President Obama Issues Memorandum Regarding Hospital Visitation Rights

The White House

Office of the Press Secretary

For Immediate Release
April 15, 2010

Presidential Memorandum – Hospital Visitation


SUBJECT: Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies

There are few moments in our lives that call for greater compassion and companionship than when a loved one is admitted to the hospital. In these hours of need and moments of pain and anxiety, all of us would hope to have a hand to hold, a shoulder on which to lean — a loved one to be there for us, as we would be there for them.

Yet every day, all across America, patients are denied the kindnesses and caring of a loved one at their sides — whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a good friend. Members of religious orders are sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives — unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated.

For all of these Americans, the failure to have their wishes respected concerning who may visit them or make medical decisions on their behalf has real onsequences. It means that doctors and nurses do not always have the best information about patients’ medications and medical histories and that friends and certain family members are unable to serve as intermediaries to help communicate patients’ needs. It means that a stressful and at times terrifying experience for patients is senselessly compounded by indignity and unfairness. And it means that all too often, people are made to suffer or even to pass away alone, denied the comfort of companionship in their final moments while a loved one is left worrying and pacing down the hall.

Many States have taken steps to try to put an end to these problems. North Carolina recently amended its Patients’ Bill of Rights to give each patient “the right to designate visitors who shall receive the same visitation privileges as the patient’s immediate family members, regardless of whether the visitors are legally related to the patient” — a right that applies in every hospital in the State. Delaware, Nebraska, and Minnesota have adopted similar laws.

My Administration can expand on these important steps to ensure that patients can receive compassionate care and equal treatment during their hospital stays. By this memorandum, I request that you take the following steps:

1. Initiate appropriate rule making, pursuant to your authority under 42 U.S.C. 1395x and other relevant provisions of law, to ensure that hospitals that participate in Medicare or Medicaid respect the rights of patients to designate visitors. It should be made clear that designated visitors, including individuals designated by legally valid advance directives (such as durable powers of attorney and health care proxies), should enjoy visitation privileges that are no more restrictive than those that immediate family members enjoy. You should also provide that participating hospitals may not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. The rule making should take into account the need for hospitals to restrict visitation in medically appropriate circumstances as well as the clinical decisions that medical professionals make about a patient’s care or treatment.

2. Ensure that all hospitals participating in Medicare or Medicaid are in full compliance with regulations, codified at 42 CFR 482.13 and 42 CFR 489.102(a), promulgated to guarantee that all patients’ advance directives, such as durable powers of attorney and health care proxies, are respected, and that patients’ representatives otherwise have the right to make informed decisions regarding patients’ care. Additionally, I request that you issue new guidelines, pursuant to your authority under 42 U.S.C. 1395cc and other relevant provisions of law, and provide technical assistance on how hospitals participating in Medicare or Medicaid can best comply with the regulations and take any additional appropriate measures to fully enforce the regulations.

3. Provide additional recommendations to me, within 180 days of the date of this memorandum, on actions the Department of Health and Human Services can take to address hospital visitation, medical decision making, or other health care issues that affect LGBT patients and their families.

This memorandum is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

You are hereby authorized and directed to publish this memorandum in the Federal Register.


Science writer Simon Singh wins bitter libel battle

Science writer Simon Singh wins bitter libel battle

Mark Henderson, Science Editor April 15, 2010

Simon Singh, the science writer, today won his legal case against chiropractors who sued him for libel over his criticism of their medical claims.

The British Chiropractic Association (BCA) this morning dropped its libel claim against Dr Singh, two weeks after a landmark judgment by the Court of Appeal ruled that the author could use the defense of fair comment.

Ely Place Chambers, which acted for Dr Singh, said in a statement:  “The BCA today served a Notice of Discontinuance bringing to an end its ill-fated libel claim against Dr Simon Singh arising out of criticisms he made of its promotion of treatments for childhood ailments.

“Dr Singh’s predicament as the sole defendant in an action brought in respect of a comment piece in The Guardian newspaper (to which the BCA never directed any complaint) was seen as a rallying point for those concerned about the abuse of UK libel laws in connection with scientific debate.

“Interest intensified when Eady J ruled that his words were not comment and that in order to defend himself he would have to prove the objective truth of what he wrote. Earlier this month the Court of Appeal overturned that ruling and this has lead the BCA to abandon its claim.”

Dr Singh was sued for libel over a newspaper article in which he accused the BCA of “happily promoting bogus treatments”, such as the use of chiropractic for childhood asthma and infant colic.

Dr Singh told The Times today: “It’s a huge relief to suddenly have this whole thing disappear. I’m still getting my head around it. I’ve got stacks of paperwork here in my office, relating to chiropractic and legal documents, and I don’t have to look at it as of today. I don’t know whether I’ll stick it in the attic or burn it.”

He said he would be pursuing the BCA for his legal costs. “The issue of costs is still outstanding. I suppose it will cost the BCA upward of £300,000, and I want to make sure they end up paying my legal costs, which will be over £100,000. It could be that I don’t get that money back: that explains why people don’t fight libel cases.”

