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Meeting the spiritual needs of LGBTQ patients

Rafael Goldstein, Rabbi H. DMin, BCC

doi: 10.1097/01.NME.0000454752.59250.f3
Department: ask an expert
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Rabbi H. Rafael Goldstein is the Chief Chaplain at The Mount Sinai Medical Center in New York, N.Y.

The author has disclosed that he has no financial relationships related to this article.

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Q: Do LGBTQ individuals have spiritual needs when they're in the hospital?

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A: The answer seems pretty clear to me as a spiritually committed gay man. I've witnessed and experienced the struggle for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals to accept themselves as they are in a society that has only recently come to terms with recognizing sexual orientation and gender identification.

In the “olden days” just a few years ago, most LGBTQ people faced discrimination, negativity, and rejection from all parts of society, including the government. It has only been a few years since LGBTQ individuals have been accepted in the military. Marriage equality is still a work in progress, although the Supreme Court's decision just last year made a huge difference. States continue to contest marriage equality, and the Supreme Court will have to rule again on this issue. The Boy Scouts continue to discriminate against gay men as leaders. It's clear that although there has been progress, a lot of work remains to be done.

Religion was used as a basis for rejecting LGBTQ people, citing Biblical passages, or other religious texts, to “prove” that rather than embrace LGBTQ individuals, they were to be outcast, condemned, and excoriated. Again, there has been tremendous progress in the last few years, most notably Pope Francis asking “Who am I to judge?” Many religious movements have come to embrace LGBTQ individuals. The debate remains in many denominations, but there has been a trend toward acceptance and openness, even as LGBTQ individuals are still often denied ordination and leadership positions.

There will always be people of faith who reject LGBTQ individuals in the name of religion, but it's no longer the only approach available. Discrimination remains, in the name of God, society, and country. There are countries where just living as an LGBTQ person is a crime; in some places, punishable by death. Yet, somehow, despite the rejection experienced by many LGBTQ individuals from their own religions, many of us have been drawn to spiritual and religious observance.

Rejection hasn't necessarily deprived LGBTQ individuals of their access to God, their Higher Power, Universal Energy, or whatever they believe might be out there. Despite the rejection, many LGBTQ individuals have consistently been members of congregations that embrace them, and when there were no embracing congregations, formed their own. LGBTQ individuals have also been leaders of spiritual movements. At a recent LGBT health workers conference, when asked if the participants in a workshop were “spiritual” and/or “religious,” the vast majority responded that they were.

When people come into the hospital, they're experiencing their most vulnerable of moments. Being in a hospital can be scary for anyone. Most patients experience a sense of loss during a hospitalization: loss of health, loss of place in their daily lives, potential loss of income, loss of autonomy, loss of control over life's circumstances, loss of dignity, loss of privacy, and loss of identity. People who come into the hospital may be confronted with menus that don't reflect their eating habits, schedules that are contrary to what they're used to, roommates with their own issues and families, the discomfort of the illness itself, and/or just a bed that they aren't used to. When patients wear hospital gowns and are identified by room and bed location, the experience can be potentially dehumanizing.

When one adds in the fact that the patient is LGBTQ, the stress level rises. Can the patient rely on staff members who are well-trained to treat everyone equally? Will care be different if a patient comes out as LGBTQ to staff? Does it make a difference in the treatment plan? From a patient's perspective, the question is if it's safe to be him- or herself when incredibly vulnerable in the hospital that can be a microcosm of society at large. Not only do LGBTQ patients have to confront issues of the illness that brought them to the hospital, they have to ascertain whether they're safe from discrimination and whether the staff will treat them appropriately when their sexual orientation or gender identification is known.

Additional complexity may also arise from the family/loved ones of the patient. Until very recently, LGBTQ family members have been denied access to patients in ICUs or other care facilities because they aren't traditional family members. Although there's now an executive order from President Obama that “nontraditional” family members be provided access, there may remain places that deny access and/or treat family members differently than other families. And involvement of these family members by definition “outs” a patient who may not have wanted his or her sexual orientation or identification known.

Many hospitals have religious connections in their history, such as at Mount Sinai Health System where I work, or are actively run by a religious denomination. Is an LBGTQ patient in a Catholic, Lutheran, Baptist, or Presbyterian hospital safe from discrimination? In addition, are his or her spiritual needs going to be addressed or will there be an erroneous assumption that because the patient is LGBTQ, he or she doesn't have spiritual needs? Do chaplains visit LGBTQ patients as they would other patients or do they assume a lack of religious/spiritual concern? The vast majority of patients pray when they're in the hospital, including LGBTQ patients.

Jewish patients are also very reticent to have chaplains visit. The typical Jewish patient presumes that a representative of any religion, or even no religion, with a chaplain title is looking to convert him or her. If asked if they would like a visit from a chaplain, almost all Jewish patients will say no. I suspect that LGBTQ patients have the same lack of trust, unfounded fears, and reticence about working with chaplains, denying themselves spiritual assistance from which they might benefit.

Very little has been published about LGBTQ spirituality in the context of healthcare but as a minority that has in many ways been persecuted, it can be inferred that these issues are worthwhile to address, which may be helpful in bringing healing, strength, and hope to all of our patients, our staff, and our community.

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