People of all colors: Palliative Care for the LGBTQIAPN+ Population

Abstract

This essay critically reflects on the access and quality of palliative care for the LGBTQIAPN+ population. Despite being essential for quality of life, these services are accessed by only 12% of the global population in need, a figure that significantly worsens for vulnerable groups, such as the LGBTQIAPN+ community. Historically, healthcare, shaped by colonialist and cisheteronormative paradigms, perpetuates structural inequalities by disregarding the cultural, social, and identity specificities of the served populations. In the Brazilian context, even with inclusive public policies like the National Policy for Comprehensive LGBTQIAPN+ Health, a significant gap persists between legislation and daily healthcare practice. Health professionals still demonstrate a lack of preparedness to adequately address the specific needs of this population, exhibiting implicit and explicit prejudices. The "discourses of no" – non-difference, non-knowledge, and non-willingness – systematically operate as mechanisms of exclusion, invisibilizing identities, transferring responsibilities, and disregarding family configurations and grief processes experienced by this community. To overcome these institutional and social barriers, it becomes imperative to adopt a decolonial and affirmative approach to palliative care. This perspective must be based on ongoing professional education, recognition of diverse experiences, the use of inclusive language, and respect for multiple support networks and "chosen families." Decolonizing healthcare practices is, therefore, an essential step towards building a more equitable, ethical, and humanized system that not only recognizes but actively values diversity and respects the dignity and individuality of all people, especially those historically marginalized and stigmatized.