Hospice faces numerous societal obstacles in providing care for transgender patients. I recently witnessed a striking example of this in our local community hospice. An elderly individual assigned female at birth (MTF) was suffering from metastatic cancer. Chemotherapy had proven ineffective and had left her profoundly weak and infirm. With no connection to her family, she had only a few friends to rely on, but even they were only available intermittently.
She was admitted to hospice, and with supportive care, her overall condition did improve. However, she found herself in a dilemma. She was well enough to leave the unit, but not well enough to return home. Being financially unable to afford a private room, the patient couldn’t be placed elsewhere. Chronic care facilities considered her as both male and female, which hindered her placement with a roommate. As she identified as female and desired a female roommate, these facilities viewed her as originally “male” and either could not or would not accommodate her preferences. Consequently, she remained at the hospice center for the remainder of her life. While the hospice provided her with exceptional care, society’s perspective on gender prevented her from ever leaving the unit.
The transgender population encounters a multitude of difficulties that hospice must also address. Socially, transgender individuals find themselves relegated to a near-netherworld existence. Forced to the fringes of society, they feel isolated, even abandoned, by family and friends. Their friendships may be confined to “gay-friendly” environments or limited to other transgender individuals.
Many transgender individuals experience economic hardships, resulting in job loss, lack of insurance, and even homelessness. Their health can deteriorate, with severe depression being a prominent issue. Impoverished and despondent, they may turn to alcohol or drug abuse. They may engage in risky behavior, exposing themselves to hepatitis and AIDS. Due to societal discrimination, many transgender people avoid seeking medical care until their health conditions have worsened significantly. In an era when patients can express themselves through nudism, unconventional hairstyles, or tattoos representing violent causes (e.g., Nazis), why should transgender individuals fear prejudice from medical staff influenced by societal biases?
Their only supposed crime is their gender identity. The Virginia Transgender Health Initiative Study revealed that almost half of transgender patients felt their doctors had little or no knowledge of transgender health issues. Roughly half of the patients surveyed felt uncomfortable discussing their transgender-related concerns with healthcare providers due to fears of ridicule, hostility, insensitivity, or refusal of treatment. Approximately a quarter of those surveyed had experienced discrimination from medical providers. As these patients avoid medical care, their treatable conditions may progress into chronic or terminal illnesses or become complicated by other ailments.
The transgender population often struggles to find support for their healthcare needs. Transgender individuals represent a “minority of minorities” and society’s most vulnerable population, as expressed by Reverend Stan Sloan of Chicago House, the creator of the TransLife Center. This center offers a safe haven for individuals who sometimes face unwelcome environments in homeless shelters, are overlooked by charitable institutions, and report feeling forgotten by the gay community. While awareness and support for gay and lesbian individuals are advancing, transgender support seems to lag behind. Hospices require additional resources to address the unique challenges faced by transgender patients, resources that extend beyond those linked solely to the gay and lesbian community.
Robert Killeen is a physician who blogs at GeriPal.