Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

Levine, Stephen B.; Abbruzzese, E.; Mason, Julia M

doi:10.1080/0092623x.2022.2046221

Cited by 46 publications

(43 citation statements)

References 105 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Yet, we do contribute to the complex debate by a helpful and practice-oriented framework for the care providers to unravel moral challenges, articulate uncertainties and make well-considered conclusions on a case-by-case basis, thereby preventing potential misunderstandings about decision-making capacity of minor’s and stimulating careful assessments in practice. Especially since the field of transgender care still lacks evidence-based consensus regarding treatment options, shown in recent critics on existing medical approaches [ 49 ], our ethics support tool is highly needed and relevant for the individual care provider.…”

Section: Discussionmentioning

confidence: 99%

How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool

et al. 2022

View full text Add to dashboard Cite

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support.

show abstract

Section: Discussionmentioning

confidence: 99%

How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The authors cite a paper by Levine et al as "evidence" that the informed consent model when poorly performed can lead to harm, and we strongly agree with that sentiment. 17 However, most evidence-based gender health clinics in the United States take this process seriously. We encourage patients to strongly vet healthcare systems to ensure this model is used before establishing care.…”

Section: Demystifying the Informed Consent Model To Gacmentioning

confidence: 99%

“…Lastly, we call into question the quality and biases present in the mentioned publication that uses language such as "temporary identity" when describing TGD persons. 17 LETTER TO THE EDITOR…”

Section: Demystifying the Informed Consent Model To Gacmentioning

confidence: 99%

A response to puberty blockers for gender dysphoric youth: A lack of sound science

Mills

Astle

Frazier

2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

show abstract

“…However, in society, there is doubt about this competence [e.g. 16,[22][23][24][25][26][27]. Furthermore, both transgender adolescents themselves and clinicians mention medical decision-making competence (MDC) as one of the main topics in the debate regarding treatment with PS [5,8,28].…”

Section: Introductionmentioning

confidence: 99%

Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians

Vrouenraets

Vries

Hannema

et al. 2022

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

According to international transgender care guidelines, transgender adolescents should have medical decision-making competence (MDC) to start puberty suppression (PS) and halt endogenous pubertal development. However, MDC is a debated concept in adolescent transgender care and little is known about the transgender adolescents', their parents', and clinicians' perspectives on this. Increasing our understanding of these perspectives can improve transgender adolescent care. A qualitative interview study with adolescents attending two Dutch gender identity clinics (eight transgender adolescents who proceeded to gender-affirming hormones after PS, and six adolescents who discontinued PS) and 12 of their parents, and focus groups with ten clinicians was conducted. From thematic analysis, three themes emerged regarding transgender adolescents' MDC to start PS: (1) challenges when assessing MDC, (2) aspects that are considered when assessing MDC, and (3) MDC's relevance. The four criteria one needs to fulfill to have MDC-understanding, appreciating, reasoning, communicating a choice-were all, to a greater or lesser extent, mentioned by most participants, just as MDC being relative to a specific decision and context. Interestingly, most adolescents, parents and clinicians find understanding and appreciating PS and its consequences important for MDC. Nevertheless, most state that the adolescents did not fully understand and appreciate PS and its consequences, but were nonetheless able to decide about PS. Parents' support of their child was considered essential in the decision-making process. Clinicians find MDC difficult to assess and put into practice in a uniform way. Dissemination of knowledge about MDC to start PS would help to adequately support adolescents, parents and clinicians in the decision-making process.

show abstract

Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

Cited by 46 publications

References 105 publications

How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool

How to deal with moral challenges around the decision-making competence in transgender adolescent care? Development of an ethics support tool

A response to puberty blockers for gender dysphoric youth: A lack of sound science

Medical decision-making competence regarding puberty suppression: perceptions of transgender adolescents, their parents and clinicians

Contact Info

Product

Resources

About