Transcript Transgender Transformation - Right to

Transgender Transformation
Right to Healthcare
Presented by:
Angie Coleman
Ana Gutierrez
Claudia Gonzalez
Jeannie Pezzano
Layza Mendre
Noblia Cruz
LaVerda Augustine
Pop Quiz : Is It Ethical & Moral?
1. Mr. Scott flew from NY to FL- to claim his 21year-old son’s belongings who passed away in a
car crash. The father was not listed in the ROI consent. The hospital clerk knew the hospital’s
rules; however, she granted Mr. Scott request. The clerk thought it was right to prevent Mr.
Scott from staying longer in FL. The clerk’s action was __
a. Ethical
b. Moral
c. Both
2. Mr. Louis White used to be Laura White until one year ago. Now Mr. White wants to update
his record (gender). Dr. Rhonda agrees that he looks like a man but she refuses to change his
Female gender in his record because the H&P still shows cervix and ovaries organs. Rhonda’s
action is ___
a. Ethical
b. Moral
c. Both
3. Mrs. Cruz was taken to ER with life-threatening injuries from a car crash. She lost so much
blood, so Dr. Dimitri ordered blood transfusion. Later, Dr. Dimitri received Mrs. Cruz’s records
from other state and it states that she cannot receive blood due to religious beliefs. Dr.
Dimitri’s action is ___
a. Ethical
b. Moral
c. Both
Ethics Vs Morals Decision-Making?
Ethics:
Refer to rules established by external sources; such as: groups,
organizations, or culture. It disregards individual’s feelings and
desires.
 Codes of conduct in workplaces (e.g. lawyers, policemen,
doctors, students follow standards of ethical code in their
organizations - professions).
Morals:
Refer to individuals own principles and beliefs of what is right
or wrong. It is usually influenced by culture, society, & religion.
 Kentucky county clerk, Kim Davis, denied marriage licenses to
same-sex couples because of her moral beliefs (morality
influenced by religion). She failed to comply with state law and
went to jail. It was unethical.
Pop Quiz : Is It Ethical & Moral?
Answers
1.
b. Moral
2.
a. Ethical
3.
a. Ethical (prevent EMTALA lawsuit)
b. Moral (Hippocratic Oath)
c. Both
Terminology
Transgender (broad term):
Relates to a person (transsexual or transvestite) who
identifies with or expresses a gender identity that differs from
the one which corresponds to the person's sex at birth
Gender Dysphoria (GD)(medical term):
Medical condition in which there is a conflict between
a person's physical gender and the gender he or she
identifies with. The person is very uncomfortable with
the gender he/she was born as.
 Signs and symptoms from/at very young age (e.g. 2 - 5):
• Suffer from depression, anxiety, withdraw from social interaction, feel
alone.
• Are disgusted by their own genitals
Terminology Cont.
 Transsexual:
A person who medically changes himself or herself into
a member of the opposite sex
 Driven by psychological needs and not for pleasure
 Transvestite:
A person who likes to dress like a person of the opposite
sex (especially a male) for purposes of emotional or
sexual gratification
 Intersex (Hermaphroditism):
Discrepancy between the external genitals and the
internal genitals (the testes and ovaries)
The Genderbread Person
Step 1: Identify the ethical question
 Is it ethical for a healthcare provider to deny healthcare
needs to transgender individuals based on the provider’s
own sense of morality?
Step 2: What are the facts?
• Legislation vary from state to state
Lack of
• Limit the assurance of transgender’
legal
rights of care
definition &
legislation • Unmonitored treatment protocols &
cost of care
Lack of
Medical
Scientific
Studies
• Leads to misdiagnose transgender
patients
• Inaccurate statistical of transgender
population
• Absence of evidence-based to create
protocols
 Discrimination and exclusion
 Few medical specialists lead GD
to fall onto unlicensed physicians
 Increase cost of care (no health
care coverage)
 Cosmetic vs medical need surgery
 Mental disorder ≠ Gender
dysphonia
 NCTE estimates there are about 3
millions transgender people
 Physicians are skeptics on how to
treat GD
Step 2: What are the facts? Cont.
Lack of
Education
• Inability to distinguish between
transgender, transvestite, and intersex.
• Create a lack reliable communication
between patients and physicians
• Cause social ostracizing and/ bulling
• Discrimination, humiliation
Perception • Religion beliefs
of the rest of • Consequences
society
 Promote better and equitable
legislation
 Acknowledge that transgender is
not a disease or birth defect
 Creates psycho-social support
 Cause stigma and exclusion
 Discrimination may cause
transgender to hurt themselves
Step 2: What are the facts? Cont.
• It is a birth defect that can be
Transgender corrected with hormones and surgery
• All transgender people want or have
True or
had sex reassignment surgery
False?
• Can identify by their appearance?
New
Identity
• Social transition is needed
• Legal identity
