Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Endegeesterstraatweg 27, 2342 AK, Oegstgeest, The Netherlands.
Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands.
Arch Sex Behav. 2020 Oct;49(7):2619-2634. doi: 10.1007/s10508-020-01762-3. Epub 2020 Jun 26.
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.
为年轻人提供肯定性医疗跨性别护理的治疗团队经常面临他们所提供的护理带来的道德挑战。例如，青少年的同意能力可能会引发几个问题和挑战。为了更有效地应对这些挑战，一些荷兰治疗团队开始使用一种相对成熟的临床伦理支持（CES）形式，称为道德案例审议（MCD）。MCD 是一种由促进者主导的、基于真实案例的集体道德探究。本研究的目的是描述团队对 MCD 的感知价值和有效性。我们使用 MCD 会议报告、个人访谈、焦点小组和 MCD 评估问卷进行了混合方法评估研究。我们的研究结果表明，荷兰跨性别护理提供者认为 MCD 在参与者面临道德挑战的情况下非常有价值。医疗保健提供者报告说，MCD 增加了团队成员之间的相互理解和开放沟通，并增强了他们在管理道德困境时做出决策和采取行动的能力。然而，医疗保健提供者也对 MCD 提出了批评：一些人认为讨论个别案例所花费的时间过多，MCD 应该产生更实际和具体的结果，并且 MCD 需要更好地融入和跟进日常工作流程。我们建议对以下三个方面进行未来研究：研究 MCD 如何有助于提高护理质量、跨性别者自身如何参与 MCD 以及 CES 如何融入日常工作流程。
