MLAFair, Tyler Mark. "Lessons on Older LGBTQ Individuals’ Sexuality and Spirituality for Hospice and Palliative Care." American Journal of Hospice and Palliative Medicine® (2020): 1049909120978742.
Abstract Hospice and palliative care are in the beginning stages of providing inclusive care to older lesbian, gay, bisexual, transgender, queer (LGBTQ) patients. This inclusivity is exceedingly more pressing given the growing population of out and aging LGBTQ individuals. Hospice and palliative literature recognizes that spirituality and religion can be fraught topics for LGBTQ patients. A few resources are available to help providers give more inclusive care. Few in hospice and palliative care, however, explicitly outline the direct connection for LGBTQ elders between their sexuality and their spiritual lives. 16 LGBTQ individuals born before 1964 were interviewed in the Colorado Front Range. Keeping with the tradition of critical theory, participants were asked “is there a connection for you between your sexuality and your spirituality? if so, what?” The interviews were analyzed using a qualitative conceptual content analysis method. All 16 participants responded that there was a connection for them. The participants expanded on this connection using five themes in their answers: the sexual act itself is spiritual; their authentic LGBTQ journey as spiritual; love/attraction is spiritual; spirituality and sexuality are inseparable; and finally, noting the ineffability of the sexuality-spirituality connection.
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Introduction
Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) sexuality and spirituality are often assumed to be at odds, or at least deeply complicated. This likely impacts the care older LGBTQ patients receive during end of life. Spiritual care is an integral part of hospice and palliative care (HPC); older LGBTQ patients deserve to receive this support in a way that holds a deep respect for their identities. It is important that HPC spiritual care practitioners be adequately informed when caring for LGBTQ individuals in order to do no harm. Nevertheless, HPC literature which clarifies the unique spiritual needs of older LGBTQ people is still in its infancy.
Sexuality and intimacy are often avoided or overlooked in HPC, despite sexuality being widely considered a “core component of the human experience” and despite research that indicates patients wish to discuss it during their end of life journeys.4 Current HPC literature recognizes that religion and spirituality are important for many LGBTQ individuals and also suggests ways to mindfully approach this when working with LGBTQ patients. Several resources exist that elucidate and aid in navigating the complicated relationship between LGBTQ people, religion, and the healthcare system. These types of resources are increasingly more necessary for HPC, given the growing population of LGBTQ individuals older than 65. However, what does not appear to be addressed in this HPC literature is if and/or how spirituality and sexuality can be connected in the experiences of older LGBTQ patients.
Discussion Because of unexplored biases, discomfort, and prejudice on both personal and institutional levels, HPC has potentially missed what turns out to be a significant dimension of the spiritual lives of many older LGBTQ individuals. HPC providers and organizations should consider how underlying assumptions about sexuality and spirituality might negatively impact the care they provide. For these 16 older LGBTQ adults, sexuality is spiritual. The spiritual insights offered by these participants are pearls born out of decades of religious exclusion and shame-seeped spiritual trauma. Through their stories, LGBTQ elders can be our teachers. Following their lead, we can make way for even more inclusive HPC practices for countless more to come.