In death we are all equal?

In the 2015 Quality of Death index the UK was ranked best in the world, but despite this inequalities and discrimination towards the LGBT community still occur too regularly. British Psychological Society Lifetime Achievement Award winner Professor Celia Kitzinger pointed to the CQC report A Different Ending, which illustrated some of these inequalities and barriers to accessing appropriate care within the LGBT community, and other stigmatised groups.

The LGBT community's history of oppression is a long and painful one, and LGBT-phobic attitudes still remain among healthcare professionals. Kitzinger gave some first-hand accounts from research with LGBT people: many lesbians and gay men were not allowed to be by their partner or spouse's bedside while they were dying, and many also experience a fear of discrimination which can be harmful in itself.

A recent study by Kathryn Almack (University of Nottingham), for Marie Curie, saw 26 per cent of survey respondents reporting discrimination relating to sexual orientation or gender identity from health or social care staff, and around three quarters said they weren't confident that services would provide sensitive end of life care for their needs. Marie Curie has made strong commitments following this research to improve its end of life care for LGBT patients, through staff training and reviewing the language used throughout its hospices and in the literature and materials it publishes.

But there is much still to be done. As well as outright discrimination, LGBT people face the dilemma of whether to disclose their sexual orientation in the first place. As Kitzinger pointed out, these people receive care against a background of entrenched heteronormativity. The families people choose, rather than those they're related to, may not be seen or acknowledged by healthcare professionals. Spirituality in an LGBT context isn't easy to navigate either: if a hospital chaplain does not share the same beliefs as an LGBT patient that person may end up lacking spiritual care as well. Those who are left behind also suffer. Kitzinger said the husbands, wives and partners of LGBT people who die often go unsupported, with some being treated as if they lost someone of little consequence.

Psychologists, Kitzinger said, have been barely involved in improving end of life care for the LGBT community. She pointed to Advance Decisions and Power of Attorney as a way to ensure LGBT people get what they want and need from end of life care. Kitzinger said we need a more culturally-sensitive health and social care system, as well as a willingness to challenge heteronormativity and heterosexism.