Monday, April 30, 2012

Amendment One: A Physician's Perspective

On May 8, North Carolina voters will go to the polls to vote on Amendment One. If passed, this controversial proposal will ensure that heterosexual marriage is the only legally recognized domestic union in the state.

Whatever political party you belong to, I strongly encourage you to look closely at Amendment One. Currently, I’m a Democrat; from this perspective this amendment is a fundamental denial of human rights to large segments of our population. This is wrong. On the other hand, in earlier years I was a Republican. From this perspective, this Amendment legalizes government intrusion into our personal lives. This is wrong too.

Many others are speaking out about potential loss of business revenues and potential legal challenges Amendment One may generate. Others complain that this is a distraction from our state government’s top priorities: to get our economy going again and lower the unemployment rate.

As a physician, I feel it's my duty to look at the potential health and safety implications of this proposed amendment. My research has led me to believe there will be a number of negative health and safety outcomes. And, as gay marriage is already illegal in North Carolina, I find Amendment One both dangerous and unnecessary.

The Physical and Emotional Health of Children, Teens and Adults
A consequence of Amendment One, should it pass, is that it will make LGBT (lesbian, gay, bisexual, transgender) people second-class citizens in North Carolina. This can generate profound stress for families.

Stress can lead to a number of physical and emotional problems. In children in particular this can lead to:
  • Decreased appetite
  • Bedwetting
  • Headaches
  • Nightmares and sleep disturbances
  • Stuttering
  • Physical aches and pain
  • Worries and fear
  • Clinging and separation anxiety
  •  Acting out
  •  Regression to earlier developmental stages
Other mental health issues can arise as well. A recent study discovered that LGBTs adults living in states with constitutional amendments banning gay marriage have increased rates of mood disorder, anxiety disorder and alcohol abuse. 

The American Academy of Pediatrics also found that depression, bullying and suicide attempts among gay teens and teens with gay parents are more common in areas where there are fewer programs supportive of homosexuals. The authors of the study stated: "The lack of societal tolerance, acceptance and support that gay and lesbian individuals, couples and their children experience can and does affect their psychosocial and physical health and safety.”

Suicide is the third leading cause of death in teens and young adults ages 15-24, and the sixth leading cause of death in children ages 5-14. However, those statistics are even higher in the gay community. LGBT youth are four times more likely to attempt suicide than their heterosexual peers. They also found "When communities support their gay young people the risk of attempted suicide by all young people drops." Teens are smart. They know that if bullying is allowed or even sanctioned then no one is safe. Stress is reduced when we acknowledge, even embrace, the concept of inclusivity as opposed to being divisive and discriminatory.

Barriers to Health Care Access
Any change in the law that confuses or negates existing agreements between non-married couples—gay or straight—can cause a disruption in the lives of the men, women and children who are in these relationships. Thus, Amendment One has the potential to:
  • prevent courts from enforcing private agreements between unmarried couples
  • interfere with child custody and visitation rights
  • invalidate domestic partnership benefits offered by local municipalities
  • prevent courts from enforcing private employer benefits to the partners and children of an employee
The wording of Amendment One as approved by the North Carolina legislature states that the amendment "does not prohibit a private party from entering into contracts with another private party; nor does this section prohibit courts from adjudicating the rights of private parties pursuant to such contracts." However, legal scholars question the effectiveness of such wording. Professors Maxine Eichner, Barbara Fedders and Holning Lau at the University of North Carolina School of Law have suggested the language is "problematically vague ... and untested."
And while Amendment One would not prohibit a private employer or insurance company from providing domestic partnership benefits, business experts worry that the very existence of a marriage amendment could keep businesses that do offer such benefits from wanting to establish locations in North Carolina.
What this tells me is that there is a strong chance of unpredictability in parental rights and family benefits if Amendment One is passed. If ultimate protection isn't ensured for North Carolina families of all makeups, many of our state's children and adults may experience an unnecessary lack of medical coverage.
Domestic Violence Laws in Jeopardy
Currently, domestic violence laws apply to North Carolina citizens of any sexual orientation, regardless of marital status. This includes people who are in common law marriages. By imposing a narrow definition of marriage, Amendment One may inadvertently remove protections from citizens who will not fall within the strict legal parameters of the amendment. These concerns are not unfounded.

In 2004, the voters of Ohio passed a similar, albeit less restrictive, amendment to their state constitution. As a result, numerous trial courts—and two appellate courts—in Ohio found that the state's domestic violence laws had become unconstitutional when applied to unmarried couples, whether gay or straight.

Fortunately, Ohio's Supreme Court later overturned those rulings. But for a full three years, batterers avoided prosecution, and the lives of many domestic violence victims were in limbo.

In North Carolina, such an Amendment could undo much of the progress our state legislature has made in holding batterers fully accountable. We cannot risk creating an environment where unmarried domestic violence victims would be unable to enforce protective orders, and domestic violence perpetrators would receive misdemeanor, rather than felony, convictions.

Final Thoughts
Should Amendment One pass, it will be difficult for legislators to later adjust the amendment for any problems that arise. The General Assembly cannot change constitutional amendments in the same way it can statutes.

It is important to remember that North Carolina already has a law that limits marriage to opposite-sex couples. This constitutional amendment is an unnecessary proposal which I believe will result in detrimental health consequences for many citizens in our state.

You can see why I'm concerned about Amendment One. If you, too, are concerned about the impact of this amendment, you should vote against Amendment One on Tuesday May 8th.

Take care of yourself,
Elizabeth Vaughan, MD