Facing the end of life can certainly be a scary and uncertain time and may be fraught with additional challenges such as discrimination and prejudices for members of the LGBTQ community. The LGBTQ community has historically faced bias and marginalization, and, sadly, this continues to be a problem and concern in current times. The end-of-life transition is a critical period in every person’s life, and it is my belief that everyone ought to feel free to be themselves and to be with the people they love without fearing that they will receive inferior medical care. A 2019 study on palliative care for LGBTQ patients found that the fear of discrimination often prevented LGBTQ patients from expressing their needs, and subsequently receiving less care and having needs go unaddressed and unmet. As an End of Life Doula, I tend to the needs of all my patients with the utmost care and sensitivity, honoring and respecting each person’s sexual orientation as part of their unique life and experience.

Some members of the LGBTQ community have grown to distrust hospitals and health providers due to a history of bias and discrimination from medical providers against LGBTQ patients. This lack of trust makes transitions in care especially difficult, as it means introducing new settings and providers, and increases the chances for LGBTQ patients to encounter adverse discrimination. Some LGBTQ patients do not even disclose their orientation or gender identity out of fear that they will be misunderstood and that their medical care will be negatively impacted. Not only does this bring pain on an emotional level for the patient, it can result in diagnoses and treatments that are inaccurate and ill-suited to the patient. I provide open, secure, and affirming communication that allows me to build trust and respect with my patients so that they feel safe bringing all of their concerns and questions to me. Being able to be open and honest without the fear of rejection and discrimination is immensely helpful in relieving patients of the draining emotions they likely have around facing death.

A big concern around any end-of-life experience is addressing the emotional and spiritual needs of the dying person and their loved ones. Some LGBTQ individuals may not have access to the same spiritual or religious reassurance that heterosexual, gender-normative people do. Not all religions are inclusive or tolerant of LGBTQ identities and family structures. All people are born into this world, and someday return into the unknown through death, and we all deserve comfort and a hand to hold as we navigate the spiritual journey of the end of life. A common question asked about death is what comes after it? Being able to discuss this safely with someone who affirms the inherent value of your life and existence makes a dramatic difference in being able to approach death with a sense of peace instead of fear and shame. 

Furthermore, LGBTQ patients’ spouses, partners, and families may struggle when grieving if their relationship is not recognized, or is dismissed, publicly or privately. LGBTQ people and their loved ones may feel pressure to hide their grief if their relationship is not acknowledged, resulting in disenfranchised grief. Disenfranchised grief can lead to reduced levels of support, due to sources of support not realizing help is needed, as well as due to bereaved loved ones refraining from reaching out. Often in medical establishments, only family and kin are allowed to visit ailing patients. If the relationships between the LGBTQ patient and loved ones are not recognized, partners and non-kin family might be turned away when seeking to visit. I encourage openness and inclusion of people important to the dying person and am able to provide continued emotional and spiritual support and guidance to grieving loved ones.

As a Patient Advocate and End of Life Doula in San Antonio, Texas, I’ve taken specialized training through the national organization Sage. Sage is a national organization that provides advocacy and services for the LGBTQ community. The SageCARE training is specific for the LGBT community and ensures that I will treat you and your family with the utmost respect and care. Feel free to Contact Me today for more information.

Almack K., Seymour, J. and Bellamy, G., 2010. Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders Sociology. 44(5), 908-924

Cloyes, K. G., Hull, W., & Davis, A. (2018). Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers. Seminars in oncology nursing, 34(1), 60–71. https://doi.org/10.1016/j.soncn.2017.12.003

Oliviere D., Monroe B., Payne S., (Eds), (2011) Death, Dying, and Social Differences: 194-6