Factors Affecting Public Opinion on Transgender Medical Care Refusal

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Principal investigators:

Matthew Grace

Hamilton College

Email: mgrace@hamilton.edu

Homepage: https://www.matthew-grace.com/

Long Doan

University of Maryland

Email: longdoan@umd.edu

Homepage: https://www.longdoan.net/

Sample size: 5028

Field period: 07/31/2019-11/08/2019

Between one-fifth and a third of transgender people have been refused treatment by a medical provider due to their actual or perceived gender identity. New federal regulations provide clinicians with even greater discretion to deny medical treatment to members of this group on the basis of religious objections. Yet, we know little about the factors that shape public attitudes toward these issues. We present results from a nationally representative survey experiment (N = 4,887) that examines how common justifications issued by providers for the denial of healthcare, and the race and gender identity of the person being denied care, intersect to shape public opinion concerning the acceptability of treatment refusal. Across three outcomes, we examine the overall acceptability, redemptive acceptability (after a medical provider has offered alternative treatment paths), and believability of the doctor’s stated rationale.
Experimental Manipulations
We use a 2 (transman, transwoman) × 4 (black, white, Latinx, Asian) × 2 (inadequate training or religious objections) factorial experiment blocked by whether respondents work in the medical field.
  1. To what extent do you agree or disagree that Dr. Smith should be [allowed to refuse/required] to treat [Name]?
  2. Why do you [strongly disagree/somewhat disagree/somewhat agree/strongly agree] that Dr. Smith should be [allowed to refuse/required] to treat [name]? In your own words, please write a few sentences explaining why you feel this way.
  3. To what extent do you agree that [inadequate training/religious objections] is the primary reason why Dr. Smith will not treat [name]?
  4. Suppose that Dr. Smith offered to refer [name] to another provider who can see [name] in the next day. To what extent do you agree or disagree that Dr. Smith should be [allowed to refuse/required] to treat [name]?

Response categories: 1=Strongly Disagree, 2=Somewhat Disagree, 3=Somewhat Agree, 4=Strongly Agree

Summary of Results
We find that religious objections are viewed as less acceptable across each outcome compared to a medical justification, in this case, inadequate training. However, the difference between religious objections and inadequate training is larger when the person being denied healthcare is white or Asian than when they are Black or Latinx. There are few differences between transmen and transwomen.

Doan, Long, and Matthew K. Grace. 2020. “Factors Affecting Public Opinion on Denial of Healthcare to Transgender Persons.” Presented at the American Sociological Association Virtual Meeting.

Grace, Matthew K., and Long Doan. nd. “Healthcare Professionals and Lay Persons’ Attitudes Toward Denial of Healthcare to Transgender Persons.” Working Paper.