Why would doctors support a Yes vote? A fundamental principle of good medical care is that all people should be treated equally. We believe that a Yes vote in the marriage equality referendum is in the best interests of the health and wellbeing of all Irish people.
Our collective clinical experience across medical specialities, combined with 30 years of international research, indicates our LGBT patients experience higher rates of physical and mental health problems. These have arisen for a number of reasons. First, due to a long and shameful history of discrimination and marginalisation, it has been difficult for some of our LGBT patients and colleagues to acknowledge their sexuality and to live open, happy and productive lives. Younger LGBT people are particularly vulnerable. There is both international and Irish research confirming that LGBT teenagers are more likely than heterosexual teenagers to experience high levels of distress and suicidality. This is explained in part by what is called “minority stress”, the cumulative effect of exclusion and marginalisation, and relates to difficulties they might have acknowledging their sexuality and accessing services and supports.
Healthcare homophobia
LGBT people of all ages can have difficulty accessing health services. Research suggests they can find it difficult to speak to their doctors about their sexuality. An Irish study found almost a quarter of LGBT patients concealed their sexual identity from healthcare professionals, as they were afraid of how they might react. Several respondents in this study described experiences of homophobia in healthcare settings.
As doctors, this is something we deeply regret and want to end by supporting an inclusive, open attitude to sexuality.
We also acknowledge the role that doctors had in terms of past discrimination when homosexuality was seen as a disease to be treated rather than addressed as a natural attribute and expression of self. We now have an opportunity to redress these wrongs by supporting our patients and acknowledging their right to equal access to civil institutions such as marriage.
Evidence from the US supports the health benefits that accrue from equal access to civil marriage. In states where same-sex marriage has been introduced, healthcare utilisation reduced in the subsequent year and health outcomes for LGBT people in those states also improved. The reverse happened in states where same-sex marriage was withdrawn.
Child issue
The issue of same-sex parenting has arisen in the debate, though unrelated to the referendum question. There is clear evidence based on decades of research across the world that children raised by same-sex couples do as well as children raised by heterosexual couples. Regardless of the outcome of this referendum, many children will continue to be brought up in families with same-sex parents. The health of these children depends on their parents having the same access to the protection of civil marriage as all children in our State.
In our health system, some of our LGBT colleagues continue to have difficulty being out at work, fearing it will have a negative impact on their career. We believe a Yes vote will allow LGBT medical students and doctors to be more open, happier and comfortable at work. It will support LGBT doctors to express openly a fundamental part of who they are. Some patients prefer having a gay doctor. Doctors who are out and proud of their sexuality are positive role models.
I have met some of the LGBT medical students in Ireland campaigning for a Yes vote. I have been struck by the commitment and enthusiasm of these future doctors but also by how a No vote would deeply hurt and exclude them. As doctors we have a duty to prevent harm and I believe that a No vote will cause harm to many people of all ages by continuing institutional discrimination in a very overt and definite way.
The highly regarded medical journal the New England Journal of Medicine published an editorial on same-sex marriage recently. It concluded that same-sex marriage is "a matter of justice and a measure that promotes health". This is a social justice and human rights issue, which will have an impact on health. For this reason, as doctors, we are calling for a Yes vote.
Prof Susan Smith is a GP in Inchicore, Dublin, and spokeswoman for Doctors for Marriage Equality