Moral Challenges in Transgender Care: A Thematic Analysis Based on a Focused Ethnography

Gerritse, Karl; Hartman, Laura; Antonides, Marte Fleur; Wensing-Kruger, Annelijn; Vries, Annelou L.C. de; Molewijk, Bert

doi:10.1007/s10508-018-1287-3

Cited by 36 publications

(60 citation statements)

References 47 publications

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“…Treatment teams working with transgender youth and adults often face ethical questions (Gerritse et al 2018). These include questions such as: whether a patient's co-existing psychiatric problems are so serious that transgender treatment should be stopped or should not take place; whether or not to pursue treatment of a youngster whose parents disagree with the recommended course of treatment; whether it is necessary to reach a multidisciplinary team consensus on the whole transgender care trajectory before beginning the first phase of the treatment; and under what circumstances an exception may be made to the current treatment protocol.…”

Section: Introductionmentioning

confidence: 99%

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Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

et al. 2019

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Clinical ethics support (CES) for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria (CEGD) at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice.

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Section: Introductionmentioning

confidence: 99%

“…Until then, the team didn't recognize the ethical component of their decisions and therefore neglected to explicitly discuss the underlying normative perspectives. The results of this study will be published in a paper co-authored by CEDG and the Department of Medical Humanities staff (Gerritse et al 2018).…”

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Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

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“…Second, LH and BM and some members of the CEGD performed ethnographic research on ethical dilemmas experienced by the CEGD team [15]. A student researcher observed the multidisciplinary meetings and analyzed the MCDs.…”

Section: Positioning Ces More Within Care Practicesmentioning

confidence: 99%

“…Another example concerned the follow up of the study mapping all ethical issues [15]. At a policy meeting of the CEGD team, the overview of all ethical issues was presented in order to perform a member check with respect to the findings of the study.…”

Section: Paying Attention To Follow Upmentioning

confidence: 99%

Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

et al. 2020

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Background: Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization. Methods: This integrative approach was developed in an iterative process, combining actual experiences in a case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences. Results: In this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design. Conclusions: In the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES.

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“…; and (3) Must we reach a multidisciplinary team consensus about the whole treatment before treatment commences, or is it justifiable for discipline X to start part Y of the whole gender affirmative treatment before a consensus has been reached? (Byne et al, 2012;Gerritse et al, 2018;Milrod, 2014;Stein, 2012;Vrouenraets et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

et al. 2020

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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.

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Moral Challenges in Transgender Care: A Thematic Analysis Based on a Focused Ethnography

Cited by 36 publications

References 47 publications

Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

Dealing with Moral Challenges in Treatment of Transgender Children and Adolescents: Evaluating the Role of Moral Case Deliberation

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