167 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 Extra time for reflection is important and useful The participants appreciated the time MCD offers for talking about problematic cases. They said this was particularly important because of the current cultural emphasis on efficiency; in general meetings, for instance, less time is available for exchanging viewpoints or discussing difficult cases. “Nowadays, with all the pressure to work as efficiently as possible, it is becoming even more important to set aside moments to discuss a difficult situation.” - Individual interview with a clinician “After all, transgender care is a subject surrounded by many controversies and one in which a lot of pressure is applied by parents, children, and interest groups. The topic is sometimes so fraught that it is helpful to put on the brakes now and then so we can discuss matters calmly first.” - Focus group with clinicians One participant reported having gotten a fresh perspective thanks to MCD. This individual remarked that professionals with more experience tend to work faster, but by applying previous experience to new situations, they run the risk of being blind to potentially different characteristics in these new situations. MCD sessions helped restore this participant’s sensitivity to the particularity of the case at hand. “Over time, you sort of put blinkers on, because similar cases appear and you do not have the time to really consider the case because of your busy schedule. You do not have time to think. That really is a problem.” - Individual interview with a clinician Critical remarks about moral case deliberation The tempo is sometimes too slow and the sessions last too long In MCD sessions, every participant is actively encouraged to contribute. A couple of participants characterized themselves as goal-oriented and said they were frustrated by the length of the deliberations, especially when they felt that participants were repeating a certain point that had already been discussed. “Sometimes I get the feeling that we know what our goal is, and we could get there faster. Maybe it is necessary to involve the whole group in a deliberation, but sometimes I find it frustrating that it takes so long.” - Individual interview with a clinician Discussing several similar cases in succession gives less insight MCD requires an organization to invest a certain amount of time, so some participants questioned whether MCD was worth the time investment. Some participants said they