TY - JOUR
T1 - Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents
T2 - Evaluating the Role of Moral Case Deliberation
AU - Vrouenraets, Lieke Josephina Jeanne Johanna
AU - Hartman, Laura A.
AU - Hein, Irma M.
AU - de Vries, Annelou L.C.
AU - de Vries, Martine C.
AU - Molewijk, Bert A.C.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent’s capacity to consent, for example, could raise several issues and challenges. To deal with these challenges more effectively, several Dutch treatment teams started using a relatively well-established form of clinical ethics support (CES) called Moral Case Deliberation (MCD). MCD is a facilitator-led, collective moral inquiry based on a real case. This study’s purpose is to describe the teams’ perceived value and effectiveness of MCD. We conducted a mixed methods evaluation study using MCD session reports, individual interviews, focus groups, and MCD evaluation questionnaires. Our results show that Dutch transgender care providers rated MCD as highly valuable in situations where participants were confronted with moral challenges. The health care providers reported that MCD increased mutual understanding and open communication among team members and strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the health care providers also expressed criticisms of MCD: some felt that the amount of time spent discussing individual cases was excessive, that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process. We recommend future research on three matters: studying how MCD contributes to the quality of care, involvement of transgender people themselves in MCD, and integration of CES into daily work processes.
AB - Treatment teams providing affirmative medical transgender care to young people frequently face moral challenges arising from the care they provide. An adolescent’s capacity to consent, for example, could raise several issues and challenges. To deal with these challenges more effectively, several Dutch treatment teams started using a relatively well-established form of clinical ethics support (CES) called Moral Case Deliberation (MCD). MCD is a facilitator-led, collective moral inquiry based on a real case. This study’s purpose is to describe the teams’ perceived value and effectiveness of MCD. We conducted a mixed methods evaluation study using MCD session reports, individual interviews, focus groups, and MCD evaluation questionnaires. Our results show that Dutch transgender care providers rated MCD as highly valuable in situations where participants were confronted with moral challenges. The health care providers reported that MCD increased mutual understanding and open communication among team members and strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the health care providers also expressed criticisms of MCD: some felt that the amount of time spent discussing individual cases was excessive, that MCD should lead to more practical and concrete results, and that MCD needed better integration and follow-up in the regular work process. We recommend future research on three matters: studying how MCD contributes to the quality of care, involvement of transgender people themselves in MCD, and integration of CES into daily work processes.
KW - Clinical ethics support (CES)
KW - Gender dysphoria
KW - Moral case deliberation (MCD)
KW - Moral challenges
KW - Transgender
UR - http://www.scopus.com/inward/record.url?scp=85087289662&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10508-020-01762-3
DO - https://doi.org/10.1007/s10508-020-01762-3
M3 - Article
C2 - 32592076
SN - 0004-0002
VL - 49
SP - 2619
EP - 2634
JO - Archives of sexual behavior
JF - Archives of sexual behavior
IS - 7
ER -