The reality of marriage equality and health care

Not long ago I fractured my shoulder and needed surgery. After the operation, my husband of 30 years did all the things a loving spouse would be expected to do: He fluffed my pillows and put toothpaste on my toothbrush (try doing that with one arm!) and overlooked my crankiness.

My husband also helped me in ways so fundamental to our status as a married couple that I barely registered them. When I was loopy after the operation, he spoke with the surgeon on my behalf; he signed me out when I was discharged; health insurance through his employer covered my medical expenses.

Right now, thousands of couples in the United States can’t take these things for granted as we did. Lesbian and gay couples who are as deeply committed as my husband and I are, who’ve shared private jokes and dumb arguments, budget-making and childrearing just as we have, can’t count on being able to fully support one another when one of them is ill or injured. Even in the handful of states where same-sex couples can legally marry, rights including spousal health-care benefits are not guaranteed.

If you Google “marriage equality” and “health care,” they are likely to appear on a list of important but unrelated issues. (The first link that popped up for me, from a local newspaper in Oregon, mentioned: “Marriage equality, better health care, salmon habitats . . . ”) But, of course, they are related. In our current political discourse, issues are labeled “social” or “economic” or “civil rights,” and so forth, but both marriage equality and health care involve all of these — and each other.

Medical professionals are in a unique position to see controversial issues in a multifaceted way because we get to know a variety of people – our patients – so intimately. The view is more nuanced behind the closed doors of the exam room than it is on Fox News or MSNBC, or on the campaign trail. For example, no matter what a doctor’s personal stance on abortion is, he or she must deal with the complex emotional, physical, and psychological needs of an actual woman who’s facing an unwanted pregnancy.

Regarding marriage equality and health care, the reality is this: Whether or not he or she acknowledges or is aware of it, every doctor has patients who are lesbian, gay, bisexual, or transgender, and sexual orientation affects health in many ways. The extent to which LGBT people are able to support their loved ones during illness is one of the most crucial.

The Human Rights Campaign, an advocacy organization, publishes an annual survey rating hospitals and other health-care facilities on various aspects of their treatment of LGBT people: the safety, comfort, and satisfaction of LGBT people in health-care settings; whether LGBT patients are offered state-of-the-art medical care and information; equity for LGBT employees; and access to partners who are ill or hospitalized.

As a physician in a leading academic medical center located in Massachusetts, the first state to legalize same-sex marriage, I like to think that my own practice would fare well in such a survey. But, as we know from the civil rights and women’ rights movements, the passage of laws and the best intentions of individuals don’t eradicate centuries of deeply held prejudice overnight.

I can think of incidents in which I’ve been insensitive to the needs of LGBT people, not out of malice, but because I’d not developed the reflexes to consider them. Recently, I was writing a prescription for a woman I’d not met before and asked her how she could be so sure she wasn’t pregnant if she wasn’t using birth control. “Because I don’t have sex with men,” she answered, with appropriate exasperation.

Once, after I reviewed with a group of medical students how best to counsel patients about safe sex, a gay student expressed amazement that I’d all but omitted LGBT patients from my presentation.

But these gaffes, I think — I hope — are isolated. What worries me more is my failure to fully appreciate how prejudice colors some of my patients’ experiences of the health-care system. For many years I’ve provided primary care for two women in their 70s who have lived together for decades. Perhaps because of the era in which they came of age, they’d never identified themselves to me as a couple, though it seemed clear that they were. They finished each other’s sentences, took notes at each other’s medical visits, and, when I called to discuss one of their test results, both got on the phone.

I sometimes wonder whether I should have encouraged them to be more open with me about the nature of their relationship, but I sensed this was not what they wanted. I’m still not sure I was right.

Once, one of the women became critically ill and required months of hospitalization outside of Boston. The other was at her bedside all day, every day. The doctor on the case called periodically to update me — progress was at times discouraging — and her companion also phoned regularly. She always left messages that began by identifying herself as the patient’s “roommate” or “friend.”

Eventually, because of excellent medical care and, no doubt, the “friend’s” loving attentiveness, the patient recovered and was able to return home. When I got the call with this news, the message was slightly different: “This is her partner . . .,” it began.

A small word, a subtle shift, and yet I couldn’t help but read volumes into it. I imagined the woman, after months by her partner’s side, after decades of denying their relationship, finally saying to herself, “Dammit, I’ve earned the right.”

Of course I don’t know for sure if that’s what she said to herself. But I do know this: I receive dozens of phone messages every week, thousands every year — and I can’t remember one that moved me more.

