169 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 “I wonder whether this [giving more thought to a case and asking more constructive questions regarding the case] is due to the [method] moral case deliberation or due to the fact that we have taken time for each case. The fact that we talked about one patient for an hour and a half is in itself enormously valuable. That is independent of the method used. Normally, we would never do that.” - Focus group with clinicians What kind of change do moral case deliberation participants perceive after moral case deliberation sessions? Changes in treatment decisions Some participants reported that they changed treatment plans because of a discussion in an MCD session. After the MCD session in question, some teammembers who were treating a particular patient held a small meeting about the MCD’s results and its implications for the individual treatment plan. They subsequently called the patient in and elaborated on their new treatment plan. “After the moral case deliberation session, we made another decision […] a different policy was applied […] instead of prescribing puberty suppression treatment [in accordance with the adolescent protocol] to an adolescent aged 17.5 years, we decided to not prescribe any medical treatment at that moment. But instead, we let the adolescent start treatment with gender-affirming hormones when he turned 18, following the adult protocol […] we are talking about a concrete change, with concrete conditions. Furthermore, a concrete policy has emerged from it. Different from what our local protocol suggests and different from what was discussed earlier with the patient.” - Individual interview with a clinician Learning effects in moral case deliberation sessions and outside Participants attributed several learning effects to MCD. The teams grew more experienced with the specific method which helped them get to the heart of a case sooner. “The repetition of the dilemma method enables you to get to the heart of the case and its policy more quickly. We are internalizing the method more and more, now that we have used it several times.” - Focus group with clinicians Thorough analysis of a particular case helped team members deal with similar cases. Some participants reported having become more aware of certain issues after they were discussed in an MCD session. They reported reacting more adequately to similar situations thanks to the discussion they had held in MCD.