Institutional Violence Perpetrated Against Transgender Individuals in Brazilian Healthcare Services: A Conceptual Analysis Based on Foucault's Microphysics of Power.

Institutional violence against transgender individuals in healthcare is a structural phenomenon with multifactorial roots and is embedded in social, cultural, political, and economic dynamics. Drawing on Michel Foucault's concept of the microphysics of power, this study analyzes how such violence unfolds within Brazil's healthcare system. For Foucault, power is not solely exercised through centralized institutions but is diffuse and present in everyday practices, relationships, and discourses. Institutional violence, while often manifesting in individual acts, is defined by its persistence and systematic occurrence over time. In healthcare settings, this violence assumes symbolic, structural, psychological, and physical forms ranging from neglect and verbal abuse to sexual violence. Foucault's framework allows for a deeper understanding of how power relations perpetuate exclusionary and dehumanizing practices. By interpreting these dynamics through the Microphysics of Power, the study reveals that institutional violence against transgender individuals extends beyond explicit acts, encompassing routine interactions that reproduce inequality and restrict access to fundamental rights such as healthcare. These practices sustain a logic of control and exclusion that operates subtly but effectively within healthcare systems, reinforcing the marginalization of trans people and undermining their right to dignified and equitable care.