179 Dealing with moral challenges in treatment for transgender children and adolescents: evaluating the role of moral case deliberation 9 CONCLUSION In this mixed method study, Dutch transgender clinicians evaluated the use of MCD as a form of ethics support. Although respondents were critical of the length of time spent on MCD, the lack of follow-up on insights gained from MCD sessions, and of the determining factors of the MCD sessions, they widely felt that it helped them to more effectively deal with moral challenges and that it contributed to improved mutual understanding, respect, and communication among their team members. Given the inherent ethical dimension of transgender care, especially in the care for children and adolescents in which the treatment can have life-long consequences, and where treatment decisions are often surrounded by complex moral controversies and uncertainties, MCD appears to be a valuable addition to current treatment models in transgender care. MCD offers a trained facilitator, who is neutral, and a specific conversation method that make it easier and more profound to reflect upon the moral dimension of specific complex decisions. During MCD, the professionals’ reasoning and knowledge are included, yet MCD makes (possible conflicts of) underlying norms and values explicit and gives suggestions how to handle the uncertainty or disagreement within a team. As such, MCD can be seen as an additional tool that can be used in complex cases. For future research, it would be worthwhile to compare the usual decision-making process by transgender teams with decision-making processes that include the use of MCD more systematically. Finally, more research is needed which focuses on the actual contribution of MCD to the improvement of care quality (including its determining factors), the involvement of transgender people in MCD, and on how to integrate CES more into daily work processes.
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