215 Summary 11 ethics support. MCD sessions were introduced in two Dutch treatment teams of gender identity clinics where specialists in child and adolescents psychiatry and psychology, and (paediatric) endocrinology worked in multidisciplinary teams. Between October 2013 and January 2015 the two teams participated in a total of 17 MCD sessions. The treatment team members evaluated the use of MCD. Data was collected using six individual interviews, two focus groups with in total 15 clinicians, a cross-sectional survey using an MCD evaluation questionnaire at two moments (T0, n = 34; T1, n = 22), and audiotapes of six MCD sessions. The clinicians rated MCD as highly valuable in situations when confronted with moral challenges. They reported that MCD helped them to more effectively deal with moral challenges, and that it contributed to improved mutual understanding and open communication among team members. Additionally, according to them, it made them pay closer attention to their own arguments and contextual factors, rather than blindly following the clinical protocol. Furthermore, it strengthened their ability to make decisions and take action when managing ethically difficult circumstances. However, the clinicians also made critical remarks about MCD: some felt that the amount of time spent discussing an individual case was excessive, that MCD should lead to more practical and concrete results, and that MCD and the insights gained during the MCD sessions needed better integration and follow-up in the regular work process. Especially in the care for transgender minors, treatment decisions are often surrounded by complex moral controversies and uncertainties. During MCD sessions, 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. More research focusing on the actual contribution of MCD to the improvement of care quality (including its determining factors), the involvement of transgender people in MCD sessions, and on how to integrate clinical ethics support more into daily work processes, is needed. Chapter 10 Ethical challenges and dilemmas are inextricably linked to transgender care, especially regarding the care of children and adolescents, and the possible life-long consequences of providing them with or refraining from early medical treatment. This is because it is a relatively new field, in which developments are rapid, there is still relatively little empirical data available on long-term outcomes, and it is a subject of a polarized debate. The challenges and dilemmas regarding early medical treatment for transgender minors, which were already expressed by clinicians about a decade ago, as described in our first article from 2015, only seem to have been enlarged and sharpened since then (Vrouenraets et al., 2015). Initially, these dilemmas seemed to be an issue only for those directly involved
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