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

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

doi:10.1007/s10508-018-1287-3

Karl Gerritse, Marte Fleur Antonides + Show 4 more

Open Access

https://doi.org/10.1007/s10508-018-1287-3

Copy DOI

Abstract

Treatment teams providing transgender-affirming medical care are inherently faced with various kinds of moral and ethical dilemmas and questions, which are becoming even more pressing due to increasing treatment numbers and public attention for transgender care. Little is known about what kinds of moral and ethical challenges manifest in clinical practice. The aim of the present research was to map the moral and ethical challenges of healthcare professionals working in a specialized multidisciplinary transgender care center. Over a period of 7 months, during a focused ethnographic study, data were collected through participant observation of multidisciplinary team meetings, observation of individual psychodiagnostic assessment sessions with clients, and analysis of transcripts and reports of a series of moral case deliberations. A thematic content analysis of the data identified various implicit and explicit moral and ethical challenges around the following six themes: (1) assessing eligibility; (2) content of treatment; (3) sequential order of the treatment steps; (4) role of the clinical guidelines; (5) differing notions regarding gender identity, and (6) decision-making process. Our research provides a detailed insight into the way healthcare professionals experience these moral and ethical challenges and how they are related to (local) guidelines, the multidisciplinary character of GD care, and its inherent implicit and explicit gender norms. Our findings suggest that good transgender care may profit from continuous multidisciplinary deliberation of and sensitivity toward the normative dimension of transgender care. The paper ends with recommendations for ethics support mechanisms in transgender care.

Highlights

In countries where healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM), those who experience distress due to incongruence between one’s experienced gender identity and sex assigned at birth may meet the criteria for a diagnosis of gender dysphoria (GD) (American Psychiatric Association, 2013)
Six main themes of moral challenges in transgender-affirming medical care were identified in the data: (1) assessing eligibility; (2) content of treatment; (3) sequential order of the treatment steps; (4) role of the guidelines; (5) notions regarding gender identity/GD, and (6) decisionmaking process
It is important to note that the quotes from individual employees and observations do not necessarily reflect the views of the Care for Gender Dysphoria (CEGD)

Summary

Introduction

In countries where healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM), those who experience distress due to incongruence between one’s experienced gender identity and sex assigned at birth may meet the criteria for a diagnosis of gender dysphoria (GD) (American Psychiatric Association, 2013). Moral challenges are here defined as situations in which the stakeholder who experiences the challenge is. In the literature on gender-affirming medical care various moral and ethical challenges have been described ranging from theoretical and taxonomical to more pragmatic and clinical. The latter are challenges such as how to go about issues of assent in the case of transgender clients suffering from comorbidity such as autism (Shumer & Tishelman, 2015), or more implicit ones such as whether it is ethically permissible to offer puberty suppression to adolescents, given that its medical and psychosocial risks have not been fully established (Vrouenraets, Frederiks, Hannema, CohenKettenis, & de Vries, 2016)

Objectives

Methods

Results

Conclusion