Introduction
Single People Have the Right to Equal Access to Medical Care
Single people have the right to equal access to medical care, and the right to protection from medical or disability discrimination based on their marital or romantic relationship status, but these rights are not actually applied in U.S. law and society. Currently, healthcare providers, health facilities, insurance companies, and other institutions that comprise the medical industrial complex discriminate against single people. The myriad health-related laws and policies that consider an individual’s marital status are not only discriminatory, but they have significant negative effects on the health of people who are the target of said discrimination. They also influence how single people are treated socially when they become ill or disabled. Because of poorly designed or inaccurately interpreted scientific studies and sociocultural bias[i], single people are often erroneously assumed to have more unhealthy lifestyles and to be less healthy than they would be if they got married. This prejudicial and faulty deficit narrative influences institutional laws and policies, from the financial and tax benefits of sharing health insurance plans and plan deductibles, to employee health benefits. Medical practitioners often assume their single patients have no support systems or, worse, that their lives are not as valuable as those of married patients. As research by Dr. Joan DelFattore shows, these stigmas impact single patients’ care and can even threaten their lives.[ii]
The Dangers of the Deficit Narrative of Single Life
Singles advocate and social scientist Dr. Bella DePaulo points out that the deficit narrative is not only discriminatory, it’s dangerous. She describes three studies showing that married patients were more likely to be recommended for transplants, even when the married and single patients were equally qualified.[iii] In an article for the New England Journal of Medicine, Dr. DelFattore described how an oncologist tried to deny her treatment based on her marital status, a not-uncommon occurrence in the healthcare world.[iv] Married people are given stronger treatments than are unmarried people fifty-three percent of the time.[v] Subsequent to her experience with the biased oncologist, DelFattore’s research revealed that the sociocultural stereotypes portraying singles as depressed, pathologized, or otherwise flawed influence physicians’ views of their single patients, leading the physicians to withhold treatment because they assume the patients “lack a fighting spirit” or are otherwise less motivated or strong than married people.[vi]
At the same time as they are being medically and financially penalized for not being married, single people are doing more volunteering and providing more health and wellness care than are married people, says Dr. DePaulo, citing a study by Ursula Henz.[vii] This is despite the fact that single people are less likely to have a second set of hands around the house to help manage the detritus of daily existence.[viii]
Singlist Healthcare Impacts Disabled and Elderly People
Disability benefits are tied to marriage, often in ways that disproportionately harm single people with disabilities. Disabled people are more likely to be single, which means, given the extensive privileging of marriage in U.S. legal and financial policy, that disabled people ultimately have less access to tax, health insurance, and Social Security benefits. Disability advocate Dr. Jill Summerville summarizes the situation:
Any cultural or legal biases that privilege marriage in building a support network or honoring an existing support network disproportionately affect disabled people, because they are less likely than able-bodied people to be married, and they are more likely to have permanent or recurring lifelong medical needs.[ix]
Singlism in healthcare also disproportionately impacts older people with increasing severity as they age. Our marriage-centric, dual-income-based society doesn’t encourage communal housing or co-housing that would benefit elderly people without nuclear families, and it doesn’t reward the kind of extra-nuclear and friendship-based support networks that allow people to age healthfully in place (think The Golden Girls).
[i] DePaulo, Bella. “Getting Married and (Not) Getting Healty: What Decades of Research Really Shows.” BellaDePaul.com, 28 December 2023, belladepaulo.com/2013/12/getting-married-and-not-getting-healthy-what-decades-of-research-really-shows/ (Accessed: 20250311)
[ii] DelFattore, Joan Ph.D. “Death by Stereotype? Cancer Treatment in Unmarried Patients.” New England Journal of Medicine, Medicine & Society. Vol 381 No. 10, 02 September 2019, www.nejm.org/doi/abs/10.1056/NEJMms1902657 (Accessed: 20250311)
[iii] DePaulo, Bella. “Discrimination against Unmarried People: Is It Legitimated by the Deficit Narrative of Single Life?” Unmarried Equality, 06 May 2020, www.unmarried.org/featured/discrimination-against-unmarried-people-is-it-legitimated-by-the-deficit-narrative-of-single-life/ (Accessed: 20250311)
The three studies cited:
- M.W. Khattak, G.S. Sandhu, R. Woodward, et al. “Association of marital status with access to renal transplantation.” American Journal of Transplantation 2010 Dec 10(12):2624-31, pubmed.ncbi.nlm.nih.gov/21070605/ (Accessed: 20250311)
- Keren Ladin, Joanna Emerson, Kelsey Berry, et al. “Excluding patients from transplant due to social support; results from a national survey of transplant providers.” American Journal of Transplantation 2019 Jan19(1):193-203, pmc.ncbi.nlm.nih.gov/articles/PMC6427829/ (Accessed: 20250311)
- Satia A. Marotta and Keren Ladin. “Marital privilege: Bias against divorced patients in medical decision-making.” Group Processes & Intergroup Relations, 2020 23(4):612-639, doi.org/10.1177/1368430219843997 (Accessed: 20250311)
[iv] Delfattore, Joan, Ph.D. “Death by Stereotype.” New England Journal of Medicine 2019;381:982-985, Vol. 381 No. 10, www.nejm.org/doi/abs/10.1056/NEJMms1902657 (Accessed: 20250311)
[v] Walton, Alice G., Ph.D. “The Marriage-Health Connection Extends to Cancer Survival.” Forbes, 24 September 2013, www.forbes.com/sites/alicegwalton/2013/09/24/the-marriage-health-connection-extends-to-cancer-survival/ (Accessed: 20250311)
[vi] DelFattore, Joan, Ph.D. “If you’re single with cancer, you may get less aggressive treatment than a married person.” The Washington Post, Health & Science, 3 December 2018, www.washingtonpost.com/national/health-science/if-youre-single-with-cancer-you-may-get-less-aggressive-treatment-than-a-married-person/2018/11/30/a1286d20-ce18-11e8-920f-dd52e1ae4570_story.html (Accessed: 20250311)
[vii] DePaulo, Bella, PhD. “Single with Ailing Parents: Who Cares?” Psychology Today, 11 August 2011, www.psychologytoday.com/us/blog/living-single/201108/single-with-ailing-parents-who-cares (Accessed: 20250729)
[viii] DePaulo, Bella, PhD. “Unselfish Singles: They give more time, money, and care.” Psychology Today, 24 February 2017, www.psychologytoday.com/us/blog/living-single/201702/unselfish-singles-they-give-more-time-money-and-care (Accessed: 20250729)
[ix] Dr. Jill Summerville, via informal email communications with the author, 20240511
Singles Equality | Singles Bill of Rights 