Diversity in LGBTIQ+ communities and implications for palliative care

Diversity in LGBTIQ+ communities and implications for palliative care

A blog post written by Hannah Morgan, National Palliative Care Project Coordinator, LGBTIQ+ Health Australia

LGBTIQ+ community diversity

It’s tempting, and often easier, to think about people who are LGBTIQ+ as one collective group who all share the same needs, wants, and life experiences. Yet, apply this same logic to heterosexual folk and you will quickly see how unhelpful this thinking is.

While many people who are LGBTIQ+ have a shared understanding of what it feels like to come up against discrimination and stigma and to overcome adversity, there are many differences across LGBTIQ+ communities that need to be considered.

Understanding the concept of intersectionality can help us to gain more clarity about what differences can look like and why it is so important to bring this perspective to health care settings. As members of the CareSearch portal review group for Community, LGBTIQ+ Health Australia is pleased to note that information on intersectionality and inclusive practice is included.

Intersectionality in LGBTIQ+ communities

Intersectionality is a term that was coined by American Lawyer Kimberlé Crenshaw in 1989. The term was originally a critique around race and gender and how this had been neglected in critical race theory.

Intersectionality provides a framework where we can see how social justice problems such as racism, sexism, homophobia, transphobia and ableism overlap, and how this can result in multiple layers of social injustice. When we look through an intersectional lens, we can better understand the various privileges and barriers a person may face.

There are many factors that impact someone’s access to appropriate health care. While someone who is transgender and gay may face a range of barriers when accessing health care, they may experience more equal access to care if they are Anglo-Saxon, male and able-bodied.

It should also be noted that some people who are LGBTIQ+ may be open about these different parts of themselves, while others may choose not to disclose this information.

In general health care as well as palliative care, it is important to assume that any person you provide a service to may be LGBTIQ+, even if they never tell you this.

LGBTIQ+ inclusive practice in palliative care: a case study

A man diagnosed with a life-limiting illness (ovarian cancer) who was assigned female at birth, and who did not feel any connection to the notion of being transgender, required palliative care at a hospice.

His wife was aware that he had been assigned female at birth, but their children were not aware. The man did not want his children to know about the fact that he was assigned female at birth.

The palliative care/hospice team upheld his privacy and confidentiality and were able to provide an excellent palliative care experience for him. He died with his family by his side, with his assigned sex at birth never coming up. [1]

What LGBTIQ+ palliative care experiences do we need to understand better?

Over the past year, LGBTIQ+ Health Australia have been undertaking a scoping review about people who are LGBTIQ+ in palliative care and health professionals’ understanding of people who are LGBTIQ+ who require palliative care. This scoping review has shown us that much less is known about some experiences within the LGBTIQ+ population.

More research is needed to find out about the palliative care experiences of people who are intersex, with the acknowledgment that intersex people can be cisgender and heterosexual and are not always connected with the LGBTQ+ community.

Non-binary people are also not mentioned in the literature. Little is known about the experiences of bisexual people in a palliative care context. The experiences of LGBTIQ+ Aboriginal and Torres Strait Islander people including Brotherboys and Sistergirls, as well as the experiences of LGBTIQ+ people from culturally and linguistically diverse backgrounds, are also under-researched areas. We are hoping to find out more about these intersectional groups in the research we are currently conducting.

You can learn more about inclusive palliative care practice by accessing our tip sheet poster resource.

Reference:

  1. Stevens EE, Abrahm JL. Adding Silver to the Rainbow: Palliative and End-of-Life Care for the Geriatric LGBTQ Patient. J Palliat Med. 2019 May;22(5):602-606. doi: 10.1089/jpm.2018.0382. Epub 2018 Dec 4.

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Hannah Morgan, National Palliative Care Project Coordinator at LGBTIQ+ Health Australia

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The views and opinions expressed in Palliative Perspectives are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health and Aged Care.