STATEMENTS OF POLICY
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF NURSING
[ 49 PA. CODE CH. 21 ]
Conversion Therapy—Statement of Policy
[54 Pa.B. 3163]
[Saturday, June 8, 2024]The State Board of Nursing (Board) adds § 21.416 (relating to conversion therapy, sexual orientation change efforts and reparative therapy—statement of policy) to read as set forth in Annex A. This statement of policy is intended to provide guidance to licensees under the Board and the general public.
Effective Date
This statement of policy will be effective upon publication in the Pennsylvania Bulletin.
Statutory Authority
Section 14(a)(9) and (b) of the Professional Nursing Law (63 P.S. §§ 224(a)(9) and (b)) authorizes the Board to impose discipline on licensees for being guilty of immoral or unprofessional conduct. Unprofessional conduct shall include departure from or failing to conform to an ethical or quality standard of the profession.
Section 102 of the Commonwealth Documents Law (45 P.S. § 1102) defines ''statement of policy'' as ''any document, except an adjudication or a regulation, promulgated by an agency which sets forth substantive or procedural personal or property rights, privileges, immunities, duties, liabilities or obligations of the public or any part thereof, and includes, without limiting the generality of the foregoing, any document interpreting or implementing any act of Assembly enforced or administered by such agency.'' Statements of policy that are general and permanent in nature are required to be codified under 1 Pa. Code § 3.1 (relating to contents of Code).
Background and Purpose
The Commonwealth has a compelling interest in protecting the physical and psychological well-being of minors, including lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual (LGBTQIA+) youths, and in protecting minors against exposure to the severe harms caused by conversion therapy. Likewise, the Board has an interest in and a duty to protect the public from nursing practices that create a danger for patients and is dutybound to enforce the provisions of the act and its regulations. These duties compel the Board to take steps to guard against the dangers posed by conversion therapy.
Conversion therapy, also known as sexual orientation change efforts or reparative therapy, is a term that describes a wide range of interventions by mental health professionals that seek to change an individual's sexual orientation or gender expression, including efforts to change behaviors, gender identity or gender expressions, or to reduce or eliminate sexual or romantic attractions or feelings toward an individual of the same gender. The term does not include counseling for an individual seeking to transition from one gender to another, counseling that provides acceptance, support and understanding of an individual or facilitates an individual's coping, social support and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, or counseling that does not seek to change sexual orientation.
Conversion therapy can pose critical health risks to LGBTQIA+ people, including suicidality, substance abuse, confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, stress, disappointment, self-blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners, problems with sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a feeling of being dehumanized and untrue to self, a loss of faith and a sense of having wasted time and resources.
The American Medical Association, the American Nurses Association, American Academy of Nursing and International Society of Psychiatric-Mental Health Nurses oppose the use of conversion therapy for sexual orientation or gender identity. Due to the lack of scientific evidence supporting conversion therapy and the risk of harm to minors, the practice of conversion therapy is also strongly opposed by the American Academy of Child Adolescent Psychiatry, American Academy of Pediatrics, American Association for Marriage and Family Therapy, American College of Physicians, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, National Association of Social Workers, Pan American Health Organization and the World Psychiatric Association.
On June 15, 2022, President Joe Biden recognized the need to promote an end to the use of conversion therapies through the issuance of Executive Order 14075, which instructs Federal departments and agencies to formulate an action plan to prevent these therapies on a world-wide basis. On August 16, 2022, Governor Tom Wolf signed Executive Order 2022-02, which was published at 52 Pa.B. 5788 (September 10, 2022), to protect Pennsylvanians from conversion therapy by directing State agencies to discourage the practice of conversion therapy. See 4 Pa. Code §§ 7.921—7.924 (relating to protecting Pennsylvanians from conversion therapy and supporting LGBTQIA+ Pennsylvanians).
Given the lack of evidence to support the use of psychological interventions to change sexual orientation as well as the overwhelming opposition within the medical and psychological professions, the Board adopted this statement of policy as a public safety measure and to ensure that its licensees are aware of the Board's position on using conversion therapy on minors.
