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Mid-Atlantic Ethics Committee Newsletter, Winter 2017

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Mid-Atlantic Ethics Committee Newsletter, Winter 2017 Health Care Law Mid-Atlantic Ethics Committee Newsletter University of Maryland Francis King Carey School of Law Year 2017 Mid-Atlantic Ethics Committee Newsletter, Winter 2017 This paper is posted at DigitalCommons@UM Carey Law. http://digitalcommons.law.umaryland.edu/maecnewsletter/72 MID-ATLANTIC ETHICS COMMITTEE NEWSLETTER A Newsletter for Ethics Committee Members in Maryland, The District of Columbia and Virginia Published by the Law & Health Care Program, University of Maryland Francis King Carey School of Law and the Maryland Health Care Ethics Committee Network WINTER 2017 Inside this issue . ETHICS OF CARING FOR TRANSGENDER Ethics of Caring for Transgender PERSONS Persons .....................................1 Clinicians and ethics consultants may encounter questions regarding the treatment of transgender persons in many medical contexts. Providers may feel less confident Organ Donation and when trying to help transgender persons because they do not know enough about their Transplantation: Ethics, foremost needs and wants. Religion, & Interprofessional In this piece I discuss some key considerations for providers to best help these Collaboration .............................5 persons. This includes understanding the right words to use, common critical needs, and the importance of advocacy. Focus on Organ Procurement Strategies ..................................7 Overriding concerns for most transgender persons are two basic desires: the ability to live authentically and to have others respond to them on the basis of who they are 1 Case Presentation .....................9 as opposed to how they may look. These concerns underlie many of the guidelines I Comments from a Speech- outline below. Language Pathologist ............9 Alternative Treatment I. Using the Right Words Consents ...... .......................12 Comments from a Hospital Providers should use Ethics Consultant .................13 the most respectful words to describe transgender Calendar of Events ..................15 persons—the words requested by transgender individuals themselves. It is particularly important that providers of transgender persons see them The Mid-Atlantic Ethics Committee as the gender they are, i.e., the gender that they identify with. Newsletter is a publication of the Finding the right words here may be difficult: “Trans is a very new term … [It] is Maryland Health Care Ethics meant to be a new umbrella term to represent all atypical genders. … Cis is a word Committee Network, an initiative of used to describe the opposite of trans.”2 the University of Maryland Francis First, providers should not refer to transgender persons as “patients.” I have thus far King Carey School of Law’s Law & intentionally used the word “person” instead of “patient.” This is because changing Health Care Program. The Newsletter or wanting to change one’s gender is not a disorder. Trans people may have disorders. combines educational articles with Being trans, however, is not a disorder. There is a distinction between transgender timely information about bioethics identity and dysphoria. Gender dysphoria is discomfort or distress caused by a activities. Each issue includes a feature discrepancy between an individual’s gender identity and the gender assigned at birth. article, a Calendar of upcoming Some trans people have gender dysphoria but not all. It is a mistake then for providers events, and a case presentation and to refer to these people as “patients” since they may not have a disorder. Further, to commentary by local experts in refer to them as patients when they may not have a disorder is implicitly stigmatizing. bioethics, law, medicine, nursing, or related disciplines. Some individuals may have symptoms, such as depression, that meet the criteria for a disorder. If this occurs, they should of course be diagnosed and treated. Depression Diane E. Hoffmann, JD, MS - Editor or anxiety, however, may be caused by living in a body that does not reflect their vision of themselves. Thus, their feelings of depression may change after they change © 2017 University of Maryland Francis King Carey School of Law Cont. on page 2 Ethics of Caring for Transgender Persons Cont. from page 1 The Mid-Atlantic Ethics their bodily characteristics. are now creating these all-genders Committee Newsletter is published three times per year by I recall one late adolescent male who restrooms. This is optimal as it the Maryland Health Care Ethics had, according to both his parents and demonstrates the most respect for Committee Network himself, felt depressed his entire life trans identities, especially trans people Law & Health Care Program since early childhood. Once he had who