sBMJ | Homophobia in medicine

Homophobia in medicine

Unfortunately, it still exists but is it lawful?

“Dear Editor, “We recently gave a lift to a consultant. In the car we chatted informally. The consultant seemed knowledgeable and concerned about issues of global equality. Later, one of us mentioned the vibrant local gay scene. Despite only having met earlier that evening, the consultant seemed at ease in telling us how he had demanded that a nurse be removed from his team because the nurse was gay. In justification he said that his colleague had, `made me feel uneasy.' When we replied that such action was probably unlawful, the consultant said that he had obviously not referred to the nurse's sexuality when demanding the move, but had cited his colleague's inability to do a good job. `All these people think about is sex,' was offered as the underlying diagnosis for the alleged incompetence. Must we tolerate intolerance?”

The studentBMJ recently received the letter set out in the box from two students. I have taken out their names and any identifiable features so that we can concentrate on the issues rather than carry out a witchhunt for anyone involved.

Sadly, the prejudice displayed here is nothing new, despite the regulatory body for doctors, the General Medical Council, clearly stating that doctors are not allowed to let their views of patients' or colleagues' sexuality prejudice their professional behaviour.¹ In a qualitative study where 28 gay and straight doctors were interviewed about how they viewed each other only one (nongay) doctor stated categorically that he did not believe that homophobia existed in the profession.² In addition, although all the nongay doctors claimed at first not to be homophobic, comments made during the interview uncovered, perhaps unconscious, prejudice. For example, one doctor was amazed that so many gay doctors were recruited into the study thinking that they would be “too ashamed to reply” and another said, “I don't think homosexuality is exactly normal.” Medical students are also wary of homosexuals, as shown in a British survey where only one in every two clinical students thought that homosexual activity could form part of an acceptable lifestyle.³ Homophobia aside, are the authors of the letter right in thinking that the actions taken by the consultant are unlawful? As the law currently stands, then no, it is not unlawful to discriminate against someone because of their sexuality. If the nurse involved had actually lost his job there might have been grounds for unfair dismissal because the consultant hid his discrimination behind the charge that the nurse was not doing a good job. Perhaps this was true, perhaps it was not.

As incredible as it may seem, as the law currently stands the Sex Discrimination Act does not protect against discrimination because of sexuality. If a woman thinks that she has been sexually discriminated against she has to identify a “comparator.” This is a man, either a real man with whom she works or a hypothetical man. She would then ask the courts to compare her treatment with the treatment this man received, or would have received. The “relevant circumstances” have to be the same. The comparator with any gay man who thinks that he has been discriminated against is a lesbian, not a straight man. This, however, was recently contested by a case in Scotland where a man was dismissed form the Royal Air Force because of his sexual orientation.⁴ The judges in the Employment Appeals Tribunal said that in the Sex Discrimination Act there is enough ambiguity in the word “sex” for it to be defined not only as meaning gender but also “sexual orientation.” Once they had made this decision it became obvious to them that the comparator for a gay man or lesbian would be a heterosexual man or woman.4 However, the government appealed against the decision and the historic conclusion reached by the original judges was reversed. The Human Rights Act offers some hope. Article 8 refers to the right for a private life and article 14 refers to the right not to be discriminated against on any grounds, so in effect, it is now unlawful to discriminate on the grounds of sexual orientation. There have already been successful cases in Britain under this ruling, brought by British service men and women and another by a man in Portugal who was refused custody of his daughter because he was gay. However, the Human Rights Act became law in England only in October 2000; it became law two years earlier in Scotland, and claims cannot be made retrospectively (personal communication, Lesbian And Gay Employment Rights (LAGER)).

But there is good news on the horizon. In October 2000 Europe agreed a Framework Directive on Employment, which makes discrimination on the grounds of sexual orientation unlawful. Although the United Kingdom government has three years to introduce the directive, it must do so. This means that in October 2003 there will be no question that lesbians and gay men will have a remedy against discrimination in the workplace.4 Legislation will eventually catch up with what the authors of the letter intuitively knew to be right anyway. Whether the consultant involved should be reported to the GMC is another matter.

Rhona MacDonald, editor, studentBMJ

I would like to thank the staff at Stonewall and LAGER for their help in researching this article.

