Transgressing Trans Healthcare Differences

Sociologists find Americans agree that transgender men and women should not be denied healthcare–though there’s still some circumstantial nuance

As transgender rights again garner national attention—in part because of Florida’s proposed “Don’t Say Gay Bill” and Texas Gov. Greg Abbott ordering the state to investigate parent-approved gender-confirming surgeries as child abuse—University of Maryland Assistant Professor Long Doan and Hamilton College Assistant Professor Matthew Grace publish a new study on Americans’ perceptions of when it’s appropriate for doctors to refuse care to a trans man or trans woman.

Doan and Grace, who met in graduate school and reconnected over this shared research interest, found most Americans to generally agree that denying care to a trans person is wrong. Only 25% of respondents said it’s acceptable for a provider to deny care to a trans person because the provider has religious objections.

“There’s a widespread belief among the American public that doctors not only have a professional, but also a moral obligation to assist those in need regardless of their personal beliefs or convictions,” said Grace. “I’m hesitant to go beyond the data in terms of forecasting what these findings suggest in terms of some of the anti-trans bills that are cropping up across the country, but I think the fact that a majority of Americans were against the denial of medical care to trans people regardless of the doctor's justification suggests that current attacks on the rights of trans people will ultimately not be viewed favorably by the public.”

Depending on patient race and gender, a larger share of respondents—46% and 55% respectively—said it was acceptable for a provider to deny care due to inadequate training. This finding comes with pros and cons, Doan notes.

“The promising thing is that people are holding healthcare providers to a higher standard than they hold others; that’s promising and reflects the heightened status of healthcare in society, that with great power comes great responsibility,” he said. “On the flip side, what the findings suggest is that if providers give reasons related to their inadequate training to treat trans medical issues, and the public is OK with that, that is problematic especially in this study.”

As the American Sociological Review paper explains, survey participants were asked to read a short scenario and answer questions about their reaction to an ill, but non-emergent individual going to an urgent care and being denied care. The details about the individual’s name and gender identity, as well as the provider’s reason for treating or not wishing to treat that person, changed depending on the vignette that the participant was randomly assigned, revealing more about people’s thoughts on the denial of care under various conditions.

For example, Doan and Grace did not find gender to be a major influencing factor in Americans’ denial of care approval or disapproval, but they did find that respondents’ answers varied by race. Compared to white patients, respondents were more likely to advocate for a doctor’s right to refuse care when the ill individual was Black and Latinx.

“Among people who are supportive of the denial of healthcare, one of the primary reasons that they give for being OK with it is, ‘Well, it’s a free country, so anyone should be able to deny services for any reason and it's on the patient to go seek a provider who is supportive of them,’ and we see an unequal application of that logic,” Doan explained. “Americans don’t apply that logic to every vignette character; they overwhelming apply it to Black and Latinx patients, so we see a little bit of colorism and racism even effecting the transgender issues that are being raised in the study.”

In addition, because no details about the patient’s condition were given aside from them not feeling well, Doan said they found evidence of a “trans broken arm syndrome” mindset in which a trans person with a medical issue that has nothing to do with gender (like a broken arm) will have that issue treated differently simply because of how they identify.

For that, Doan, who will next compare the public’s beliefs on this issue to providers’, believes the solution is clear.

“On the one hand, medical training is cis-normative and doesn’t give enough attention to trans issues, but on the other hand, there also needs to be a decoupling of healthcare that a trans person might need from trans-specific healthcare,” he said. “It’s a combination of having more adequate training, and a decoupling of the issues so that more providers will feel that they are able to treat non-trans related issues if they did not receive that training.”

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Published on Wed, Mar 30, 2022 - 11:43AM