To receive credit, your facility must:

Include LGBTQ-specific information in the medical decision-making briefing provided to patients and/or ensure that they know they can designate any person of their choice as a medical decision-maker.

Resources:

• For more information, review CMS guidance on medical decision making, or the HRC/American Health Lawyers Association publication Revisiting Visitation.

Here are some LGBTQ-specific medical decision making examples:

• Keck Medical Center of USC's pamphlet has a section on "Who can I appoint as my health care agent?". In this section, they explicitly name that anyone, including a same-sex or domestic partner can be named as health care agent.
• Indiana University Health Ball Memorial Hospital communicate that patients can appoint an unmarried partner of the same or opposite sex as their healthcare representative.
• Rush Oak Park Hospital's LGBTQ policy statement encompasses Medical Decision-making. They state that patients have the right to appoint a same-sex partner as their agent.
• Penn Student Health Service's section on Advance Directives offers explicit examples of who may named a health care agent including a domestic partner.
• University of Kentucky Albert B. Chandler Hospital's pamphlet affirms that patients have the right to choose any health care surrogate regardless of sexual orientation or gender identity.
• University of Texas Medical Branch Hospitals states in their page on Patient Rights and Responsibilities that patients have the right to designate a same-sex partner as surrogate decision maker.

To receive credit, your facility must:

Include LGBTQ-specific information in the medical decision-making training provided to staff.

Healthcare facilities should provide training modules to staff that are specifically tailored to the special case of advance healthcare directives and same-sex couples. These training modules should make explicit mention of LGBTQ individuals and detail the unique consequences that can result from a failure to recognize the advance healthcare directive of a same-sex couple. The training modules should reiterate the staff’s duty to follow all applicable state and federal advance healthcare directive law, especially in the areas of reciprocity, presumptive validity, and the definition of designated agents.

Here are some examples of LGBTQ-specific information included in medical decision-making trainings:

• VA James A. Haley Veterans Hospital states in their staff training module that same-sex partners can be named as medical decision makers.
• Vanderbilt Hospital and Clinics explicitly confirms in their trainings that patients have the right to name anyone, even an unmarried same-sex partner, as their health care agent.
• Shore Medical Center's trainings for staff also explicitly include that same sex partners can be included in advance directives.

To receive credit, your facility must:

Have a policy or official practices related to the treatment of intersex children that delays medically unnecessary procedures until the patient is old enough to make an informed decision.

Intersex is an umbrella term that refers to the approximately 0.5 to 1.7 percent of the population born with variations in sex characteristics such as chromosomes, gonads, and/or genitals that vary from what is considered typical. Non-medically necessary procedures intended to change genital appearance and reproductive anatomy to fit arbitrary norms are frequently performed on intersex children before the child can have a voice in the matter and make an informed decision.

Resources:

• Providing Ethical and Compassionate Health Care to Intersex Patients: Intersex Affirming Hospital Policies written by interACT: Advocates for Intersex Youth, Lambda Legal, and Proskauer Rose LLP. This guide offers concrete steps for medical providers to provide sensitive, non-discriminatory care to intersex patients, including recommended policies regarding the provision of affirming care to prevent liability and ensure patient-centered decision making by avoiding non-consensual interventions that can be safely delayed until the patients are old enough to participate in the decision.
  
• I Want to Be Like Nature Made Me’: Medically Unnecessary Surgeries on Intersex Children in the US is a groundbreaking report from Human Rights Watch that examines the physical and psychological damage caused by medically unnecessary surgery on intersex people, who are born with chromosomes, gonads, sex organs, or genitalia that differ from those seen as socially typical for boys and girls. The report examines the controversy over the operations inside the medical community, and the pressure on parents to opt for surgery.
• Affirming Primary Care for Intersex People 2020 from the National LGBTQIA+ Health Education Center is a community-informed clinical guide on primary care for intersex people provides an overview of intersex terms and concepts, the health concerns of intersex people, intersex-affirming practices, and resources for further learning.
• What We Wish Our Doctors Knew is a brochure created by InterAct Advocates for Intersex Youth that provides advice from intersex youth to doctors and other medical providers.
  

Here are some examples of hospitals that have announced policies related to delaying medically unnecessary procedures on intersex children:

• Read Ann & Robert H. Lurie Children's Hospital of Chicago's statement on Intersex Care at Lurie Children's
• Read this press story on Boston Children's Hospitals decision to stop performing two types of intersex surgery on children