🙅‍♂️Non-maleficence

Non-maleficence is a core principle of medical ethics. It states that a healthcare provider has a duty to ‘do no harm’ to a patient. It directs a healthcare provider to consider the benefits of all procedures and weigh them against the potential risks and burdens on the patient.

In tandem with that is the need to learn and gain practical experience. The medical sector has set out protocols to allow practitioners to gain knowledge in a safe manner while minimizing the risks for patients.

What can healthcare providers do to ensure non-maleficence when treating LGBTQIA+ people?

Promote an inclusive atmosphere that is supportive of the needs of LGBTQIA+ people.

Do not offer harmful interventions, including referrals. For example, acknowledge that conversion therapy is not evidence-based and is harmful, and will not be provided to the patients even if asked to.

Refer to other healthcare providers if you are not comfortable treating LGBTQIA+ people.

Case Study: Non-Maleficience

Kumar* is a trans man referred to a clinical psychologist in Ipoh General Hospital. He said the clinical psychologist had zero knowledge on the basics of SOGIESC. During the session, she gave him a Myers–Briggs Type Indicator (MBTI) test. “When the result came out, she said that my MBTI scores showed that I was more ‘Feeling’ (F) than ‘Thinking’ (T), despite being a man. She said that it means that I don’t have enough hormones, because it is abnormal for men to feel or perceive. “This is such a wrong, damaging and toxic perception of masculinity. It’s normal for men to be emotional.”

In addition, he said that the clinical psychologist knew nothing about SOGIESC minorities and was asking him basic questions on gender. “She was asking me questions like ‘Are you a girl or a boy?’. I had to spend my time explaining to her about who I am, about SOGIESC minorities. I had to be stern on my perceptions and boundaries and tell her what to do or what to say.”

Key Takeaways

• The clinical psychologist lacked knowledge on SOGIESC to conceptualize the patient’s case accurately.

• The clinical psychologist was misinformed and believed that it is abnormal for men to be emotional which is a stigmatizing and toxic perception of men/masculinity. Trying to fit the client into a stereotype of what a man should be further exacerbates toxic masculinity and can be harmful to the patient.

• Attributing the patient’s ability to perceive and feel based on hormones is harmful, especially if her choice of treatment is to withhold or reduce his hormone dosage. This can exacerbate his gender dysphoria and lead to more mental health issues.

• Mental health providers should take extra steps to learn about SOGIESC and challenge their biases about masculinity. They should also educate themselves on the myths and misconceptions of gender stereotypes, especially its biological roots.

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

*Names changed to protect confidentiality