Where We Stand
Section: Sexual and Reproductive Health Care
Policy: Protecting Patients and the Practice of Medicine in a Time of Disinformation about Gender-Affirming Care
Appendix W

Protecting Patients and the Practice of Medicine in a Time of Disinformation about Gender-Affirming Care

COMMENTS:

Legislation that intrudes into the practice of medicine and interferes with the patient-physician relationship risks the health and welfare of all patients, but especially of marginalized communities. Major medical associations stand together in opposition to government interference in the patient-clinician relationship and the provision of health care based on the physician’s best clinical judgment and on clinical evidence and the standard of care.[1] [2] [3] [4] [5] Laws that intrude into the privacy of physician-patient communications “compromise the rights of both patients and physicians” [6] and “compromise the patient-physician relationship which is essential to the provision of safe and quality medical care.” [7] Such laws restrict access to care and advance a political or religious agenda at the cost of high-quality medical care and public health. This type of legislation often disproportionately harms women or marginalized groups in our society.

The Oregon Medical Association (OMA) Statement on Gender-Affirming Care has previously stated that “[t]he OMA stands in opposition to any government action that perpetuates any form of discrimination, and specifically we oppose the use of the legislative and legal process to coerce discriminatory behavior from others.” [8] In recent years, socio-political discourse has shifted towards political actions targeting transgender people, including their access to healthcare. There has been a particular focus on the decision of clinicians and parents to allow transgender adolescent children to begin medically transitioning.[9] Conversations around transgender rights and gender affirming care are occurring in a public and politicized space, without adequate consideration and incorporation of peer-reviewed, scientific knowledge into the formation of opinions and legislation, resulting in dangerous situations for those delivering and receiving care.[10] [11] [12] [13] Disinformation, often spreading rapidly on social media, has had an outsized influence on policy decisions despite efforts to combat disinformation by health professionals.[14] [15] [16] Legislative, executive, and judicial actions taking away the rights of transgender people and their access to gender affirming care have continued despite recognition and support of these treatments as the standard of care by major medical associations. Gender affirming care is recognized by major medical organizations to be medically necessary and is associated with reductions in suicide and improved quality of life.[17] [18] [19]

According to Trans Legislation Tracker, a non-profit dedicated to documenting and bringing awareness to the historic rise in anti-transgender laws, there has been a sharp increase in bills nationwide attacking gender affirming healthcare in 2023 (i.e. from 35 in 2022 to 178 as of October 2023). Of the 85 anti-transgender bills that have become law in 2023, those criminalizing gender affirming care, often under the guise of protecting minors’ health or parental rights, make up the largest category.[20] In some states, the act of providing what has been shown to be an important part of standard healthcare for this community is proposed to be a felony, legally equivalent to child abuse. [21] [22] [23] [24] The current rescinding of transgender rights and criminalization of gender affirming care is a clear regression of human rights. It is not only reminiscent of laws from the 1950s and 1960s used to justify the arrest of gender non-conforming people[25] but also paves the way for the legal subjugation of transgender people, and eventually, threatens their rights and safety when presenting authentically in public. Oregon’s new law (as of Summer 2023) expands legal protections for LGBTQ+ people, requiring state Medicaid and some private insurers to cover aspects of gender affirming care, and protects clinicians who render that healthcare.[26] [27] This is an excellent start to protecting the rights of transgender people. However, it cannot stand alone, especially given the lack of robust federal protections for transgender people, and the scale of anti-transgender sentiment spreading across the U.S.

Bills that aim to suppress gender affirming care and impede the integration of transgender people into public life rely on inaccurate and misleading scientific claims and threaten both transgender patients and the healthcare clinicians and family members that care for them.[28] [29] The anti-transgender agenda in legislative and political spaces produces wide-spread fear- mongering and hatred in social media and in-person environments.[30] [31] The spread of disinformation around transgender adults and children, and often drag queens and intersex people concurrently,[32] [33] is actively harming these marginalized groups that are the targets of an increasing number of hate crimes and are at risk of having their constitutional rights infringed upon.[34] Pervasive disinformation surrounding gender affirming care for children and adults is not rooted in factual scientific or medical knowledge, but continues to spread through political commentary disguised as news and on social media and remains a popular source for a portion of the population. Dissemination of messages that lack scientific backing is reminiscent of other recent instances of disinformation that have gained traction, including the beliefs that ivermectin can treat COVID or that vaccines cause autism.[35] [36] Physicians have an obligation to share evidence-based medicine, as is already recognized by the Oregon Medical Board (OMB) and supported by codified Oregon law.[37] The OMB points out that “licensees are respected members of our communities with the power to impact the health and wellbeing of Oregonians. As experts in the field of medicine and health care, they are looked to for advice and guidance, and the public relies on our trusted health care professionals for reliable, unbiased information. OMB licensees are therefore expected to use their voices to share factual, evidence-based information and to correct any misinformation or disinformation that has a potential to harm the public.”[38]

