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Gerritse K, Hartman LA, Bremmer MA, Kreukels BPC, Molewijk BC. Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:687-699. [PMID: 34008081 PMCID: PMC8557156 DOI: 10.1007/s11019-021-10023-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 05/10/2023]
Abstract
Over the past decades, great strides have been made to professionalize and increase access to transgender medicine. As the (biomedical) evidence base grows and conceptualizations regarding gender dysphoria/gender incongruence evolve, so too do ideas regarding what constitutes good treatment and decision-making in transgender healthcare. Against this background, differing care models arose, including the 'Standards of Care' and the so-called 'Informed Consent Model'. In these care models, ethical notions and principles such as 'decision-making' and 'autonomy' are often referred to, but left unsubstantiated. This not only transpires into the consultation room where stakeholders are confronted with many different ethical challenges in decision-making, but also hampers a more explicit discussion of what good decision-making in transgender medicine should be comprised of. The aim of this paper is to make explicit the conceptual and normative assumptions regarding decision-making and client autonomy underpinning the 'Standards of Care' and 'Informed Consent Model' currently used in transgender care. Furthermore, we illustrate how this elucidation aids in better understanding stakeholders' ethical challenges related to decision-making. Our ethical analysis lays bare how distinct normative ambiguities in both care models influence decision-making in practice and how foregrounding one normative model for decision-making is no moral panacea. We suggest that the first steps towards good decision-making in gender-affirming medical care are the acknowledgement of its inherent normative and moral dimensions and a shared, dialogical approach towards the decision-making process.
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Affiliation(s)
- Karl Gerritse
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
- Department of Ethics, Law and Humanities, Amsterdam UMC, location VUmc, de Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
- Department of Psychiatry, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - Laura A Hartman
- Department of Ethics, Law and Humanities, Amsterdam UMC, location VUmc, de Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
- The Netherlands Centre for Ethics and Health (CEG) and the Council of Public Health & Society (RVS) The Netherlands, Parnassusplein 5, 2511 VX, Den Haag, The Netherlands
| | - Marijke A Bremmer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Bert C Molewijk
- Department of Ethics, Law and Humanities, Amsterdam UMC, location VUmc, de Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
- Faculty of Medicine, Center for Medical Ethics, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
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