LGBT bioethics: Visibility, disparities, and dialogue

Despite the legalization of same-sex marriage in 19 states and the District of Columbia and an executive order to prohibit federal contractors from discrimination against lesbian, gay, bisexual, and transgender employees, LGBT individuals face tremendous hurdles in access to health care and basic human rights. A special report published by The Hastings Center, LGBT Bioethics: Visibility, Disparities, and Dialogue, is a call to action for the bioethics field to help right the wrongs in the ways that law, medicine, and society have treated LGBT people.

The editors are Tia Powell, founder and director of the Einstein-Cardozo Masters of Science in Bioethics program and director of the Center for Bioethics at Montefiore Medical Center and Albert Einstein College of Medicine in the Bronx, and Mary Beth Foglia, an affiliate faculty member in bioethics and humanities at the University of Washington and a health care ethicist with the Department of Veterans Affairs.

The contributors include award-winning author Andrew Solomon and leaders in health care, law, and ethics. One writer, Jamie Lindemann Nelson, is a transgender bioethicist who explores the role of science in the search for identity by transgender people.

In their introduction, Powell and Foglia outline the singular role that bioethics can play in ongoing efforts to ameliorate the injustices that LGBT people experience. They recognize the ways in which bioethics has helped other vulnerable populations: effecting policies to reduce abuses of research participants and helping to establish the ethical and legal framework concerning end-of-life care. "However, bioethics has only rarely examined the ways in which law and medicine have defined, regulated, and often oppressed sexual minorities," they write. "This is an error on the part of bioethics."

Several commentaries focus on specific populations: children and adolescents, LGBT seniors, LGBT veterans, and LGBT patients in the public safety net.

Two articles critically examine the belief that sexual orientation is biologically determined. Andrew Solomon cautions that findings about the origins of any stigmatized condition, such as a disability, have been used "to erase it, by either treating it or taking measures to prevent it." He looks to bioethicists to consider the implications for "LGBTQ" individuals – including the possibility of "extirpating a community and an identity" – and to "help build a social consensus as to how and whether such potential knowledge should be exploited and by whom."

Another article questions the scientific basis for "born that way" assertions and argues that "claims about innateness, immutability, and lack of choice about sexual orientation should not be the primary basis for LGB rights." The authors, Tia Powell and Edward Stein, professor of law and the director of the Gertrud Mainzer Program in Family, Law, Policy, and Bioethics at Cardozo School of Law in New York, write that "thoughtful and respectful analysis of the development of crucial aspects of human identity, including the development of full variety of sexual orientations, is a better route toward understanding and civil rights."

In releasing this report, Hastings Center President Mildred Solomon calls on the scholarly bioethics community to do much more to rally health care leaders and policy makers to ensure the human rights of LGBT persons. "This set of essays breaks new ground in articulating the reasons why LGBT persons must be respected – not because they are "born that way" but because they have inherent worth," she says. "We must respect individuals' rights to live authentically. The ideas in this publication are a virtual call to arms to the bioethics and health care communities."

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For more information and a list of authors, see the table of contents and abstracts.