may also be able to file a complaint with the Department of Health and Human Services or the state's Office of Civil Rights.
Recent legislation in some states, such as Indiana and Mississippi, has granted religious clinicians the right to refuse to treat LGBTQ+ patients, citing protection of religious liberty. These laws have been criticized for supporting discrimination and undermining protections for minority groups.
