Clinician referral and conscience
How does clinicians' treatment of transgender people affect their families?
Family members may want to discuss their reactions to a transgender relative's ability — or inability — to access care from Christian or non-Christian providers. Research indicates that a shortage of knowledgeable providers is the largest barrier to transgender health care, followed by discrimination and other systemic barriers. Family members may bring mixed feelings about scenarios like:
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their relative wanting care that simply isn't available locally
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local providers being capable but unwilling to provide it
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their relative experiencing rejection or judgment while seeking care
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(in some cases) relief, surprise, or shock that care was obtained at all
One helpful reframe for processing these feelings with families: How would you, as a clinician, want another provider to treat one of your own transgender loved ones?
This also raises a genuinely contested question: under what circumstances should a clinician refer a transgender patient elsewhere for transition-related care? Some medical professional groups hold that Christian providers shouldn't be required to provide treatment they believe is morally wrong or harmful — for example, prescribing medication or writing letters supporting a minor's transition. But what's the right course when a physician is capable of providing care but believes it may be harmful? Secular ethicists note the physician's obligation to provide non-emergency care isn't clearly defined (McCoy, 2006), and the AMA's Principles of Medical Ethics allow physicians to choose whom they treat outside emergencies — though this sits alongside ACA Section 1557's non-discrimination protections around gender identity in insurance coverage (more in the Clinical History section).
Where a physician is simply unfamiliar with transgender care standards rather than morally opposed, referral may be the better option; secular ethicists recommend a harm-reduction approach to such referrals when options are limited (Dietz & Halem, 2016).
For mental health clinicians specifically, a related tension can arise when a client professes strong Christian faith and the clinician assumes that faith and transgender identity are incompatible. Two articles explore when referral is ethical versus discriminatory:
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Cox, M.R. (2013). When Religion and Sexual Orientation Collide. Counseling Today.
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Dessel, A.B. et al. (2017). LGBTQ Topics & Christianity in Social Work. Social Work & Christianity, 44(1–2), 11–30 — see "Referring LGBTQ Clients," pp. 17–19.
Further reading: Barsky (2019); Gerritse et al. (2018); Hruz (2020); Kaplan (2014); Kimberly et al. (2018); Reamer (2014); Swann & Hebert (2009).
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