👩‍🎤Autonomy

Autonomy refers to the right of competent adults to make informed decisions about their own bodies and medical care. This means that healthcare providers cannot impose treatments or interventions on patients without their informed consent. Instead, they must provide patients with all relevant information, including potential risks, benefits, and alternatives, to enable them to make informed decisions about their care to enable active involvement of the patient in their treatment.

The principle of autonomy relates to the right to self-determination and privacy. In tandem with that, practitioners have a duty to maintain the confidentiality of the patients.

What can healthcare providers do to ensure autonomy of LGBTQIA+ people?

Accept and respect the identities that patients identify with. This includes calling patients by their name instead of their name as per legal documents, and using the correct pronouns.

Provide detailed information and seek consent before providing any form of treatment. Care must be taken to consider healthcare literacy of each individual patient in the informed consent process. If a patient does not give consent, practitioners should respect their decision.

Respect the patient or an appointed proxy to make healthcare decisions that are in alignment with the patient’s goals.

Respect the patient’s needs and decisions. For example, a transgender person seeking treatment for gender dysphoria may or may not opt for hormonal and/or surgical treatments.

Case Study: Autonomy

A cisgender gay man, Damian* visited a private psychiatrist for his symptoms of depression and anxiety. He disclosed his sexuality to the psychiatrist during his mental health assessment. After the assessment, the psychiatrist referred Damian to a Christian conversion therapy support group. “I’m a doctor, so I cannot tell you what is right or wrong. But I recommend you to this place and meet people in this support group. They face the same thing you do and want to change. They can change, so can you.”

The doctor also spoke to Damian’s mother, who accompanied Damian to his psychiatry appointment. The doctor theorized that his mother was not a good parent and that excessive internet access was the reason why Damian was gay. Damian did not go to the conversion therapy as he believed his sexuality was not a problem or a mental health issue, he was however angered by the fact that his mother was affected by the psychiatrists’ remarks.

Key Takeaways

• While Damian shared his sexual orientation with the psychiatrist, he was not seeking support services for his sexual orientation. Conversion practices are widely and globally recognised as unscientific and harmful practices. As such, recommending such harmful practices to patients is not only against the best the interest of the patients, it will also result in harms and negative effects, including loss of trust in healthcare professional.

• Reaching out and misinforming a patient's parent without their consent violates the patient’s privacy and other medical ethics.

• Healthcare providers should respect patients’ SOGIESC and refrain from pathologizing or offering harmful recommendations based on their personal views about LGBTQIA+ people.

Source: Challenges to Mental Health Access Among LGBT People, Galen Centre, 2019

*Names changed to protect confidentiality