Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, Amsterdam, The Netherlands.
BMC Med Ethics. 2022 Sep 22;23(1):96. doi: 10.1186/s12910-022-00837-1.
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.
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.
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.
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.
在为跨性别和性别多样化的青少年提供护理时，决策能力是一个复杂的概念，因为这种护理涉及到一个人正在发展的性别认同，并且涉及到的治疗选择往往缺乏国际共识。即使进行了能力评估，决策过程中也会出现道德挑战。在这里，传统的临床伦理支持形式，如道德案例审议，可能不适用，因为它们没有提供主题指导。因此，本研究旨在开发一种面向实践的伦理支持工具，以帮助护理人员在处理跨性别青少年护理中决策能力方面的道德挑战时使用。
该研究采用参与式设计，与护理人员密切合作开发工具；他们在发展和传播的所有阶段都有发言权。首先，对 9 名护理人员进行了关于经验道德挑战和伦理支持需求的访谈。在此基础上，构建并讨论了工具的结构和内容，然后在两次焦点小组会议上进行了讨论，之后有 4 名护理人员测试了该工具，并从团队和咨询委员会收集了额外的反馈。最终的工具提交给了所有荷兰跨性别青少年护理的护理人员。
护理人员表示需要指导来定义和评估决策能力。主要的道德挑战涉及与年轻客户讨论生育选择、处理同时存在的心理健康问题以及父母的决策角色。最终的工具名为“能力顾问”，是一个包含四个部分的交互式 PDF：（1）澄清信息；（2）识别疑虑和道德问题；（3）指导对话；（4）概述和结论。
在一个有争议的护理环境中开发伦理支持工具非常重要，因为它旨在帮助个别护理人员在实际实践中定义、讨论和处理他们的道德挑战。为跨性别护理人员开发的“能力顾问”有助于提高他们的道德敏感性和道德能力。它是开发创新和综合主题伦理支持形式的一个例子。
