October 23, 2006

Marriage Equality & Health (Part 2)

Posted at 5:27 pm (Pacific Time)

In my previous post, I summarized research findings on the health benefits of marriage. The data show that marriage bestows many benefits and protections with important implications for physical and mental health.

What are the health consequences for same-sex couples of being denied the right to marry?

Empirical data aren’t yet available to directly assess how governmental nonrecognition affects same-sex couples. But it is reasonable to conclude that their differential treatment, vis-a-vis married heterosexuals, creates special challenges and obstacles with ultimately negative consequences for their well-being. Without legal recognition, partners in same-sex couples lack both the practical benefits of marriage and the buffers marriage provides against the psychological and social consequences of traumatic events.

For example, their financial situation is likely to be less stable than that of married couples because they don’t enjoy the many economic protections of marriage in areas such as taxation and property rights. Even when gay and lesbian employees don’t fear dismissal or harassment because of their sexual orientation, they nevertheless receive fewer job-related benefits than their married coworkers. Family leave policies, health insurance, and pension plans, for example, typically include an employee’s spouse but not a same-sex partner. And when benefits such as health insurance coverage are extended to a same-sex partner, they are taxed as income; this is typically not the case for benefits to heterosexual spouses.

Because same-sex couples lack the protections that marriage provides when a spouse dies, they must incur the considerable expense of creating legal protections for the surviving partner through wills, trusts, and contracts for joint ownership of property. And these measures don’t always protect the partner. A will can be contested by the decedent’s biological relatives, for example and, unlike a spouse, the surviving partner is likely to incur a substantial tax burden when taking sole legal possession of a home that the couple jointly owned.

The consequences of having one’s intimate relationship unacknowledged by the law are not only financial. For example, a member of a same-sex couple may be excluded from her or his partner’s medical care. She or he may be denied as basic a right as access to the partner in a hospital setting restricted to “immediate family” members, such as an emergency room or intensive care unit. When a member of a same-sex couple dies, her or his surviving partner may experience a similar negation of their relationship. She or he may not even be able to make funeral arrangements.

Such experiences of what is sometimes called disenfranchised grief may compound the considerable psychological distress experienced by the surviving partner, with potentially long-term mental health consequences.

Examples of other areas in which same-sex couples are disadvantaged relative to married couples include immigration (foreign nationals cannot secure residence or citizenship through their relationship with a US citizen of the same sex) and private communication (members of same-sex couples can be called to testify against their partner in legal proceedings).

As a consequence of these and the many other forms of differential treatment to which they are subjected, same-sex couples are exposed to more stress than married couples, especially when they encounter life’s inevitable difficulties and challenges. Because experiencing stress increases one’s likelihood of mental and physical illness, their lack of legal protection places members of same-sex couples at greater risk for health problems compared to married couples.

But is complete marriage equality necessary to alleviate these disparities? Can’t the problems and inequities experienced by same-sex couples be adequately addressed through arrangements such as civil unions and second-parent adoptions?

I’ll address that question in the final post to this series.

For a more detailed discussion of these and related issues, see my 2006 paper, Legal Recognition of Same-Sex Relationships in the United States: A Social Science Perspective, published in the American Psychologist, vol. 61, pp. 607-621.

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