(Non)universal healthcare

Institutional discrimination of trans* people within the system

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Although rhetoric surrounding the Canadian healthcare system focuses on its accessibility and affordability for large swathes of the population, patients from the trans* community are actively left out. Trans* people face a myriad of challenges and barriers: harassment in everyday life, a lack of legal recognition, and problems with accessing even the most basic healthcare.

While there is a disturbing lack of studies on systemic barriers facing trans* people in Canada, the statistics that are available are bleak. An Ontario-based study by Trans PULSE Project (a community-based research project) found that over half of the trans* people surveyed lived on less than $15,000 per year. A U.S. study published in 2010 found that 28 per cent of respondents postponed medical care when sick or injured because of discrimination, while 19 per cent noted that they were refused medical care because of their gender non-conforming status.

J.R.**, a non-binary-gendered person, told The Daily that the postponement of medical care because of discrimination within the system is a real problem in Canada as well. “I know too many people who are resistant or fearful of trying to navigate medical institutions at all because they know that something could easily come up that makes their potential healthcare provider stop seeing them as worthwhile, or [even] human.”

A common complaint from trans* patients is misgendering – calling somebody by a name other than their preferred name, or using the incorrect gender pronouns. According to J.R., they often have problems with receptionists who don’t know which pronouns or name to use. Gabrielle Bouchard, trans* advocacy coordinator at the Centre for Gender Advocacy, agreed that what could be perceived as small mistakes can stress out and disempower patients. “[As a trans* patient] you know that the very place that is supposed to make you feel better will treat you like a thing to be displayed, [and] judged,” said Bouchard.

Other times, invasive questions that often have nothing to do with the health problem in question can make the system unsafe for patients. “If you go in for [pneumonia], what genitals you have is irrelevant to the problem at hand,” said Bouchard. “There is no correlation between your genitals and any given treatment for [your] lungs, right?”

The acceptance of a person’s identity is also a barrier that faces trans* people in the healthcare system. “Trans* people might not have legal recognition of the identity that they live in their everyday lives,” Bouchard explained, pointing out that the discrepancy of name or legal gender with preferred name and preferred pronouns can result in problematic situations. “Or [their] identity might not fit with what is perceived as ‘normal’ by the healthcare system and personnel.”

“[As a trans* patient] you know that the very place that is supposed to make you feel better will treat you like a thing to be displayed, [and] judged,” said Bouchard.

For J.R., that could lead to health problems – trans* patients sometimes have different health risks than what their medical forms might suggest, especially when taking hormones. “If I have to request information or help from a medical professional who assumes that because there’s an ‘F’ on my medical forms that I have only a ‘woman’s’ set of risk factors to consider, that leaves out a large swatch of issues that need to be taken into account.”

This kind of respect for identities is crucial, Bouchard argued. “Staff and physicians have to understand that it does not matter if they agree with trans* realities or not – they have a job to do and that job is to help people.”

A recent CBC article entitled “Transgender people face strife at the doctor’s office” ostensibly covered the issues that trans* patients face in the healthcare system, but had many problems of its own. Bouchard disagreed with how the article shifted the onus for respectful and safe care onto the patients themselves, rather than the healthcare system. “We’re talking about a systemic problem here […] The problem must be addressed by the system with the help of organizations and people who are in a position to give them good information, not a patient who’s been mistreated in a healthcare setting.”

While many healthcare systems have room to grow, some have begun to implement concrete change. The Canadian Professional Association for Transgender Health, formed in 2007, aims to set voluntary guidelines for healthcare along with other professions. In Toronto, Mount Sinai Hospital implemented a Gender Identity Policy that aims to create a safer healthcare environment for trans*, intersex, and two-spirit patients.

The policy was an “active approach to ensure equitable treatment,” according to Marylin Kanee, Director of Diversity & Human Rights at Mount Sinai Hospital. The policy’s implementation in 2012 came after community consultations were conducted in 2008 with several marginalized communities, as well as a decision by the Ontario Human Rights Commission in 2012 to protect gender identity and gender expression under the Human Rights Code. The policy educates staff on trans* issues and lays out rules for treating trans* patients. It addresses using preferred pronouns and names, placing trans* patients in gender-segregated rooms according to their identification, and so forth.

“The problem must be addressed by the system with the help of organizations and people who are in a position to give them good information, not a patient who’s been mistreated in a healthcare setting.”

According to Kanee, the policy has already made a difference at Mount Sinai. “Sometimes [positive changes are] ‘small’ things like ensuring everyone uses the correct name or pronoun, or a group of nurses reading the policy to decide where is the appropriate and safest room for a transitioning patient,” Kanee explained. However, neither Kanee nor Bouchard knew of any hospitals in Montreal with similar policies protecting the rights of trans* patients.

A number of grassroots organizations based in Montreal do exist to help trans* people find safe healthcare. The Centre for Gender Advocacy offers resources and referrals for trans* people, and also offers workshops for healthcare professionals on trans* issues. Action Santé Tranvesti(e)s et Transsexuel(le)s du Québec (ASTTEQ), also known as Quebec Trans Health Action, advocates for improved access to healthcare through mobilization, education, and so forth. Project 10, a trans* support group for youth and the greater community, maintains a database of trans*-friendly healthcare professionals. There are many more grassroots organizations that can’t fit into a single article, but for the most part, they haven’t been able to penetrate the higher levels of the healthcare system in Canada.

Overall, Bouchard, Kanee, and J.R. all agreed that healthcare providers need to work hard on creating trans*-friendly spaces. “It shouldn’t be up to the patient to try to figure out who is going to be judgmental, mislead or misinform you based on your gender expression, identity, or your race, class, or sexuality,” said J.R. “It’s not the responsibility of trans* people to educate the people who are supposed to take care of them. Basic personal safety and dignity shouldn’t have to be a major consideration in seeking help, the way it is for many trans* people.”

The Daily mistakenly attributed the Ontario-based study to the Centre for Addiction and Mental Health. In fact, the study was carried out by the Trans PULSE project, a community-based research organization. The Daily regrets this error.