are non-binary (i.e., they do not University of Maryland surgery to remove his breast tissue, identify as either men or women). Francis King Carey School of Law however, he reported feeling happy for This third bathroom may, though, 500 West Baltimore Street the first time, virtually overnight. be suboptimal if some transgender Baltimore, MD 21201 persons are fearful of revealing their 410-706-7191 Providers should also use the right transgender identity by entering the pronouns. Providers should not Diane E. Hoffmann, JD, MS, Editor bathroom. choose pronouns for a person, but Anita J. Tarzian, PhD, RN, Some may assert that this concern is Co-Editor should simply ask the person, “What pronouns would you like me to use not problematic because transgender Contributing Editors: for you?” Transgender persons want persons should be as proud of who Joseph A. Carrese, MD, MPH their providers to know their gender they are as anyone else. While true, Professor of Medicine this assertion fails to take into account Johns Hopkins University and how they want to be addressed. Providers should use the pronouns important subjective differences, Brian H. Childs, PhD people request, even if the provider as well as the increased likelihood Community Professor of Bioethics, is unfamiliar with that pronoun. In of harassment and violence against Mercer University School of transgender people. For bathrooms, Medicine, Savannah, GA addition, it is important for providers to call these individuals by the correct as for all considerations, providers Evan DeRenzo, PhD first name, regardless of whether that should take into account the full range Ethics Consultant name is reflected on legal documents. of individual experiences. Some Center for Ethics transgender persons may not feel Washington Hospital Center Some providers believe that these persons should have to take the sufficiently confident in their status Edmund G. Howe, MD, JD initiative to tell the provider if they to let others know about it or may be Professor of Psychiatry, would like their providers to call unwilling to face the increased risk of U.S.U.H.S. Department of harm. Providers should thus adjust to Psychiatry them a name that corresponds with their gender. This view, however, what these persons individually need Laurie Lyckholm, MD is not ethically optimal because it rather than over-generalize based on Asstistant Professor of Internal all transgender persons. Medicine and Professor of discriminates against transgender Bioethics and Humanities, persons less willing to take this Transgender persons’ sexual Virginia Commonwealth initiative. Thus, it may be better for orientation—which indicates the School of Medicine providers not knowing how to refer to partners to whom they feel sexually Jack Schwartz, JD these individuals to take the initiative attracted—likewise, lies along a Adjunct Faculty and ask them. spectrum. Regardless of gender University of Maryland identity, persons may be attracted to Francis King Carey School of others of the same or the opposite Law II. Respecting Transgender Persons’ gender or both, and this may change Individual Needs Henry Silverman, MD, MA over time. The sexual feelings a Professor of Medicine Attempting to use the right words person experiences may also change if University of Maryland is just one of many ways that they take hormones. Some trans men providers should attend to transgender may experience increased aggression Comments to: persons’ individual needs. Another or agitation due to testosterone and [email protected] consideration is the much publicized the libido of some trans women The information in this newsletter concern regarding bathroom use. taking estrogen may decrease.3 If is not intended to provide legal I recall meeting years ago with a trans women have bottom surgery, advice or opinion and should not be LGBT group of professionals. One of afterward they may have to continue acted upon without consulting an its transgender members suggested to dilate their vaginas. Providers can attorney. that, when feasible, there should be benefit transgender persons by sharing three bathrooms instead of two, one this knowledge with the transgender for men, one for women and one for persons in their care. All too often, 2 Mid-Atlantic Ethics Committee Newsletter people of all genders. Some places transgender persons report knowing more about their medical realities than who are not mental health specialists, could refer the evaluation to others the providers. Justifiably, transgender such as endocrinologists, want and/or advocate for the trans person persons want their providers to inform psychological consultation prior to by telling the insurance company that them rather than the reverse. prescribing medications. While this such evaluations are discriminatory. in itself may be ethically questionable
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