He said that he will continue to campaign for libel reform, and pointed out that Peter Wilmshurst, a cardiologist, is still being sued for libel for criticisms he made of an American company’s medical device.

“The Court of Appeal judgment says that when a science journalist is sued for libel for criticizing evidence, the defence of fair comment should be the default position. But that doesn’t stop libel tourism, or huge companies suing individual scientists, journalists or bloggers to silence them, or change the burden of proof, or reduce the huge costs that are involved.

“The great thing is that yesterday the third of the three major political parties published its manifesto, and all three are committed to a libel reform bill. We need one.”

US – Hope and Hurt for Trans Americans in the APA’s Proposed DSM Revisions… [2010-04-13]

US – Hope and Hurt for Trans Americans in the APA’s Proposed DSM Revisions… [2010-04-13]

Hope and Hurt for Trans Americans in the APA’s Proposed DSM Revisions

by: Steve Williams
< >


On Monday, the National Gay and Lesbian Task Force praised the American Psychiatric Association’s (APA) favoring of “gender incongruence” and refutation of “gender identity disorder” (GID) as part of its suggested revisions to the upcoming 5th edition of the Diagnostic Statistical Manual (DSM), a text that is used by clinicians and psychiatrists to diagnose psychiatric illnesses. However, the Task Force notes that there is much work to be done on the problematic diagnostic criteria that still mislabels many trans and gender variant people as having a mental disorder.

>From the press release< >:

WASHINGTON, April 12 — The National Gay and Lesbian Task Force today affirmed the American Psychiatric Association’s (APA) refutation of “gender identity disorder” in favor of “gender incongruence,” but calls for the removal of “transvestic disorder” and expresses concerns about other proposed revisions to the upcoming 5th edition of the APA’s Diagnostic and Statistical Manual (DSM).

“We see this revision as an evolutionary step toward removal of all diagnoses related to gender nonconformity in the DSM,” said Jaime Grant, director of the National Gay and Lesbian Task Force’s Policy Institute. “Gender variance is not a psychiatric problem; it’s a natural human variation that in some cases requires medical attention and support.”

The National Gay and Lesbian Task Force released this statement as part of its commentary (linked below) on the latest proposed revisions to the APA’s Diagnostic Statistical Manual.

In their feedback, the Task Force praises the aforementioned shift as being more reflective of current understanding of trans identity and as a move towards “affirming a natural variance in human gender identity”.

However, the Task Force notes that there is still work to be done. Specifically, the Task Force calls for the removal of the defamatory classification of “transvestic disorder” – used to replace “transvestic fetishism” < > but given the same diagnostic criteria – which singles out transwomen (those that identify female but were birth-assigned male) as essentially being sexually deviant.

It notes that the “very notion that cross-dressing among female-born individuals is never pathological, while cross-dressing among male-born clients has multiple pathological manifestations reeks of a kind of sexism we find astonishing for psychiatry in the 21st century. It is well past time for the removal of disorders associated with disfavored versions of femininity, which call to mind the infamous 19th century diagnosis of ‘hysteria’ in women.”

As such, the Task Force calls for the removal of “transvestic disorder” and its controversial and heavily challenged specifier “autogynophelia”

The Task Force makes it clear that while the move toward “distress-based” diagnosis in DSM-V should be applauded, strong concerns remain that the guidelines are still vague and that they fundamentally fail to recognize the difference between what is termed “minority stress” – that is to say, the emotional distress that LGBTs face as a marginalized group that is subject to discrimination – and that of stress brought about by “specific gender expression.” The Task Force reiterates a need to make it clear that distress as a result of societal discrimination should not be used as evidence of a mental disorder.

Why are Changes to the DSM Needed?

The blanket categorization of gender variant and trans identity as a disorder creates unnecessary and harmful barriers to surgical and hormonal transition treatments that also reinforces the social stigma that persists surrounding trans issues. The perpetuation of this stigma and the discrimination that many trans patients face in health care is something that the Task Force references in its comments on the proposed DSM-V changes:

Data from the National Gay and Lesbian Task Force/National Center for Transgender Equality’s National Transgender Discrimination Survey compiles questionnaires from 6,500 transgender and gender nonconforming people across the United States. Fifty percent (50%) of our respondents report being forced to educate their medical providers to ensure they received adequate and sensitive care. Nearly half of our sample reports postponing some form of medical care because of the pervasive discrimination they faced at the hands of insensitive or bigoted healthcare providers. Thus, the National Gay and Lesbian Task Force advocates for the full declassification of Gender Incongruence, alongside improvements within the International Classification of Diseases and U.S. health care systems to ensure adequate access for all transgender people seeking medical support to fully embody their gender identity.

The label of mental disorder is also particularly harmful to transitioned individuals who may be happy and functional in every respect following their gender reassignment but are still maligned by the current diagnostic criteria which labels them as having a disorder. This can impact many areas of a trans person’s life, but in particular can be damaging to their career and employment opportunities.