There is also ethical grounding for the protection of gender-affirming care and the clinicians involved in this type of care. At its core, gender-affirming care is aligned with the promotion of human rights and the four principles—autonomy, beneficence, non-maleficence, and justice—as articulated by Beauchamp and Childress over four decades ago. Regarding autonomy, transgender and gender-diverse patients are entitled to rights of self-determination, bodily autonomy, gender expressivity, and informed consent.[39] [40] The principle of nonmaleficence imbues a negative requirement on clinicians, meaning they must not aid in the propagation of bias, stigma, and misinformation surrounding gender-affirming care. Contrastingly, beneficence imbues a positive requirement, meaning there is both a professional and ethical obligation to actively remove barriers to care, advocate for patient's rights, and challenge generational systems of oppression that disproportionately affect marginalized populations. The final principle, justice, is meant to enshrine equity and accessibility in healthcare; under this view, transgender and gender non-conforming patients are “equally entitled to a fair distribution of healthcare resources.”[41]

Harmful narratives around gender affirming care need to be removed from and corrected in socio-political discussions, and policies around health care decisions should be considered from a medical, scientific, and ethical standpoint by qualified professionals. A concerted response by medical associations, healthcare organizations, hospital leaders, communications staff, community organizations, and security and law-enforcement agencies; diligent fact checking by responsible journalists; and removal of disinformation by social media platforms is necessary to counter the effects of disinformation.[42] The regulations and laws proposed in anti-transgender legislative campaigns are incompatible with the fundamental ethical principles of health professions and the doctor-patient relationship and would subject patients, parents, physicians, and educators to scrutiny associated with criminal penalties.[43] [44] These actions represent deprivation of rights under color of law and are incompatible with the values and foundational principles of the Oregon Medical Association. The methods of this public and political anti- transgender movement stand as a cautionary example of how discrimination can intrude into health care and distract from the very real and pressing health concerns facing Oregonians and communities across the country. Medical professionals and medical associations are uniquely positioned to counteract disinformation and have an obligation to advocate for all patients’ rights and their access to healthcare. These policy recommendations directly support the OMA’s mission to promote equitable and accessible healthcare and conserve the ability of physicians and PAs to safely practice medicine.

*** For this reason, some sources cited in this commentary are not from peer-reviewed journals.

List of articles for further reading: (not directly referenced in the text)

McNamara M., Abdul-Latif, H., Boulware, S., Kamody, R., Kuper, L., Olezeski, C., Szilagyi, N., & Alstott, A. (2022). A Critical Review of the June 2022 Florida Medical Report on the Medical Treatment of Gender Dysphoria. Available from: https://medicine.yale.edu/lgbtqi/research/gender-affirming- care/florida%20report%20final%20july%208%202022%20accessible_443048_284_5517 4_v3.pdf

OregonLaws: Online Oregon Law Library. (n.d.). ORS 677.188 – Definitions for ORS

677.190. Retrieved November 9, 2023; Available from: https://oregon.public.law/statutes/ors_677.188

Oregon Medical Board. (2005). Professionalism: Statements of Philosophy. Retrieved November 8, 2023; Available from: https://www.oregon.gov/omb/board/Philosophy/Pages/Professionalism.aspx

Oregon Medical Board. (2016). Social Media: Statements of Philosophy. Retrieved November 8, 2023; Available from: https://www.oregon.gov/omb/board/Philosophy/Pages/Social-Media.aspx

Oregon Medical Board. (2021). Cultural Competency: Statements of Philosophy. Retrieved November 8, 2023; Available from: https://www.oregon.gov/omb/board/Philosophy/Pages/Cultural-Competency.aspx

Reed, E. (2023). Anti-Trans Court “Expert” Couldn’t Name A Single Medication For Blocking Puberty. Available from: https://www.erininthemorning.com/p/anti-trans-court- expert-couldnt-name

Reed, E. (2023). No, Trans Hormone Therapy Does Not “Increase Heart Disease By 95%.” Available from: https://www.erininthemorning.com/p/no-trans-hormone-therapy- does-not

Reed, E. (2023). “Rapid Onset Gender Dysphoria” Republished In Junk-Science Journal With A Shady Record. Available from: https://www.erininthemorning.com/p/rapid-onset- gender-dysphoria-republished

The Oregonian. (2023). House Bill 2002: Oregon Legislature Bill Tracker. Retrieved November 9, 2023; Available from: https://gov.oregonlive.com/bill/2023/HB2002/