Is It Wrong to Donate to Candidates You Can’t Vote for?

I have felt uncomfortable with the idea of donating money to candidates in elections in which I have no voting rights — such as senators in states other than my own. I always believed that only those able to vote in an election and who will be directly affected by it have the right to donate to the candidates. It has become clear to me, however, that individual senators and other elected officials outside my state do indeed have a powerful effect on the entire country. Is it appropriate for me to donate to candidates in elections in which I cannot vote? Christine, Seattle

Given that campaigns for public office in this country require citizen contributions, you are absolutely entitled to help candidates from districts and states other than your own. (Whether the way that elections are financed here is good for our democracy is another question.) As you recognize, the effects politicians have aren’t confined to their immediate constituencies. On the contrary, the prospects for our country depend on who holds elective offices at every level. For one thing, representatives from each of the states in the U.S. House and Senate vote on national legislation. For another, policies in one state affect what happens in others. Guns stolen in Pennsylvania are used in crimes in New Jersey. Children educated in Texas end up working in California. Voter suppression in Florida affects the composition not only of its State Legislature but also of its legislative delegates in Washington and could determine who wins the White House. We are one nation; if we’re to aim at liberty and justice for all, we need to do it together.

I am a transgender man who is currently in medical school and at the point in my training when I am seeing patients day to day. I am also at the point in my physical transition where no one would assume, or even reasonably guess, that I am trans.

If a patient of mine expresses their discomfort with trans people or a belief that trans people are mentally unstable, should I attempt to remove myself from that patient’s care if at all possible? Should I inform the patient that I am trans and give them the option of choosing another doctor? (On the latter, I would lean toward not doing so, because I feel I have a right to my privacy and because my safety could easily be compromised in my current work environment.)

I wish this were just a hypothetical, but colleagues have informed me that they have had patients make such comments in the course of asking them routine questions about how they would like to be addressed or while taking a routine sexual history. I have myself come close to the situation they describe a few times, particularly with adolescents with whom our practice is to ask for their gender identity when taking their social history.

This dilemma also raises questions for my future as a provider when I may find myself in a situation where I can’t reasonably extricate myself from the patient’s care without impairing the health care they receive. Do I then have an obligation to reveal that I am trans? Name Withheld

The details of your religious or ethnic identity might make some of your patients uncomfortable but are of no relevance to your ability to serve them. The same goes for the details of your gender identity. You have no duty to tell them. They have no right to ask. Transphobia isn’t a nut allergy — your being transgender isn’t a hidden danger that vulnerable people need to be warned about. If patients somehow learn that you’re transgender, and react with prejudice, they are free to cease coming to you for help. But you shouldn’t take the initiative when it comes to indulging irrational and regrettable preferences.

There are also circumstances in which doctors effectively fire patients they find intolerable — a different kind of allergy to nuts — and that’s acceptable when the patient can find care elsewhere. It’s common enough for physicians (members of a profession that is something like 44 percent nonwhite) to encounter vile remarks with respect to their color, accent, presumed ancestry and the like. Misogyny is hardly a rare condition, either. In institutional settings, clinicians mostly try to absorb the blows. Where possible, though, hospitals and clinics should try to accommodate staff members who want relief from abusive patients. We rightly put the welfare of patients first. But the welfare of health care providers matters, too.

I have been a patient at a health center that caters to the L.G.B.T.Q. community for over 30 years. During that time, I have had several physicians assigned to me, and at times that has included licensed practical nurses, or L.P.N.s, as well as transgender caregivers. At one point, it became obvious to me that my doctor of many years, a woman, had made the decision to transition and was choosing to be addressed by the pronoun “he.” The same physician then requested that I find a new caregiver because he was going to pursue research.

I was then assigned to a wonderful L.P.N. who, after years of delivering excellent care, chose to leave her job for personal reasons, which then left me without a care provider. I was then assigned other doctors that included several transgender members of the staff.

I believe the choice of a physician is an extremely personal and important issue for anyone. My question is this: Do I as a patient have the right to request that I not be assigned for personal reasons to any one doctor or caregiver? Also is a clinic or hospital legally obligated to provide the full background of any of their physicians to perspective patients?

I am a gay male in a very happy biracial marriage. I am neither a racist nor do I discriminate against any one group. I do, however, feel I have the right to make my own decision about who my physician is. Name Withheld, Brooklyn

If you want consistency in care and your health center can’t offer that, you should look for another. And you do, in principle, have the right to refuse care from a provider. But why are you interested in getting a provider’s “full background”? Have you decided that you don’t want to be treated by a trans person? You say you don’t discriminate against any group; but that would indeed be discriminatory. What would you say about someone who categorically refused care from gay or black doctors? Having a right to do something doesn’t make it the right thing to do.

And no, the clinic doesn’t have a duty to provide you with information about the people who work there, beyond facts that are relevant to their expertise. As I’ve said, gender identity — like sexuality, religion, race, ethnicity, national origin, political affiliation and a whole lot else — isn’t one of those facts.

My ex-husband’s new fiancée recently contacted me, insisting that I give up my last name. She and I just happen to share a first name, which is unsurprising. It’s a name that is as common as Hannah or Elizabeth. I think she wants the name to herself, which is understandable, but I still don’t want to change it. It has been my name for nearly 20 years, which is almost half my life and my entire adult life.

My reasons are not personal but professional: I married my husband in my early 20s, while in grad school (my diploma is in my married name) and so are all my major publications. We divorced amicably some time ago, and I never bothered to change my name; it just seemed easier to keep my married name. Since then, my career has really taken off, and I’m fairly well known in my field.

My ex’s fiancée thinks I’m “sick and stuck in the past” and that I should be “embarrassed to not let things go.” That isn’t the case at all. It’s true that my ex and I talk rarely; we are polite when we do see each other. Though my ex-husband is indifferent about the name change, he won’t get his wife to back off.

Is it terrible and unethical to keep it? Again my first name is generic and his last name is generic — think Johnson or Smith. And a Google and social media search yields hundreds of people with the same name. I don’t think it’s a big deal; she is furious, and I’m worried her anger could escalate to harassment.

Is it wrong to stand my ground? Is it unethical to disregard her and keep a name?

I can’t reach out to friends as many of them are mutual or near mutual, and I don’t want things to get messy or embarrassing for anyone. Name Withheld

The late scholar and poet John Hollander delighted in noting that the word “preposterous” had the literal meaning of “before-afterly.” This woman’s demand is, in the fullest sense, a preposterous one. She has things backward. You’re the one who had the name first, and you’re the one who has built a professional career under that name. If this latecomer is worried about distinguishing herself from you, she can hyphenate her existing surname with your ex-husband’s or keep it as it is.

I would ask her to stop communicating with you about this. What’s embarrassing here is her behavior, not yours. May I add that the tone of her communications suggests that her problem isn’t with your name but with the fact that her future husband was once married to you? It would seem to be the fiancée who is “stuck in the past.”


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