Integrative Clinical Ethics Support in Gender Affirmative Care: Lessons Learned

Laura Hartman,Bert Molewijk,Annelijn Wensing-Kruger,Guy Widdershoven,Thomas Steensma,Annelou de Vries,Martin den Heijer

doi:10.1007/s10730-019-09376-6

Abstract

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.

Highlights

A growing number of practitioners and experts see clinical ethics support (CES) for health care professionals and patients as part of good health care
We presented the preliminary outcomes to the Centre of Expertise on Gender Dysphoria (CEGD) team at a policy meeting, raising awareness of the variety of moral dilemmas the team faces and moral decisions it makes on a daily basis
These needs are not just the needs that are explicitly formulated by the CEGD team, they can be needs of the CEGD according to the CES staff

Summary

Introduction

A growing number of practitioners and experts see clinical ethics support (CES) for health care professionals and patients as part of good health care. The Centre of Expertise on Gender Dysphoria (CEGD) provides gender affirmative care for individuals who experience Gender Dysphoria (GD) in the Netherlands. 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

Objectives

Discussion

Conclusion