Beyond inclusion

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My first year in PA school rather effectively taught me how much gray exists in medicine. Our bodies aren't always predictable machines. We can't always bank on pushing a specific button to get a certain result. We are fine works of art. We are intricate. We are body, but we would be nothing without mind, emotion, love, and spirit. To me, medicine represents an intersection between puzzling over physical science while lovingly interacting with soulful individuals. As a PA student, I've spent an inordinate amount of time obsessing over the science—fighting, sometimes in vain, to understand hepatorenal syndrome, or the ovarian cycle, or pharmaceutical BP—struggling to remember that the real reason I ever decided to walk down this road toward medical practice was to work with people. I want to provide physical care, but also to provide an emotionally safe space for people, for all people, to seek health and well-being. I thought that is what all aspiring and practicing providers aimed to do.
Last year, this view was challenged. The Christian Medical & Dental Associations (CMDA), an organization with a large constituency in my region, released two ethics statements about LGBTQ identification.1,2 Although arguably attempting to be inclusive, the statements include many details that are discriminatory, hurtful, and potentially dangerous. It scares me that healthcare providers are being encouraged to practice medicine, practice the art of caring for fellow human beings, in a discriminatory manner.
The statements profess the dangers and reversibility of same-sex attractions and thus discourage acceptance of an individual for who he/she/ze/they innately are. For example, one ethics statement asserts that “deciding on a same-sex lifestyle and pursuing same-sex fantasies and encounters are voluntary and involve moral responsibility.”1 This type of thought process inherently promotes closed-mindedness and condescension while ignoring the biologic basis of sexual and romantic attraction. Subsequently these teachings minimize the love and commitment shared by same-sex couples. Later in the statement, the authors assert that “homosexual relationships are typically brief and successive,” propagating antiquated and stereotypical views of homosexuality, such as the incorrect assertion that gay couples cannot maintain long-lasting and committed relationships.
When the CMDA statement says, “Approval of same-sex marriage is harmful to the stability of society, the rearing of children, and the institution of marriage,” it bolsters the misconception that children raised by homosexual parents face disadvantages and thus discourages medical support for couples seeking fertility services or adoptions. This contentious subject has been a topic of debate for years and was assessed by Columbia Law School in 2016.3 Its overview found four studies citing disadvantage to children reared in same-sex households and 74 studies that found no difference in outcomes between children raised by opposite-sex versus gay or lesbian parents.3 Notably, in the four studies showing negative outcomes, most subjects were raised by opposite-sex parents for a period of time before one parent came out as gay or lesbian and left the relationship. The trauma inflicted on a child by the disruption of family stability clearly introduces a new, and unaddressed, variable to those studies. Research of this type is challenging because it requires doing large longitudinal studies; however, after reviewing the 78 cited peer-reviewed papers, the Columbia overview found that an “overwhelming scholarly consensus, based on over three decades of peer-reviewed research, that having a gay or lesbian parent does not harm children.”3
Furthermore, the CMDA statements make reference to adverse health consequences associated with being LGBTQ, such as elevated rates of substance abuse. It is simplistic to imply that substance abuse and its concurrent increased medical costs to society at large can be controlled by discouraging nonheteronormative sexual attractions.
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