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@NEJM Ask the Author & Experts: Civil Rights and Health--Beyond Same-Sex Marriage

Perspective

Civil Rights and Health — Beyond Same-Sex Marriage

The recent Supreme Court decision in Obergefell v. Hodges, which rejected as unconstitutional state bans on same-sex marriage, was a major milestone for the lesbian, gay, bisexual, and transgender (LGBT) civil rights movement. Soon after the decision, a dental hygienist, chatting with me on an airplane, mentioned that her gay niece was getting married. “How nice,” she said, “that this is now legal everywhere. In the past, gay people were so often treated very badly!” The idea that the acceptance of same-sex marriage as part of the fundamental right to marriage heralds the end of bad treatment of LGBT people and denial of their rights may be a commonly held notion, but it’s most likely overly optimistic, as well as contrary to the evidence on health disparities.

The Court had found in prior decisions that there is a fundamental right to marry — for example, in Loving v. Virginia, which banned miscegenation laws prohibiting interracial marriages. Now, Justice Anthony Kennedy, writing for the majority in Obergefell, has made both a very human case for extending marriage rights to same-sex couples — “marriage . . . embodies the highest ideals of love, fidelity, devotion, sacrifice, and family” — and a constitutional case for affording such couples equal protection (under the 14th Amendment). He states clearly that “the Constitution grants them that right” — for it grants all Americans “equal dignity in the eyes of the law.”

It is less clear, however, that the decision represents a significant change in the way LGBT people will be treated in the United States. Public policies such as legalizing same-sex marriage may well have positive effects on the daily lives, health, and welfare of LGBT people. But other legal and health policy battles remain if we are to ensure that “being treated badly” becomes a thing of the past.