⚖️Justice

As a principle, justice encourages healthcare providers to weigh whether a health intervention is ethical, fair, and balanced or not, and assess its compatibility with the law and the patient’s rights.

Additionally, the principle of justice is closely linked with non-discrimination. Non-discrimination is a fundamental principle in medical ethics that emphasizes fair and equitable treatment for all individuals, regardless of their sexual orientation, gender identity, or any other characteristic. To uphold justice is to treat all people equally and equitably without discrimination.

In the Malaysian context, LGBTQIA+ people have struggled to access healthcare due to discriminatory practices by healthcare providers and systemic barriers.

What can healthcare providers do to ensure justice when treating LGBTQIA+ people?

Undergo cultural competence training that specifically addresses the needs and concerns of LGBTQIA+ people.

Adopt and enforce policies that explicitly prohibit discrimination based on sexual orientation, gender identity, or any other protected characteristic.

Respecting an individual's gender identity by using correct names and pronouns, and providing gender-affirming care for transgender and gender-diverse individuals.

Ensure that LGBTQIA+ people have equitable access to a full range of healthcare services. This includes reproductive health services, mental healthcare, and preventive care tailored to their unique needs.

Case Study: Justice

Gia* wanted to change the name on her identification card. She was asked to provide a letter from a gynecologist working at a government hospital following gender-affirming procedures.

In Malaysia, some trans people were allowed to change their name, gender marker, and other gendered details in their legal documents, particularly identification card (IC) based on medical intervention. To do so, a trans person has to seek a court order to instruct the National Registration Department to change their details on legal documents. Typically, medical evidence of medical transition is provided to support their court order.

It has, however, become increasingly challenging for trans people even with medical intervention to seek legal gender recognition. the letter will help confirm that the gender-affirming procedures took place.

The first doctor Gia met was a Malay Muslim doctor. The doctor refused to certify her document because he believed that gender-affirming procedures are not recognised in Malaysia. Gia presumes that his religious beliefs could be an influencing factor. The second doctor Gia met a Chinese non-Muslim doctor, helped her with the certification. The letter helped Gia to change her name on the identification card, however, she was unable to change her gender marker.

Key Takeaways

• Medical professionals should be informed and guided by the principle of justice and the best interests of their patients or beneficence. In this instance, for trans people to have legal documents that reflect their gender identity or legal gender recognition (LGR). In the absence of LGR, it would subject them to more harm and increase their barriers to accessing public institutions and services. All of which, contribute to poor quality of health and well-being, as explained through the framework of SDOH.

• Medical professionals regardless of their assumptions and personal beliefs should act in the best interest of the patients, and facilitate or support patient’s desire to seek higher quality of life.

Source: On the Record - Violence Against Lesbians, Bisexual Women and Transgender Persons In Malaysia

*Names changed to protect confidentiality