• Different rights due to new sex
• Medical record gender change issues
 False
 False
 False
 No EHR meaningful-use objectives
 Appearance, new standards and
habits
 Change legal name, SSN, driver
license, passport, birth certificate
amendment, school records, etc.
 Acquire new sex rights and duties
Step 2: What are the facts? Cont.
• Low number of specialists in the
Cost of care transgender transformation
influenced • Lack of insurance coverage
by
• Extended physical, psychological, and
counseling care
• The transformation process of two-years
$ 20,000
has an average cost of ____________.
Common • The genital surgery of _______,
$17,000 _______for
$1,000
cost of care therapy, $1,500
$500
_____for hormones, and _____for
doctors’ visits and lab tests.
• Extended care, medications
 Makes care and treatment more
expensive and patients suffer
because many of them cannot
afford those cares
 Few facilities, few doctors VS large
number of patients)
 No EHR meaningful-use objectives
(COPs)
 Continuous hormones treatments
and possible complication due to
excess of hormones and drugs site
effects
Step 2: What are the facts? Cont.
Step 3: Identify the Stakeholders
Individual
Values
Community
Transgender
Community
Organization
Values
Legal
Step 3: Identify the Stakeholders. Cont.
How transgender is perceived by different sectors of the society?
 Individual Values
 Beliefs (personal identity, right to be
different, rights to be accepted)
 Organizational Values: Standards,
protocols, regulations
 Health care providers (physicians, nurses, HIM)
 Culture
 Insurance companies
 Rights
 Scientific studies (evidence, education, lack of
studies)
 Legal: Legislations
 Constitution
 Human Rights
 Legislators (vary by states)
 Community: Local and national
 Religion community (faith, taboo,
misconception)
 Education / Schools (imitation, bullying,
counseling)
 Social media (psych-social influence, isolation)
 Supporters vs opponents
Step 4: What are the options in this case?
 Accommodate Transgenders:
 By providing quality healthcare
• Increase awareness by education in the medical field
• Education should include a transgender sensitivity outline for the workplace
 Create laws that should stop discrimination by health insurances towards transgender patients
 Standardize Transgender Surgeries
• Must go through pre surgery evaluations, post surgery therapy and lifelong hormone balancing
 Government to give incentives for research on Transgenders
 Change EHR’s to reflect sex change both before and after
 Do not Accommodate Transgenders:
 Theories suggest that trans genders that have not undergone reassignment surgery have a higher
life expectancy
 Gender Reassignment is not medically necessary and should not be paid for by health insurance
companies
 To accommodate these individuals in the health record could potentially be life threatening
 Be as God intended to be
Step 5: What should be done?
We have decided that it is ethically correct
to accommodate transgenders in health
care facilities by modifying policies,
procedures and improving the quality of
services that are provided to these
individuals.
Step 5: What should be done? Cont.
 Develop a code of conduct in medical facilities with regulations respecting
patients with Gender Dysphoria. These code of conducts must enforce their
constitutional and human rights
 Create clinical and administrative standards and protocols that will educate staff
on how to address transgender patients
 Require staff to complete an educational sensitivity training program on how to
treat transgender patients
 Identify clinical staff that may have prejudice towards trans genders and address
any issues ( to prevent that it becomes a discrimination lawsuit)
 Offer transgender patients a survey to monitor the quality of care and treatment
being received
 Allow an option in EHR to identify gender and sex before and after the surgery
although not altering the medical necessity and identification of birth sex.
Step 5: What should be done? Cont.
Create a Standard of Care
1
2
3
4
5
• Counseling with a mental health specialist to determine mental state and whether they have
gender dysphoria (GD) or not.
• Oversee the environment the individual lives in and whether a support system is present.
• Educate the individual regarding options, treatments, therapy and length of process, etc.
• Thorough planning of treatment between all involved such as physicians, therapists,
psychiatrist, family, etc.
• Continuously following hormone therapy regimen and schedule.
6
• Coordinating with physician and proper personnel regarding subsequent surgeries and
supporting treatments.
7
• Counseling for the post operative patient and relatives and/or support system involved in care
Step 5: What should be done? Cont.
Education &
Training
Protocols
Code of
conduct
Survey the
Overall
care/
Standardize
Accommodate Transgender patients
Ensure equal quality of care
Step 6: What justifies your choice?
