Exiting the Clinic: An Institutional Ethnography of Trans and Gender-Diverse Individuals’ Care in New Brunswick, Canada
Abstract
This dissertation explores the systemic challenges faced by trans and gender-diverse (TGD) individuals navigating institutional pathways of care, with a specific focus on gender-affirming care in New Brunswick (NB), Canada. Employing institutional ethnography (IE) as a methodological framework, this work investigates the care landscape shaped by administrative policies, geographic barriers, and institutional failures that impact TGD individuals' access to affirming healthcare. This study also highlights the importance of examining how social determinants of health intersect with gender identity to affect healthcare outcomes for TGD individuals. The closure of Clinic 554 is used as a central case study to highlight the gaps in formal care services and the resulting care deserts created in NB, emphasizing the significance of geographies of care in determining accessibility and quality. Furthermore, I examine the historical trajectory of trans medicine, the evolution of trans medical ethics, and how dominant medical narratives have shaped the treatment of TGD individuals. It also addresses the emergence of community-driven care models, including mutual aid networks, as a response to the failures of institutional systems. The "Code of Ethics and Community Guidelines for Trans Mutual Aid Group NB" exemplifies how alternative care systems are developed, emphasizing principles like inclusivity, consent, and community accountability. This grassroots mobilization, based on radical care practices, aims to dismantle oppressive systems and foster affective solidarity and collective well-being. By centring community knowledge and experiences, this work emphasizes the value of lived expertise in shaping effective and responsive care models. The findings reveal that TGD individuals and care providers encounter persistent systemic barriers, ranging from the undertraining of providers to the administrative violence embedded in institutional practices. These challenges necessitate reimagining care that centers marginalized communities' needs and experiences and goes beyond institutional structures. Overall, the dissertation contributes to the emerging discourse on transfeminist care ethics, advocating for an ethos of trans care that emphasizes relationality, interdependence, and community-led initiatives. By grounding care in transfeminist ethics, this work aims to build a future where care is accessible, just, and rooted in solidarity and mutual flourishing for all TGD individuals.