Discrimination is when you are treated badly or less fairly because you have a particular attribute. Many people worry that they will face discrimination if they tell their health professionals they are LGBTQI+. While many health professionals are caring and supportive, discrimination in cancer care can happen. However, there are laws to protect LGBTQI+ people seeking health care. Knowing your rights may help reassure you that you are being treated fairly.

Is discrimination unlawful?

Under the Commonwealth Sex Discrimination Act 1984, it is against the law for health professionals, hospitals and treatment centres to discriminate against you because of your sexual orientation, gender or intersex status. It is also unlawful for them to discriminate against same-sex couples. Legislation in most states and territories also protects people from discrimination in certain areas of public life, including health care, because of their sexual orientation or gender.

Examples of unlawful discrimination in the health care setting include:

• refusing to provide you with care because you are LGBTQI+
• providing you with a lesser standard of care because of your sexual orientation, gender or sex characteristics
• making offensive comments, jokes or negative remarks about LGBTQI+ people
• not acknowledging your same-sex partner/s as next of kin
• using incorrect names and pronouns on purpose

How to deal with discrimination

• If you feel comfortable and safe doing so, raise the issue with the health care facility. All hospitals and health services should have a procedure for patients to provide feedback and complaints. Check with the cancer care coordinator, social worker or nursing staff.
• Make notes about the behaviour or incident. List dates and names of people who saw the behaviour. This will help you remember what happened so you can explain it later.
• Think about what you would like to happen to resolve the issue. A quick conversation may help to sort out any simple misunderstandings.
• If your complaint is about a specific person and you don’t want to talk to them directly – or you have spoken to them and the issue remains unresolved – speak to the cancer care coordinator, nursing unit manager or social worker at the hospital or treatment centre about the complaint.
• Most complaints are resolved through mediation or conciliation. This is an informal way of agreeing on an outcome.
• If mediation or conciliation doesn’t help, you may have the option to go to an administrative tribunal or to court for a legal judgment that must be followed.
• Contact the Australian Human Rights Commission (call 1300 656 419 or visit humanrights.gov.au) or the discrimination agency in your state or territory to lodge a complaint. Contact these organisations or seek legal advice to work out which organisation is best for your situation before you lodge a complaint.
• Talk to a lawyer for specific advice about your situation. Cancer Council's 13 11 20 Information and Support Line may be able to refer you to a lawyer for legal advice (which may be free if you cannot afford to pay).

Harassment

People may have different ideas about what is offensive or unacceptable behaviour. Just because the person did not mean to be offensive does not make it okay. You have the right to complain if you feel that you’ve been intimidated, bullied or harassed by health professionals, other hospital staff or other patients, or if you experience hurt, humiliation or distress because of their actions.

Other types of complaints

• Health complaints organisations: If you are unhappy about the ethical or professional conduct of a health practitioner, you can contact the health complaints organisation in your state or territory. Serious cases may be referred to the Australian Health Practitioner Regulation Agency (AHPRA). For more information, visit www.ahpra.gov.au.
• Medical negligence: This page does not cover breaches of duty of care by health providers. If you are thinking about making a medical negligence claim, seek independent legal advice.

Coming out to your cancer care team

At the time of the cancer diagnosis, you may or may not have come out as LGBTQI+, or you may be out to some of your friends, family and contacts but not others. Some people want to be out to their cancer care team, others feel it is not important, and some may not have a choice because information about their body is already in their medical records.

Choosing to come out to your cancer care team may make it easier for you to discuss your needs, preferences and values, and can help ensure you receive culturally safe care. It also means that your treatment team can recommend the most appropriate treatments for you, give you relevant information and connect you to LGBTQI+ support groups.

Whether you feel safe coming out to your cancer care team may depend on whether you’re still questioning or exploring your identity, your past experiences of discrimination and prejudice, and whether you have been mistreated by other people after disclosing your sexual orientation, gender or intersex variation. It may also be influenced by how you felt when you came out to family and friends.

The reality of having cancer treatment is that you are asked to repeat your cancer experience multiple times with multiple doctors. You also need to decide whether to share your sexual orientation, gender or intersex variation with each health professional you meet. Coming out is a process, and it’s okay to come out slowly and when you feel ready. This can be stressful and emotionally draining, and you may be worried about how your health professionals will react.

Benefits of coming out

• You don’t have to hide who you are and can be yourself.
• You may be more satisfied with your cancer care and feel that it better meets your needs.
• Your partner/s (if you have them) are more likely to be recognised and included.
• It makes it easier to talk about how treatment affects sex and intimacy.
• Your treatment team can tailor information for you.
• You will be less likely to have your cancer overlooked.
• Fear of negative reactions and being made to feel unsafe.
• Worry about receiving discriminatory or a lesser standard of care.
• Anxiety about having to come out multiple times.
• Fear of being alienated from your family at a time of need.
• Concerns about potential breach of confidentiality.

When you may not have a choice

Sometimes it may be medically necessary to share information with your cancer care team, so they have the information they need to make a diagnosis or recommend treatment. This could include which reproductive organs you were born with, whether you have an intersex variation, or whether any sex characteristics have changed over your life.

People with an intersex variation may not have a choice about how much to reveal to their cancer care team if these details are listed on their medical records, and you may find this upsetting. However, you may want to share your preferred terms for body parts and discuss how your intersex variation will impact your cancer care.

You can work with your doctors and treatment team to ensure your information is shared and discussed with respect, and that you are not outed or discriminated against.

What if I’m not out?

You may not be out to all your family and friends, and don’t want your cancer care team to share personal information with others. If you decide to come out to your cancer care team, they are legally required to keep your health information private and generally can’t share it without your permission. If you are worried about being outed, it can be helpful to let your cancer care team know.

How to come out to your health professionals

You deserve to be treated with respect by all the health professionals who look after you. If you find the thought of disclosing your sexual orientation, gender or intersex variation stressful, some of the following tips and suggestions may be helpful to you.

• Decide beforehand: Before your appointment, think about how much information you want to share and who you want to share it with. Prepare some notes so you don’t forget anything.
• Practise: You may feel more confident talking to your health professional if you practise what you want to say with your partner/s, family and friends.
• Have someone with you: Consider having a support person, such as a partner, family member or close friend, with you to help with the discussion and to provide support. They can also help you debrief and provide assistance with making a complaint if you receive a negative reaction. If you don’t feel safe, you can choose to leave the room.
• Do it in writing: If you’re not a confident speaker, write down what you want to say to your health professionals. You can also ask your GP to include information about you in their referral letter to other specialists, such as your sexual orientation, intersex variation, pronouns or preferred name.
• Ask for privacy: If you’re in a ward or open area, ask to speak in a quiet, private place where you won’t be overheard.
• Communicate your pronouns: Consider including your pronouns when you introduce yourself. You could say “My name is Parker Jones and I use they/them pronouns”. If you are misgendered, you could provide a simple correction such as “Oh, I use they/ them pronouns, thanks.” Wearing a pronoun badge is another way to remind people of your pronouns.
• Introduce you partner/s: If you have a partner or partners, encourage them to come to your appointments. This lets your doctor know who’s important to you. Before your first appointment, it’s okay to phone or email your doctor to find out if they are LGBTQI+ friendly. You could say, “My wife will attend the appointment with me, we are both women, just so you know.”
• Communication aids: You can use the Genders, Bodies and Relationships Passport to make telling your health professionals about your gender, body and relationships easier. 
• Seek support: Contact QLife, a national peer support and referral service for LGBTI people. Call 1800 184 527 or visit qlife.org.au.