How Bioethicists Want Doctors to Approach LGBT Patients Differently

Medical terminology comes from “a time when we only understood gender or sexuality difference to be a sin or a crime.”

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Dr. Lance Wahlert is a codirector of The Project on Bioethics, Sexuality, and Gender Identity at the University of Pennsylvania who is leading the way in establishing the burgeoning academic field of Queer Bioethics. He explains some of the issues he’s studying and why the medical community needs to start thinking differently about LGBT issues.

What is queer bioethics?

Well, bioethics is the study of the ethically and morally correct things to do for patients, families and research subjects in science and medicine. Queer bioethics is an attempt to make sure that kind of work is being attentive to the special needs of LGBT persons, largely because science and medicine have been historically not supportive of those needs. A lot of work has been done in the humanities on queer theory, but not as much has been done that has reached the medical and clinical communities.

Why are these questions so important right now?

Pretty much all the nomenclature and terminology we have — homosexual, intersex, and so on — they’re late 19th century conventions. They’re from a time when we only understood gender or sexuality difference to be a sin or a crime. So the very terms we use today come out of pathology. Part of why it’s so important that we’re sensitive to the medical and scientific needs of this community is that in many ways, their identities were in some fashion born out of science and technology.

What’s an example of an issue that queer bioethics would tackle?

Here’s an example: With transgender persons, on the one hand, it’s not right to pathologize a person as sick for having those differences. On the other hand, they sort of need that pathology, to gain access to all kinds of medical services and have the insurance to provide them. So it’s a complicated relationship and issue.

And what are some areas in which interesting research is currently being done?

We have people studying the way we take sexual histories and the appropriateness of the language we use. There’s been some discourse about this for the past decade — like, is it appropriate to ask someone if they’re homosexual or not? Do we ask if you’re a man who has sex with a man? Do we ask people more generally what kind of people you have sex with and what kind of sexual acts do you do? Those questions can be incredibly loaded. How we ask people about their sexuality can in turn be empowering and chastising.

An area that gets a lot of attention is intersex children — children born with hormonal or anatomical aspects of both genders. Part of what queer bioethics is concerned with is making sure that the response isn’t just “how do we handle or manage” these individuals, but how do we actually serve them. HIV/AIDS and its effects on the homosexual population is another issue that bioethics has been concerned with. In all these cases, our concern is to make sure that we’re not just studying these affected individuals, but actually thinking about what science and medicine look like from their perspective.

There’s a lot of debate about transgender and intersex children and the appropriateness of giving hormones. What’s your take?

We find that the most bioethically appropriate thing to do is to follow the lead of the child in terms of what they want, but also to take steps at a rate proportional to maturity. From one 12-year-old to another, there can be a big difference in what they want and how ready they are for certain things. Most people agree that doing radical surgeries is best if waited until the individual is a little older and the body has matured. There’s no right answer, because kids between 11 and 16 are really at different maturities and are growing at different rates. In some cases, hormones to prevent puberty are the right decision, but in other cases it’s not. In many cases, that’s what bioethics is about: mediating problems rather than providing templates for what an absolute solution is. It gives us a framework to think about what’s right for a patient and a family, while still knowing that each case is different.

What are some subject areas or topics that you see the field addressing in the future?

One issue is how we define “healthiness” for LGBT persons. So, it’s considering what “sexual healthiness” or “sexual safety” means in the LGBT community. “Safe sex” is not an absolute term across communities — what it means changes across different communities. What might look like promsicuity might not in another, and what looks like a healthy relationship can look different in different communities. We’re making sure not to be tied to heteronormative notions of what sexual health looks like.

I talk sometimes about “what is the queer BMI?” For example, there’s also a whole part of gay male culture focused on being overweight — known sometimes as bear culture or chubby culture. On one hand, we think of being overweight as unhealthy, but on the other hand these are people who are accepting and loving their bodies in a perhaps more loving and healthy way than they ever have in their lives. Addressing what healthiness, is phyiscally and mentally, in the queer community is another very complicated issue.