 Deontological Theory:
Society has a duty to accommodate
transgender health care needs.
Analysis of Principles
Beneficence
Justice
Patient-Centered Care
Non-maleficence
Right based
Step 6: What justifies your choice? Cont.
 Analysis of Principles
 Beneficence: promoting acceptance and education among the population, so
transgenders get better support from other sector of the society. Healthcare
professionals is to do good for all patients.
 Justice: making transgender individuals part of the society as anyone else
 Nonmaleficence (forbids): preventing that transgenders people feel shame,
loneliness, depression, rejection, etc. by treating them equal
 Patient-centered care: promoting and improving scientific studies that help the
transgender population getting the proper care. Improving relationship and
communication between physicians and transgender individuals
 Right based: enforcing transgender human rights brings sense of freedom to
them and their loved ones.
Step 7: How can this ethical problem be prevented?
 Collaboration (join efforts to promote the changes)
 Clinical Protocols and Code of Conduct (Ethical environment)
 Community involvement
 Family & friends support
 Approach to change (Cornerstone culture)
 Education/training
 Positive experience
 Respect for person gives the sense of
 Dignity
 Enforcing confidentiality
 Equality of care – Ethical
 Non-judgement (be compassion)
 Fairness
 Integration
Conclusion
 Ethics: refer to established rules, standards, code of conducts
 Morals: refer to personal beliefs of what is right and wrong
 Legislation: law structure, financial budget
 Research studies to create medical evidence-based standards
•
Allow the creation of protocols for treatments, procedures, etc.
•
Facilitate the HIM professional with the accuracy of
o Actual gender identity of the patient’s record (for ROI, statistical data)
o Coding (e.g. Pdx: Gender identity disorder F64.1, Sdx: Reassignment surgery status Z87.890 and link them
with Pcs: Surgical excision of male reproductive system (Penis) 0VBS0ZX)
•
Increase number of licensed specialists who can treat GD patients
 Promote insurance coverage based on medical necessity
 Education: health professionals, community, etc.
 Having a better understanding about transgender emotional and acceptance issues because they
are at risk of hurting themselves
 Provide equal quality of care to transgender individuals and improve their quality of life are
topics that need more consideration and compassion by the community in general
 This presentation was very enlightening to distinguish ethic from moral values . . .
Gender Dysphoria Diagnosed at Young Age
(True story - excellent books)
 Hillary’s and Jeff’s journal of their five-year-old son
Ryland’s transition from girl to boy
 Jazz Jennings: A transgender girl born in a boy’s body.
Her parents noted that Jazz was clear on being female
as soon as she could speak.
It was until Jared was 4-year old when he, now she
was diagnosed with gender dysphoria
Gender Dysphoria (Transgender)
 This is a gender identity condition, not a disease (individuals are born with it)
 Our goal: bring to light the issues that transgender individuals face every day
 The first step is to get education about this topic. Enjoy this video. . .
Life As A 5-Year-Old Transgender Child
References

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
http://alfa-img.com

http://www.cirp.org/library/legal/USA/haas1/

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
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
http://dailybruin.com/2016/02/05/ucla-ashe-center-takes-steps-to-improve-lgbt-health-care/

http://www.diffen.com/difference/Ethics_vs_Morals

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
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
http://www.gendercentre.org.au/resources/polare-archive/archived-articles/illustrating-be-who-you-are.html

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
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
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
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
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
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
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
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
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
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
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
https://www.probe.org/what-is-a-biblical-view-of-transgendered-people-and-hermaphrodites/

http://www.religiousinstitute.org/acting-out-loud/transgender/

https://transgenderequality.wordpress.com/2012/03/

http://thinkprogress.org/lgbt/2012/12/03/1271431/apa-revises-manual-being-transgender-is-no-longer-a-mental-disorder/

http://time.com/3599950/intersex-meaning/

https://www.youtube.com/watch?v=kVmau1cM5TU#t=11