171 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 What recommendations can the interviewed professionals offer with respect to the future use of moral case deliberation? Structurally embedding moral case deliberation sessions Most participants recommended that MCD sessions be structurally embedded into regular interdisciplinary meetings. Most expressed a belief that structurally embedding MCD sessions would increase the successful use of MCD. Furthermore, some participants said they would appreciate the opportunity to hold ad hoc MCD sessions on urgent cases in their regular clinical work. However, others argued that it would be too difficult in practical terms to schedule such an ad hoc MCD session. “I wonder whether there will be a moral case deliberation session if you do not structurally embed it in your organization. Especially when it is with a large group, it is difficult to find a date for an ad hoc moral case deliberation session. I think that moral case deliberation is therefore more likely to succeed if we do it structurally, in regular interdisciplinary meetings.” - Individual interview with a clinician Training teammembers as moral case deliberation session facilitators Some participants said it would be of great value to have a colleague trained as an MCD session facilitator because this would make it easier to organize ad hoc MCD meetings. Others doubted whether this colleague could show the neutrality required of an MCD facilitator, because he or she would also be a member of the treatment team. “It would be good to have the expertise in-house. That would lower the threshold for an ad hoc moral case deliberation session.” - Focus group with clinicians “I wonder whether a member of the team can achieve the neutrality needed to be a facilitator of moral case deliberation sessions.” - Focus group with clinicians Using elements of moral case deliberation in other meetings Some participants saw the potential value of using elements of MCD to structure discussions in other meetings. The participants mentioned various steps of the dilemma method that they wanted to introduce as part of regular team meetings (such as brainstorming on alternatives and the table with norms and values for the various treatment or decision options). “One of the great things I find are the questions: ‘What are your alternatives?’ [and] ‘Are there alternatives?’ These are questions that could also be considered during regular meetings. What is the broad range of available options? Our discussions are often just yes or no.” - Individual interview with a clinician
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