Description of this Statement of Policy
This statement of policy clarifies that it is the position of the Board that being LGBTQIA+ is not a disease, disorder, illness, deficiency or shortcoming. This statement of policy notifies licensees that the Board may find the use of conversion therapy on an individual under 18 years of age to be unprofessional or immoral conduct. Additionally, under this statement of policy, licensees who use conversion therapy on an individual under 18 years of age may be subject to discipline by the Board.
Fiscal Impact and Paperwork Requirements
This statement of policy will have no adverse fiscal impact on the Commonwealth or its political subdivisions and will impose no additional paperwork requirements upon the Commonwealth, political subdivisions or the private sector.
Sunset Date
A sunset date is not being established for this statement of policy. Its need and efficacy will be periodically monitored by the Board.
Additional Information
Persons who require additional information about this statement of policy may submit inquiries to the Counsel, State Board of Nursing, P.O. Box 69523, Harrisburg, PA 17106-9523, RA-STRegulatoryCounsel@pa.gov.
Order
The Board acting under the authority statutes, orders that:
(a) Chapter 21 of 49 Pa. Code is amended by adding a statement of policy in § 21.416 to read as set forth in Annex A.
(b) The Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(c) This order shall take effect upon publication in the Pennsylvania Bulletin.
COLBY P. HUNSBERGER, DNP, RN, CNEcl,
ChairpersonFiscal Note: 16A-5149. No fiscal impact; recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 21. STATE BOARD OF NURSING
Subchapter D. INTERPRETATIONS
STATEMENT OF POLICY § 21.416. Conversion therapy, sexual orientation change efforts and reparative therapy—statement of policy.
(a) Background. Conversion therapy, also known as sexual orientation change efforts or reparative therapy, poses critical health risks to lesbian, gay, bisexual, transgender, queer/questioning, intersex and asexual individuals, including suicidality, substance abuse, confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, stress, disappointment, self-blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners, problems with sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a feeling of being dehumanized and untrue to self, a loss of faith and a sense of having wasted time and resources. The American Medical Association, the American Nurses Association, the American Academy of Nursing and the International Society of Psychiatric-Mental Health Nurses oppose the use of conversion therapy for sexual orientation or gender identity. Due to the lack of scientific evidence supporting conversion therapy and the risk of harm to minors, the practice of conversion therapy is also strongly opposed by the American Academy of Child Adolescent Psychiatry, American Academy of Pediatrics, American Association for Marriage and Family Therapy, American College of Physicians, American Psychiatric Association, American Psychoanalytic Association, American Psychological Association, National Association of Social Workers, Pan American Health Organization and the World Psychiatric Association.
(b) Board authority. The Board has statutory authority to license, regulate and discipline a licensee in this Commonwealth. Under section 14(a)(9) and (b) of the act (63 P.S. § 224(a)(9) and (b)), the Board is authorized to impose disciplinary or corrective measures on a licensee for being guilty of immoral or unprofessional conduct, which includes departure from or failing to conform to an ethical or quality standard of the profession.
(c) Guidelines. The following conversion therapy guidelines should be considered by a licensee to ensure compliance with the act and the Board's regulations.
(1) Being lesbian, gay, bisexual, transgender, queer/questioning, intersex or asexual is not a disease, disorder, illness, deficiency or shortcoming.
(2) Conversion therapy includes the following conduct:
(i) A practice or treatment that seeks to change an individual's sexual orientation or gender identity.
(ii) An effort to change the behavioral expression of an individual's sexual orientation, change gender expression, or eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.
(3) Conversion therapy does not include a practice or treatment that provides counseling for an individual undergoing gender transition, counseling that provides acceptance, support, and understanding, or the facilitation of coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices. Conversion therapy does not include a practice that does not seek to change sexual orientation or gender identity.
(4) In a disciplinary action brought against a licensee, the Board may find the use of conversion therapy on an individual under 18 years of age to be unethical, immoral or unprofessional conduct. A licensee who uses conversion therapy on an individual under 18 years of age may be subject to discipline by the Board.
[Pa.B. Doc. No. 24-793. Filed for public inspection June 7, 2024, 9:00 a.m.]
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