This guest column was written by Meghan Macmillan.

For many people it is uncomfortable thinking about mortality. What does it mean to grow old, to become ill or to die? These are not easy questions to wrestle with, but they are important for each of us to look at. 

Being queer, trans, or any identity outside of the cis-hetero norms of our society makes this even more important. Our doctors, nurses, caregivers are starting to get more training in diversity and how not to make assumptions about the patients they treat, but anyone who is 2SLGBTQ+ has all seen bias (both conscious and unconscious) impact the healthcare experiences of ourselves or our loved ones.   

As someone who works with those experiencing serious illness and end-of-life, I get to see the difference it makes to have these difficult conversations ahead of time. The end-of-life needs of the 2SLGBTQ+ community are similar to the general population in that it’s important to talk about what kind of care we want. However, because our community often does not fit neatly into the medical boxes of “family”, there are some additional decisions that need to be looked at to ensure our safety, dignity and comfort

When a person is incapacitated, the medical system looks to their “Substitute Decision Maker” or SDM to make decisions on their behalf. There is a legal standard that health providers go by in emergencies, unless a person has previously legally appointed someone to act for them. Depending on a person’s situation their SDM will be assumed to be their spouse, parent, child, sibling, or other relative (generally in that order). But this framework does not take into account that 2SLGBTQ+ people are often estranged from their families and may prefer that decisions be made by a friend or partners that are not legally recognized as a “spouse”.

There are many reasons that those in our community may not feel that their legal family will best represent their health decisions. Your SDM advocates for things including: medical decisions, who may visit you, who receives information about you, and the type of intimate care you receive. If you feel that a friend or chosen non-immediate family member may better represent you than the person the law assumes would care for you, then it is important to have these conversations with your chosen person and fill out the forms to legally make them your Power of Attorney. While this may sound intimidating, once your decisions are made it is not a difficult process to go through and the forms are free online.

Our health can change at any time, accidents and disease don’t recognize age. We all deserve to be surrounded by the people we love and care about in times of need. While this kind of conversation may feel uncomfortable it is definitely one worth having. Take this as the sign to add it to your “to do” list, get it done, and then congratulate yourself on some definite self care.  


guest post, Personal experiences

SPECTRUM offers a safe place where LGBTQ2+ individuals can be themselves and find community and supports.