Posts Tagged Massachusetts

Granny dropped the F-bomb

I’ll start this post with a story.  Yesterday I made a quick trip to Trader Joe’s for a few things, and outside the store was a young guy with a petition about an effort to end anti-gay bullying in local schools.  He wasn’t blocking the door, the stairs or ramp to the door, the sidewalks, or either of the crosswalks leading to the store.  Some people stopped to talk to him, and others walked past to do their shopping.  On my way out, I was waiting to cross the street and an elderly woman, with a walker, crossed the perpendicular street toward the store.  The guy chimed in with his opening line: “Help stop anti-gay bullying in our schools.”  Now, instead of just ignoring him and walking by, this old lady started ripping this kid a new one.  She actually yelled — verbally abused — this kid just for standing on a street corner, trying to do social justice work.  I was nearing my limit of listening to this when she stopped.  She walked part of the way up the ramp toward the store and lo and behold, she started screaming at this guy again.  I couldn’t take this woman’s attack any longer, so I turned around and said: “Lady, give the guy a break.  He’s here trying to do social justice work…” and mid-sentence, this granny looked me square in the eye, gave me the finger, said “F*ck you!” and walked/rolled into the store.

I was shocked.  In fact, the whole thing shocked another guy on the street walking his dogs, who turned to me and said: “What was that all about?!”  I briefly recounted.  It didn’t even seem that she was upset by the kid’s social justice goal.  It could’ve just as easily been a petition fostered by Young Republicans for Ron Paul.  She was angry by virtue of the mere fact that the kid had the gall to speak to her.

As I walked home with my eggs, vanilla (yes, I was baking) and a head full of disbelief, I started to think about a local law I read about recently.  Since 1968, the town of Middleborough, MA, has had an anti-profanity by-law on its books.  The by-law says: “Whoever having arrived at the age of discretion accosts or addresses another person with profane or obscene language in a street or other public place, may be punished by a fine of not more than $20.00 dollars [sic].”  Why would this be in the news recently?  Well, because on Monday the townspeople voted to approve a civil fine (the same $20) instead of a criminal penalty.  The language of the by-law is the same; the difference is just that the cops can enforce it as a civil penalty rather than a criminal offense, which means none of the processes and procedures that apply to criminal violations apply.  Feel free to check out the by-law (downloadable here), the approved change, the authorizing statute, and some commentary here, here, and here.

For the moment, let’s ignore the somewhat obvious questions about potential conflict with the First Amendment and assume the by-law is constitutional, valid, and enforceable.  Who has rights to complain of an infraction here?  Probably I do, because granny dropped the F-bomb while addressing me.  But that’s not really the point.  What about the guy with the petition?  I honestly can’t remember what words the woman said to him.  Is it profane to scream at him regardless of her word choice?  Profane can be defined as contempt or irreverence for “sacred” things, ideas or principles (see here and here).  How sacred is the guy’s right to stand on a street corner and respectfully ask for help for his cause?  Exactly what does this law cover?  And who gets to make that decision… the cop who levies the fine?  Further, at the end of the day, is $20 — or even $40 assuming granny violated the law when she addressed both me and the guy — enough of a penalty to make a difference?

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“Culturally competent” health care

A recent NYT story retells the story of a patient who needed a catheter.  The patient presented as female, engaging in certain feminine gender performative behaviors.  The day of the surgery arrived and, lo and behold, the surgeon was surprised to find a biological male.  It seems the pre-operative work-up did not include sufficient discussion with the patient or a physical examination of the patient’s body into which the surgeon was soon to cut.

The real life problem is apparent.  Non-gender-normative individuals have a much more difficult time finding meaningful access to health care.  As the article depicts, this is not the first instance of or revelation about this type of problem.

Recent HHS recommendations seem to attempt to curtail this effect.  Among other things, “HHS will encourage new and existing health profession training programs, including behavioral health … programs, to include LGBT cultural competency curricula. The lack of culturally competent providers is a significant barrier to quality health care for many LGBT people, particularly those who identify as transgender.”  But, as the article notes, this proposed future action simply hasn’t cut it.  At least, not yet.

This is where the law enters the discussion.  Recommendations from Health and Human Services are just that.  Recommendations.  What is the law doing to mandate so-called “culturally competent” health care delivery?  Frankly, nothing.

Take Massachusetts as an example.  The first state to legalize gay marriage and the 16th state to pass a gender identity equality bill governs physician licensing by statute and regulation, none of which require this cultural competency.  Medical school accreditation standards similarly do not require training on this specific type of bedside manner and patient care, though a couple of standards perhaps come close (see ED-22 and ED-23).

So, it might seem that the easy solution is to legally mandate queer-friendly interpersonal skills sensitivity training for health care professionals.  The question becomes — how?  How can the law mandate good interpersonal skills, and how could such a mandate be enforced?  Should medical malpractice lawsuits be filed based on a failure to engage with patients in a respectful and meaningful way?  In the case described in the NYT article, the patient outcome wasn’t one that would typically fall into the medical malpractice category; the catheter insertion procedure went well.  Assuming this were to become the default regulation, is it feasible given the time and money required to file a suit these days?  Would such a requirement run into conflict with conscience clauses?

The question boils down to whether the law can, and should, require sensitivity to gender identity and other non-hegemonic identities or classifications in health care delivery (and potentially in other spheres of social service systems as well).  This is a real life social problem, but to date, the law has not been a player.

I look forward to your comments.

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