Advancing inclusive health care for people who identify as 2SLGBTQIA+

News & Updates | September 8, 2023 | Dying With Dignity Canada

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A black and white headshot of Keri-Lyn Durant

Keri-Lyn Durant recently defended her dissertation and received her PhD from Lakehead University. Her research interests include the use of digital storytelling in grief and bereavement, 2SLGBTQIA+ aging, palliative care and end-of-life care, and medical assistance in dying (MAID). She is also an applied theatre specialist and puppeteer; Keri-Lyn is the voice of Phoebe, an inquisitive sloth puppet, who talks with children about death. We talked to Keri-Lyn about her work in, and the importance of, compassionate end-of-life care for those who identify as 2SLGBTQIA+.  

You helped develop a resource called Speaking Up and Speaking Out with Kathy Kortes-Miller, a toolkit for health care providers to aid health care professionals in offering inclusive care that addresses the needs of 2SLGBTQIA+ older adults. It is currently being revised but can you comment on the reason for its creation and the planned outcomes?

Kathy and some colleagues are part of The Diverse Experiences in Aging Research (DEAR) Collaborative, an interdisciplinary, inter-institutional research group whose goal is to account for and understand diversity in aging. They were hearing from gerontological circles that elder 2SLGBTQIA+ people were experiencing barriers to access in their health care. It’s one thing to slap a sign on your door that says, “We are inclusive,” but the people inside the facility need training and resources. People have the best of intentions but there is some work to be done to actually create inclusive and safe spaces. Saying that, health care professionals are already burdened and often overworked, so what we were trying to create was something that could be applied practically with actual tangible resources.  

Can you share some of the recommendations you developed?  

There was a section on ways that you can show inclusivity from the threshold. You start with the sign on the door and then provide gender neutral washrooms within the space. Ensure that the forms you ask patients to fill out use gender-neutral terms. So, for example, instead of asking a person’s sex, male or female, use an open-ended question like, “I identify my gender as _______,” or make sure the emergency contact relationship can be chosen family and not just biological.   

We also recommend developing a manifesto for the staff to read, understand and sign. It could be something like, “I am an ally in your health care. I commit to asking the right questions and empowering you in this space.”  

At the outset, we have to get our egos out of the way. We can’t assume we know everything, in fact, we can’t assume anything anymore. We need to ask questions like, “How would you like me to address you?” We need to have conversations to get to know the patient, and we need to be humble.  

We also addressed the issue of trauma-informed care; we need a complete picture of a patient’s experience. For example, we can’t assume that a gay man wants to be referred to as queer. There is a generation over the age of 50 who lived through the HIV/AIDS crisis and gay bath raids where the word queer was used against that community. So again, we need to gather information from the patient to fully understand their needs.  

How do you integrate inclusive practices into a health care environment?  

It takes practice and accountability. We’re not always going to get it right, so we need to own our mistakes, apologize and correct them. That’s how we learn anything new. You have to be willing to say, “I’m so sorry I misgendered you. Would you please let me know how I can refer to you and please accept my apology.”  

There has to be a simultaneous acknowledgement that everybody is equal, but also a commitment to not treating everyone the same, because sameness doesn’t equal fairness. We have to arrive in the space, ready to treat the person we see in front of us based on who that person says they are, not who we assume or think they are supposed to be.  

We also need to move past guilt. Guilt is not an action; it is an emotion. My action is me saying, “Yes, I have White privilege. Yes, it’s based on a colonial system. What’s my next move?” Personally, I think a lot about the voiceless and the people who are never invited to the table, never even considered. I need to direct my agitation and anger into places where it’s hopefully going to affect change.   

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