Though seeking to remedy this, the proposed changes to DSM-V, with its good intentioned move from GID to “gender incongruence,” could perpetuate this problem due to ambiguous criterion that also might potentially widen diagnosis to include people that do not even fit the standard definition of gender disphoria< >. You can learn more about this by going here < > to read a concise but thorough analysis of the proposed changes as written by Kelley Winters of GID Reform Advocates.

Overall, the proposed revisions show progress toward recognizing transgender and gender variant identity while removing the label of “disorder” and the stigma that comes with it.

That said, these changes add up to only perfunctory alterations that, for LGBT rights advocates, dance around the heart of the issue – namely that gender identity variance is not a pathology. As such, reform advocates will continue to work strongly to push for less ambiguous, less gender binary  criteria in the DSM to prevent gender variant persons from being unfairly categorized as having a psychiatric problem when no subjective distress or impaired function is evidenced, and for medical assistance to be refocused from a gatekeeper approach to one of facilitating patient care and support that is outcome orientated.

The release of DSM-V is now scheduled for May, 2013.

To read and make a comment on the DSM revision process, please go to by April 20.

You can view the National Gay and Lesbian Task Force’s commentary on DSM-V here < > which summarizes many of the important positive and negative aspects of the proposed changes in an easily digestible way.

Related Reading:

• DSM-V Gender Expert Choices Anger LGBTs Over Past in Reparative Therapy

• Psychiatry’s Civil War

• Transvestic Disorder and Policy Dysfunction in the DSM-V

• HRC Resources on Gender Variance in Children

© 2010 CARE2.COM, INC.

ENDA Should Not Be The Goal!

ENDA should not be the goal but rather the starting point for LGBT/T workers rights.

All too often when I read about ENDA the stories are about people who are already so far up the socio-economic chain as to make their struggles with employment sound like fables.

Focusing on the Susan Stantons of the world makes for good news.  I’m sure she is a decent person and all that and I am equally certain that her losing her job was a vile act of discrimination.

But is the struggle for employment non-discrimination really all about those in the middle and upper classes?

What about those of us who work in restaurants and big box stores?  Or those even more lumpen who have to do sex work because even restaurants and big boxes won’t hire them?

Lets focus for a moment on those workers in what has been labeled by the privileged elite as the “New Service Economy”. There is a reality that was laid out in Barbara Ehrenreich’s  book Nickel and Dimed: On (Not) Getting By in America that life sucks for those workers making less than 15 to 20 thousand dollars a year.  One is often unable to keep a roof over one’s head, eat, afford transportation to and from work and the clothes required to work.

Never mind the thought of getting SRS or any of the other procedures commonly required by those in transition including but not exclusive to: Mandated professional psychiatric care.  Electrolysis and hormones.

The great bulk of the medically uninsured are in this category.  But even for those insured medical costs related to transsexualism and transgenderism are often specifically excluded.  Sometimes using the pre-existing condition clause if the policy lacks a specific exclusion.

There is another proposition slowly making its way through the process.  One I hear almost no mention of in the LGBT/T press or activist circles but hear plenty about in the left wing circles that are a major influence on me.

Something called the Employee Free Choice Act that would help end the corporate strangle hold of workers attempting to unionize and organize to promote the rights and interests of the workers.  Too often we have no redress, no one to represent us and argue that our working conditions are un-fair or even dangerous.  Not to mention humiliating, stressful and degrading.

Working conditions suck in the US.  American workers work longer hours with less job security or benefits that do the workers in almost every other industrialized nation.

Oh I forgot we live in a post-industrialized society where the rich become ever richer by moving their money around, creating nothing except an endless cycle of bubbles and recessions, while the rest of us have become the new servant class.  As a member of that servant class I am required to smile and lie to sell others cheap poorly made product, food that is often a nutritional nightmare.  All the while knowing the reality of what I am doing and smiling as well as shuffling in a properly subservient manner.

There is a dirty secret that misses the news for all its coverage of the Tea Bagger, neo-Nazi racist pigs.  There is an equally angry left wing under class of overly educated peons who have read Marx, Kropotkin and Bukharin.

ENDA isn’t the end of the struggle for LGBT/T workers rights.  It is the starting point

The Return of Christian Terrorism

From Alternet:

Threats of right-wing violence have doubled in the past year. What is behind the latest upsurge in the movement to create a Christian theocratic state?

By Mark Jurgensmeyer

April 15, 2010

When Scott Roeder, the murderer of Wichita Kansas abortion clinic provider Dr. George Tiller, had his day in court, he spent much of his rambling self-defense quoting the words of another abortion clinic assassin, Reverend Paul Hill. In the 1990s my own research had brought me into conversation with others in the inner circle in which Hill and Roeder were at that time involved. So it was a chilling experience for me to realize that this awful mood of American Christian terrorism—culminating in the catastrophic attack on the Oklahoma City Federal Building—has now returned.

Continue reading at:

Many of the same people who readily see how horribly oppressive the Islamo-fascist states are to women as well as LGBT/T folks have a blind eye when it comes to the West’s own homegrown theocratic oppressors.   Yet Christianity has as bad a record as Islam does when it comes to committing genocide against people who do not believe the same sky daddy fantasies as they do.

The biggest problem with monotheism is it has too many gods.

No gods, No masters.