The anti-LGBT "bathroom" issue has been featured extensively in the news media since North Carolina passed a law requiring transgender people to use facilities that coincide with their birth sex. What has inexplicably fallen below the radar, however, is the recently-enacted Tennessee law that allows mental health counselors and therapists to decline to care for certain patients if it would violate the clinician's "sincerely held principles." Although this stipulation is non-specific, the law was enacted solely with LGBT patients in mind.
The Tennessee legislature passed it, and Gov. Bill Haslam quietly signed it on April 27th. As physicians, not to mention citizens of the United States, we find this law unethical and immoral, and nearly matched in repugnance by the relative silence with which this law has been met. While a few groups have denounced the law and diverted their conferences from the state, we believe there should be increased publicity, more vigorous backlash against the move and a concerted effort to get it repealed.
As health care practitioners, we are professionally and ethically bound to care for every patient who seeks our care. On rare occasions, we transfer care to a colleague because of the request of the patient, generally because they either seek another opinion or because they feel there is a personality conflict. Even more seldom, a physician will tell a patient that they can no longer care for them; this is almost exclusively because the patient is not following our recommendations despite repeated attempts to explain, counsel and bargain, and we feel the relationship is therefore non-therapeutic.
Clinicians care for every imaginable demographic, without, we hope, any prejudice or outward discrimination (though many studies have demonstrated certain inherent biases in various treatment patterns, which certainly should be discouraged and minimized). We also frequently care for people with whom we disagree or by whom we are offended, whether it be someone with opposing political views, a racist or even an enemy combatant. We still must attempt to give each person the best treatment possible, as all patients are in need of care and our duty is to help them.
Tennessee is the only state to have enacted such a law. Rep. John Ray Clemmons, a Nashville Democrat, tried to weaken the legislation through amendments, but failed. "It's intriguing to me that this body is wanting to stand in the way of people seeking help in the state of Tennessee," Mr. Clemmons said during a floor debate on the bill.
Now, the American Counseling Association has announced plans to move its conventions out of Tennessee next year, stating that this law violates its code of ethics. This new legislation is especially problematic with psychiatric care, as much of the mental conditions that LGBT patients experience are precisely because of this kind of discrimination, and the effects of this new legislation can only add to their distress. Clinicians who follow such a law may therefore be actively inflicting harm on the individual seeking their care.
Although it is easy to say that care could simply be transferred to another counselor who is more comfortable with LGBT people, this is a very dangerous and slippery slope to begin to descend. What about rural areas, where very few counselors practice? What if none of the therapists in a group practice wants to take on these patients? What other "sincerely held principles" will health care workers choose to use to deny care to patients? What other patient characteristics will next become allowable "opt-outs"?
What we are discussing is not a specific treatment or procedure that a practitioner is uncomfortable performing because of their belief system, such as an abortion or physician-assisted suicide. This is a patient, a human being, who is being denied health care simply because of their innate sexual orientation. Businesses, celebrities and the federal government as well as regular citizens should aggressively respond to this egregious law with the same vigor and pressure as they have with the North Carolina "bathroom bill."
Would we react differently if care providers were given the right to refuse to care for black people? Oh wait, we've already been down that horrible road.
Dr. Jeffrey Brauer (firstname.lastname@example.org) is a pulmonary and critical care physician at Sinai Hospital of Baltimore. Dr. Colleen Christmas is a geriatrician at Johns Hopkins Bayview Medical Center and is director of the Primary Care Leadership Track at Johns Hopkins Medical School.