160 Chapter 9 1. How valuable do transgender care professionals evaluate MCD as CES, or in other words, what is their opinion of MCD? 2. What kind of change do MCD participants perceive after MCD sessions? 3. What recommendations can the interviewed professionals offer with respect to the future use of MCD? 4. Which MCD outcomes do the professionals hope to see when taking part in MCD sessions, and which MCD-related outcomes do they actually experience during MCD sessions and afterward in their daily work? METHOD Participants and procedure During the period when the data for this study were collected, from February 1, 2014, until April 13, 2015, there were two gender identity clinics offering gender-affirming medical treatment (GAMT) in the Netherlands. These were (1) the Centre of Expertise for Gender Dysphoria at the Amsterdam University Medical Centres, location VU University Medical Centre (VUmc) in Amsterdam, which offered care for children, adolescents, and adults; and (2) the clinical treatment for transgender adolescents clinic at Curium-Leiden University Medical Centre in Leiden, which offered care for children and adolescents. At both locations, specialists in child and adolescent psychiatry and psychology, endocrinology, and paediatric endocrinology worked in multidisciplinary teams. The two teams followed the same diagnostic and treatment procedures, had similar protocols, and regularly held joint meetings. In 2013, the board overseeing transgender clinical care in the Netherlands introduced MCD to complement the two teams’ regular care and decision-making processes. The aim was to create opportunities for the clinicians to thoroughly reflect on the moral dilemmas they faced in difficult cases. Therefore, MCD was only intermittently used by the transgender teams. In the period from October 2013 until January 2015, the two teams convened for nine joint meetings during which a total of 17 MCD sessions were held. During six of these joint meetings, two or three parallel MCD sessions were held, depending on the number of participants. In each of these parallel MCD sessions, a different case was discussed. We analysed six of these MCD sessions for this study. The sessions were led by trained and certified MCD facilitators employed by the Department of Medical Humanities of the Amsterdam University Medical Centres, location VUmc, which is responsible for all CES services at that institution. The sessions analysed in this study used the MCD dilemma method, which consists of the 10 steps listed in Appendix C (which can be found at page 224) of this study (for a detailed example of an MCD dilemma method see the paper of Stolper et al., 2016). Furthermore, clinicians from both teams completed a validated