Suzanne Koven is an internal medicine physician who blogs at In Practice at, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • Molly_Rn

    It is a matter of discrimination and it should be outlawed. We are all supposed to be equal under the law.This is no different than race or religion or gender. It is discrimination. As a matter of fact who cares what the churches say. My husband and I were married by a judge and are just as married as someone who had a mass. It is not a religious rite. It is a legal union of two people. After the Catholic Church cleans us its pedophile problems maybe I will listen to what they have to say.

    • Bhai_Mian

      “”It is not a religious rite”………Really?

      Marriage was ALWAYS a religious rite and started as one since the ancient times. It still is a religious rite. Doesn’t matter if some perverts in the US or random countries of Europe believe other wise.

      • sFord48

        If it is a religious rite, then those religions that accept same sex marriage should be able to legally marry their members instead of being discriminated against.

        • Bhai_Mian

          Actually None of the religions endorses Homosexuality, what to talk about same sex marriages. There is NO single endorsement of homosexuality in any of the holy text books of the major religions of the World ( Christianity, Judaism, Islam, Hinduism and Buddhism)

          It is the people who want to change the religion as per their needs to give a holy sanction to their perversions.You want to continue with this , then go on; but don’t bring religion into it.
          It is not about discrimination. It is about forcing YOUR way of life on others who do not agree to be a pervert.

          • Molly_Rn

            Pervert!?! You are out of line. People
            can be married by a judge or other official and are just as married as someone
            who has a religious ceremony. We are not perverts we just don’t believe in god
            or religion. We want religion out of marriage and out of our lives. Separation
            of church and state also means protection from religion.

    • Girly

      As I said above I think US civil marriage and religious marriage should be separated. Fidelity is important to me and that’s why I want a religious marriage. The US government won’t stop people from doing what makes them happy and there are no consequences for cheating in a civil marriage. I shouldn’t be forced to get civilly married if I only want a religious marriage. I don’t want to be civilly married and I think requiring it is discrimination and doesn’t keep a separation of church and state.

      • Molly_Rn

        got news for you. Many religious marriages end due to infidelity. Getting
        married in a church is no guarantee of anything. If marriage were a religious
        union only and not a legal or civil union, then you wouldn’t need to get a
        license from the state. This is a matter of civil rights. What if the law said Christians
        couldn’t get married or people
        who choose mates older than themselves couldn’t get married, you would see how ridiculous
        it is to discriminate against homosexual people. I don’t believe in your Bible
        and couldn’t care less what it says about homosexuality so why should your
        religion stand in the way of my rights or anyone else’s, separation of church
        and state.

        • Girl

          I never said I was a Christian or I believed in the Bible. I made reference about separation between church and state and you assumed you knew my religious beliefs. Civil law does say that it’s illegal to get religiously married without having a legal or civil union and that is why I said it was discriminatory. I don’t want a marriage license from the state and I am forced to get one if I want to be religiously married.

          I’m not promising to be faithful in a civil contract, there are no consequences if I break the contract, and I don’t want it. I know infidelity happens in religious marriage but that doesn’t make promising fidelity to my husband any less important to me.

          I don’t know why you think civil marriage will remain a legal union between two people. You can defend your views about civil marriage but it will not stop continuous legal changes to include everyone and make them happy. It doesn’t matter if the legal changes are different then your views about marriage because like you said “it’s a matter of civil rights.”

  • Girly

    Marriage in the US doesn’t provide an automatic right to health information about a spouse. Hospitals withhold information from a spouse if they don’t have permission from the patient to discuss the case. Marriage is unnecessary for medical decisions because anyone can be assigned as power-of-attorney.

    Medical students should know that being straight or married doesn’t make sex safer. Married straight people are the fastest growing group of new HIV cases. The new HIV cases are because of affairs. A large number of affairs are between married men and male partners or prostitutes and then the married man goes home and passes HIV to his wife.

    People get married to justify their relationship to each other and society. I think civil marriage and religious marriage should be separated. If I had a choice I would be happy justifying my relationship with a religious marriage and I wouldn’t get civilly married.

    Civil marriage is a contract, like a legal document you’d sign before building a house, buying a car, or getting a bank loan. Laws are continuously changing and civil marriage could be easily changed. Medicine changes easily to include other people or redefine what can be done.

    Civil marriage could be changed to include multiple spouses, same-sex spouses, incest, bestiality, or whatever makes people happy. It’s not against US civil law if people are unfaithful and civil divorce is about dividing assets and deciding parent responsibility. When figuring household income for benefits many US government programs don’t consider civil marriage. The US government counts the income of every person living in a household and the people could be spouses, relatives, or non-related friends.

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