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The Added Import of Advance Directives for the Transgender Community

By dailin
Published June 30, 2021

Advance directives are incredibly important legal documents everyone should have. They specify your wishes not only for end-of-life care, but also for any medical care necessitated by emergency.

Without an advance directive, the responsibility for making your healthcare decisions when you’re incapacitated usually falls to biological family members according to state laws. For many transgender individuals, that outcome is unacceptable.

There is a legal fix, though: Setting up an advance directive today.

Let’s look at some of the documents in an advance directive, and how they can help you ensure your identity is respected even when you’re unable to advocate for yourself.

Living Will

Your living will is a set of directions or preferences for your medical care should you become incapacitated and unable to express your wishes. This particular document is a set of directions for your doctor in case of the worst, commonly covering topics like:

  • CPR.
  • Intubation.
  • Dialysis.
  • Feeding tubes.
  • Life support.
  • Etc.

Added Importance for the Transgender Community

If you are transgender, you will likely want your living will to include a few additional stipulations. First, you can use this document to specify your pronouns. You can also instruct the medical staff on your name, even if you have not yet been able to legally change it.

Importantly, a living will is where you’d lay out your wishes regarding any hormone therapies while you are incapacitated. A living will is also where you would direct medical staff and any other professionals on how you would like to be dressed. When gendered clothing is available, would you like to be dressed in men’s or women’s clothing?

This is important not just in the hospital, but also in settings such as assisted living and funeral homes.

Medical Power of Attorney

A living will is almost always accompanied by a medical power of attorney. You can also set up a medical power of attorney independent of living will, but ultimately you should have both.

When you give someone medical power of attorney, you are telling the doctor that this is the person who should be making decisions about your healthcare should you be unable to make them yourself.

Added Importance for the Transgender Community

If you do not have a medical power of attorney, the person making your healthcare decisions will be a next-of-kin family member determined by your state laws. If you have a spouse, in most cases they will be your default healthcare proxy.

If you do not, the next person on the list is usually a biological family member, like a parent, adult child or sibling. That may be okay if your family respects you and your identity. But it is not okay if they do not.

Even if you have a spouse, overly zealous biological family members can cause harm or confusion in the chaos that is end-of-life or emergency medical care. It is best to lay out your specific wishes through a medical power of attorney so there is no question or room for argument about who is making medical decisions on your behalf.

To avoid this situation even more explicitly, if you know you have problematic biological family members, you can include a section in your living will labelled, ‘People That Should Have No Authority.’

Hospital Visitation Directive

Most hospital visitation policies allow your biological family to visit you in the hospital — and sometimes only your biological family. A hospital visitation directive can both limit the biological family members who are allowed to visit you, and expand visitation privileges to your family of choice.

Learn more about advance directives for the transgender community.

Advance directives are one tool in an arsenal of legal documents you can use to affirm your identity, healthcare wishes and even financial legacy. To learn more about how to use these tools to assert your rights, turn to organizations such as the Transgender Law Center in California.


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