Caring for an Unconscious Transgender Patient at the End of Life

Abstract

Individuals who identify as transgender (trans) or other gender-diverse identities are highly marginalized populations within the United States health care system. Transgender individuals experience a broad range of health disparities leading to devastating health outcomes. Experiences with discrimination and biased care often result in a lack of trust in providers and reduced care seeking, yet providers frequently rely on communication with trans patients to build competence. Consequently, when a trans patient has restricted communication, whether due to biological or psychological reasons, their care can be further disrupted. The nursing code of ethics compels the provision of competent care to all patients, regardless of demographics or gender identity,

Applied patient-level palliative care interventions designed to meet the needs of sexual and gender minorities: A scoping review and qualitative content analysis of how to support sexual and gender minorities at end of life

“…End of life teams also anticipated and responded to systemic challenges particular to their sexual and gender minority patients. A case study by Lippe et al 47 reflects on the systemic barriers encountered when providing care to a transgender person at end of life including anti-trans attitudes and violence within healthcare that affect both the transgender individual and their loved ones. In response, Lippe et al 47 describe having applied a structured approach to anticipating ethical questions and reflecting on one’s biases in this circumstance.…”

“…A case study by Lippe et al 47 reflects on the systemic barriers encountered when providing care to a transgender person at end of life including anti-trans attitudes and violence within healthcare that affect both the transgender individual and their loved ones. In response, Lippe et al 47 describe having applied a structured approach to anticipating ethical questions and reflecting on one's biases in this circumstance. Lopez and Getzel highlight how the Gay Men's Health Crisis responded to abuse, neglect, and prejudice encountered by gay men living with AIDS when accessing the healthcare system and social service organizations, and how they integrated advocacy into their service approach.…”

Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals

“…Palliative care for TGNC patients is complicated by a multitude of legal and policy issues that may prevent providers from contacting any individual not legally identified as next of kin or a health care proxy. Families of origin or families of choice may not have been involved in the person's care, yet may need bereavement and additional support that address “disenfranchised grief,” wherein the mourning process is disrupted by stigma, a lack of social recognition, and invalidation of identity 23…”

“…Families of origin or families of choice may not have been involved in the person's care, yet may need bereavement and additional support that address "disenfranchised grief," wherein the mourning process is disrupted by stigma, a lack of social recognition, and invalidation of identity. 23 The roles and responsibilities of family caregivers are multifaceted and demanding, often affecting all domains of quality of life. 24 TGNC patients are less likely to have as caregivers legal partners or adult children (the most common types of caregivers) and more likely to have friends or families of choice.…”

Healthcare needs and assets of gender diverse older adults: A systematic integrative review

“…Campbell and Catlett (2019), the authors provide recommendations for meeting the transgender participant's spiritual needs, including advocacy for spiritual care, creation of safe spaces for spiritual expression, clinician development of skillful means through education, and affirmation of gender identity. And inLippe et al (2021), an outline for transgender-inclusive primary palliative care is provided integrating the concepts of cultural humility, moral archaeology, and a palliative communication framework. Although many of the recommendations are consistent with those described for gender diverse older adults in other studies in this review, they are based on a small sample, indicating a need for more research in the realm of palliative and end-of-life care for gender diverse older adults.…”