Trans? Here’s Why You Need An Advance Medical Directive

In some ways, there has never been a better time to be trans. Last June, the U.S. Supreme Court ruled that an employee cannot be fired simply for being gay, lesbian, or transgender—a historic victory for the LGBTQ community. And a broad majority of Americans now support trans rights, enabling individuals to move ahead in politics, the professional world, and their own communities regardless of their gender identity.

But as any trans person will tell you, much remains to be done. Trans individuals are often targets of violence, and the legal protections that include sexual orientation often specifically exclude gender identity. Health insurance does not typically cover hormone therapy or gender-confirmation surgery. And when it comes to public accommodations, transgender people may encounter hostility despite civil rights laws that prohibit certain businesses from discriminating against their customers. 

In this climate of uncertainty, it is important to do what you can to protect yourself from discrimination—to make sure your life is the best it can be, despite the world around you. From a legal standpoint, preparing an advance medical directive may be a surprisingly good place to start.

You may be familiar with advance directives. They enable you to name a “health care agent”—someone you trust who will manage your health care if you ever become incapacitated. They also say what kind of care you want to receive in an end-of-life situation, like a terminal illness.

For trans individuals, an advance medical directive can also help make their care as dignified as possible. For example, the document can instruct your health care providers to address you by your preferred name and pronouns, regardless of your legal name or the gender marker on your driver’s license. This simple provision can prevent the distress of being called by the wrong name at an especially vulnerable time.

To help prevent being misgendered, you can also request that your appearance be maintained to align as much as possible with your stated gender. Including this instruction in your advance directive will alert your health care providers as to your wishes and also help your health care agent ensure that they are followed.

Your advance directive is equally important when it comes to your funeral and burial arrangements. Most importantly, it enables you to name someone who cares about you to plan your funeral and dispose of your remains. This can be a difficult circumstance to think about—no one likes to contemplate their own mortality. But if you don’t name someone to take responsibility for your final arrangements, it will fall to your closest living family member. This could be an estranged relative or someone who disapproves of your gender expression. Designating the right person is therefore essential.

In addition to putting a trusted individual in charge, your advance directive can state the name and pronouns you prefer to be used in an obituary, eulogy, and any tributes on social media. These vital instructions will ensure that, whenever it happens, your final sendoff reflects your true identity.

An advance medical directive is part of a complete estate plan, which also usually includes a will and durable power of attorney. Having these documents prepared is one thing you can do to help protect yourself in a world of uncertainty. Contact an LGBTQ estate-planning attorney to get started.