Useful information LAGER (Lesbian and Gay Employment Rights) www.lager.dircon.co.uk Stonewall website (for gay and lesbain equality) www.stonewall.org.uk

studentBMJ 2001;09:357-398 October ISSN 0966-6494

Rose L. Homophobia among doctors. BMJ 1994;308:5867.
McColl P. Homosexuality and mental health services. BMJ 1994;308: 5501.
Why the decision in Macdonald v Ministry of Defence is important. www.lager.dircon.co.uk/Lawmay2001.htm (accessed 4 September 2001.)

Responses published this month

Articles	Responses
EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)	Eleanor James (October 08, 2001) Read this response

EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)	Edith Schneider (October 16, 2001) Read this response

EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)	Stephen Ford (October 21, 2001) Read this response

	EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)
	Eleanor James (October 08, 2001) Final year medical student, Oxford University james@worc.ox.ac.uk
	Unfortunatley, it is apparent from the report of these two students, and the research of several bodies including the Gay and Lesbian Association of Doctors and Dentists, that homophobia does indeed exist in the medical profession. A number of gay colleagues of mine choose to operate under a self-imposed policy of 'don't ask, don't tell' when it comes to being 'out' at work. This is for a number of reasons, including avoiding any potentially negative responses (which thankfully are usually just embarrassement, and feeling 'uncomfortable' like the poor consultant in this article). Otherwise, few people actually enjoy their personal lives being used as a piece of social currency by their colleagues, as medics are inherent gossips. I would also add that my sexuality really should be of no interest to my colleagues unless they are my friends also, and frankly am often suprised that it is of any interest to anyone, but perhaps that is my own naivety in action. I have generally been 'out' at medical school, largely beacuse I socialise with my friends here, and it would seem churlish and tedious to attempt any kind of 'dual- identity' with them. I haven't experienced any homophobia directly, but have overheard some comments from people who were obviously feeling 'uncomfortable' in one way or another. Rarely do these comments make me angry, as they always seem slightly pathetic, as after all it is a 'phobia'! The gems I have been party to have reinforced the idea that a lot of homophobia and 'discomfort' amongst medics arises from our peculiar inability to see one another as people, as well as professionals. Particularly, during a course on human sexuality, several students engaged in some 'anti-batty' banter (most likely to cover up some embarrassment). A good friend of mine pulled them up on this, pointing out that in a hall full of one hundred people, there may be some who were gay, and so would be offended by such chat. The reply came, "Well, yes of course, statistically speaking, but surely not anybody HERE?"

	EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)
	Edith Schneider (October 16, 2001) occupational therapist and med student Edith.Sch@t-online.de
	It's hard to believe that a person's sexual orientation should be of any importance in the performance of their job. I know enough doctors by now and there are straight ones that I wouldn't send my dog to. As far as I am concerned it's a persons medical skills and his/her concern for the patients that matters, nothing else. Since when is it anybodies business what two consenting adults are doing together?

	EDITORIALS Homophobia in medicine Rhona MacDonald (October 2001)
	Stephen Ford (October 21, 2001) 5th Year Medical Student University of Liverpool sr_ford@hotmail.com
	MacDonald's editorial concerning homophobia ¹ in medicine was flawed on two counts. Its evidence base was too small to demonstrate the prevalence of homophobia; and it blurred two distinct concepts - discrimination on grounds of sexual orientation and disapproval of homosexuality. There was no worthwhile evidence produced that homophobia is widespread in the medical profession. 28 doctors saying that there is homophobia in the NHS ² is no evidence at all. The study's questions are unlikely to evoke neutral answers: respondents not wishing to be thought homophobic may say that homophobia is common, as denying the presence of homophobia "implies" homophobia in the respondent. A second survey, cited to confirm the presence of homophobia among medical students ³, was poorly interpreted. 50% of medical students may find homosexuality "unacceptable" but that does not necessarily entail homophobia or prejudice. It is perfectly possible for people to disapprove of aspects of another person's lifestyle - be it motorcycling, Catholicism, bigamy or homosexuality - and yet maintain a working relationship with him or her. Challenges tantamount to "agree with our victimhood or be included amongst the oppressors" are innately coercive, polarise debate and are counterproductive. What is needed is a reinforcement of the principles of professionalism (in keeping with the GMC regulations ⁴), not an assault on freedom of thought. MacDonald R. Homophobia in medicine. Unfortunately, it still exists, but is it lawful? studentBMJ 2001; 9: 358-9. Rose L. Homophobia among doctors. BMJ 1994; 308: 586-7. McColl P. Homosexuality and mental health services. BMJ 1994; 308: 550-1. General Medical Council. Good medical pratice. London: GMC, 2000.