STATEMENTS OF POLICY
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF OSTEOPATHIC MEDICINE
[ 49 PA. CODE CH. 25 ]
Conversion Therapy—Statement of Policy
[54 Pa.B. 3165]
[Saturday, June 8, 2024]The State Board of Osteopathic Medicine (Board) adds § 25.218 (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 Board-regulated practitioners and the general public.
Effective Date
This statement of policy will be effective upon its publication in the Pennsylvania Bulletin.
Statutory Authority
Section 15(a)(8) and (b)(9) of the Osteopathic Medical Practice Act (act) (63 P.S. § 271.15(a)(8) and (b)(9)) authorizes the Board to refuse, revoke or suspend the license of a physician, physician assistant, respiratory therapist or athletic trainer guilty of immoral or unprofessional conduct. Unprofessional conduct includes any departure from, or the failure to conform to, the standards of acceptable and prevailing practice. Under section 3(g) of the Acupuncture Licensure Act (63 P.S. § 1803(g)), acupuncturists licensed with the Board are subject to all disciplinary provisions applicable to medical doctors as set forth in the act. Under the Board's regulations, perfusionists and genetic counselors are subject to discipline under section 15(a)(8) and (b)(9) of the act, respectively.
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 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.
Due to the lack of scientific evidence supporting conversion therapy and the risk of harm to minors, the practice of conversion therapy is 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 Medical Association, 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 adopts 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 Board-regulated practitioners 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, a Board-regulated practitioner who uses 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 Osteopathic Medicine, P.O. Box 69523, Harrisburg, PA 17106-9523, (717) 783-7200, RA-STRegulatoryCounsel@pa.gov.
Order
The Board acting under the authority statutes, orders that:
(a) Chapter 25 of 49 Pa. Code is amended by adding a statement of policy in § 25.218 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.
JOHN BULGER, DO, MBA,
ChairpersonFiscal Note: 16A-5340. 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 25. STATE BOARD OF OSTEOPATHIC MEDICINE
Subchapter D. MINIMUM STANDARDS OF PRACTICE § 25.218. 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 opposes 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 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 Medical Association, 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 Board-regulated practitioners in this Commonwealth. Under section 15 of the act (63 P.S. § 271.15), the Board is authorized to refuse, revoke or suspend the license of a Board-regulated practitioner who is guilty of immoral or unprofessional conduct.
(c) Guidelines. The following conversion therapy guidelines should be considered by Board-regulated practitioners 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 Board-regulated practitioner, the Board may find the use of conversion therapy on an individual under 18 years of age to be immoral or unprofessional conduct. A Board-regulated practitioner who uses conversion therapy on an individual under 18 years of age may be subject to discipline by the Board.
[Pa.B. Doc. No. 24-794. Filed for public inspection June 7, 2024, 9:00 a.m.]
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