Loading…
Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications
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 deci...
Saved in:
Published in: | Medicine, health care, and philosophy health care, and philosophy, 2021-12, Vol.24 (4), p.687-699 |
---|---|
Main Authors: | , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323 |
---|---|
cites | cdi_FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323 |
container_end_page | 699 |
container_issue | 4 |
container_start_page | 687 |
container_title | Medicine, health care, and philosophy |
container_volume | 24 |
creator | Gerritse, Karl Hartman, Laura A. Bremmer, Marijke A. Kreukels, Baudewijntje P. C. Molewijk, Bert C. |
description | 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. |
doi_str_mv | 10.1007/s11019-021-10023-6 |
format | article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8557156</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2528919100</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323</originalsourceid><addsrcrecordid>eNp9UU1v1DAUtBAVLQt_gAOKxKUXt_6IY6eHSqiFUqkSFzhbb70vG5fETu0Eqf8eL1sK7QH54LHfvPHzDCHvODvhjOnTzDnjLWWC03IWkjYvyBFXWlDTSPmyYGkaqmshD8nrnG8ZY9ww9Yocypoxwww_IutLdD77GOgIP3zYVjBNKYLrMVc-VHOCkLcYNpiqHmGYewcJzyoXg8NpXmCoIMBwn30uYFPh3HtXLv04DQXMRTi_IQcdDBnfPuwr8v3zp28XX-jN16vri4831NW6nqngHWhwGwVraSQK1TqhdK2hlpwLqY3odL0Gw5sGuaiVMgBaNV3ToTOtFHJFzve607IeceMwlOkHOyU_Qrq3Ebx9Wgm-t9v40xqlNFdNETh-EEjxbsE829Fnh8MAAeOSrVDCtLwtXhfqh2fU27ik4sSOZYwpzpe1ImLPcinmnLB7HIYzu4vQ7iO0JUL7O0K7m-L9v994bPmTWSHIPSGXUthi-vv2f2R_AUZkqCA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2588813838</pqid></control><display><type>article</type><title>Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications</title><source>Springer Nature</source><source>Art, Design & Architecture Collection</source><creator>Gerritse, Karl ; Hartman, Laura A. ; Bremmer, Marijke A. ; Kreukels, Baudewijntje P. C. ; Molewijk, Bert C.</creator><creatorcontrib>Gerritse, Karl ; Hartman, Laura A. ; Bremmer, Marijke A. ; Kreukels, Baudewijntje P. C. ; Molewijk, Bert C.</creatorcontrib><description>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.</description><identifier>ISSN: 1386-7423</identifier><identifier>EISSN: 1572-8633</identifier><identifier>DOI: 10.1007/s11019-021-10023-6</identifier><identifier>PMID: 34008081</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Conceptual analysis ; Decision Making ; Delivery of Health Care ; Education ; Ethical Analysis ; Ethics ; Gender ; Health care ; Humans ; Informed Consent ; Medical Law ; Morals ; Philosophy ; Philosophy of Biology ; Philosophy of Medicine ; Scientific Contribution ; Theory of Medicine/Bioethics ; Transgender Persons</subject><ispartof>Medicine, health care, and philosophy, 2021-12, Vol.24 (4), p.687-699</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323</citedby><cites>FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323</cites><orcidid>0000-0001-7500-2164 ; 0000-0002-0415-1127 ; 0000-0002-9713-4835 ; 0000-0003-1944-9759 ; 0000-0001-8997-0596</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2588813838/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2588813838?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,776,780,881,12840,27901,27902,34752,34753,44176,74698</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34008081$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gerritse, Karl</creatorcontrib><creatorcontrib>Hartman, Laura A.</creatorcontrib><creatorcontrib>Bremmer, Marijke A.</creatorcontrib><creatorcontrib>Kreukels, Baudewijntje P. C.</creatorcontrib><creatorcontrib>Molewijk, Bert C.</creatorcontrib><title>Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications</title><title>Medicine, health care, and philosophy</title><addtitle>Med Health Care and Philos</addtitle><addtitle>Med Health Care Philos</addtitle><description>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.</description><subject>Conceptual analysis</subject><subject>Decision Making</subject><subject>Delivery of Health Care</subject><subject>Education</subject><subject>Ethical Analysis</subject><subject>Ethics</subject><subject>Gender</subject><subject>Health care</subject><subject>Humans</subject><subject>Informed Consent</subject><subject>Medical Law</subject><subject>Morals</subject><subject>Philosophy</subject><subject>Philosophy of Biology</subject><subject>Philosophy of Medicine</subject><subject>Scientific Contribution</subject><subject>Theory of Medicine/Bioethics</subject><subject>Transgender Persons</subject><issn>1386-7423</issn><issn>1572-8633</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>K50</sourceid><sourceid>M1D</sourceid><recordid>eNp9UU1v1DAUtBAVLQt_gAOKxKUXt_6IY6eHSqiFUqkSFzhbb70vG5fETu0Eqf8eL1sK7QH54LHfvPHzDCHvODvhjOnTzDnjLWWC03IWkjYvyBFXWlDTSPmyYGkaqmshD8nrnG8ZY9ww9Yocypoxwww_IutLdD77GOgIP3zYVjBNKYLrMVc-VHOCkLcYNpiqHmGYewcJzyoXg8NpXmCoIMBwn30uYFPh3HtXLv04DQXMRTi_IQcdDBnfPuwr8v3zp28XX-jN16vri4831NW6nqngHWhwGwVraSQK1TqhdK2hlpwLqY3odL0Gw5sGuaiVMgBaNV3ToTOtFHJFzve607IeceMwlOkHOyU_Qrq3Ebx9Wgm-t9v40xqlNFdNETh-EEjxbsE829Fnh8MAAeOSrVDCtLwtXhfqh2fU27ik4sSOZYwpzpe1ImLPcinmnLB7HIYzu4vQ7iO0JUL7O0K7m-L9v994bPmTWSHIPSGXUthi-vv2f2R_AUZkqCA</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Gerritse, Karl</creator><creator>Hartman, Laura A.</creator><creator>Bremmer, Marijke A.</creator><creator>Kreukels, Baudewijntje P. C.</creator><creator>Molewijk, Bert C.</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>88H</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>AABKS</scope><scope>ABSDQ</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AVQMV</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K50</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1D</scope><scope>M1P</scope><scope>M2N</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PEJEM</scope><scope>PGAAH</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PMKZF</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7500-2164</orcidid><orcidid>https://orcid.org/0000-0002-0415-1127</orcidid><orcidid>https://orcid.org/0000-0002-9713-4835</orcidid><orcidid>https://orcid.org/0000-0003-1944-9759</orcidid><orcidid>https://orcid.org/0000-0001-8997-0596</orcidid></search><sort><creationdate>20211201</creationdate><title>Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications</title><author>Gerritse, Karl ; Hartman, Laura A. ; Bremmer, Marijke A. ; Kreukels, Baudewijntje P. C. ; Molewijk, Bert C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Conceptual analysis</topic><topic>Decision Making</topic><topic>Delivery of Health Care</topic><topic>Education</topic><topic>Ethical Analysis</topic><topic>Ethics</topic><topic>Gender</topic><topic>Health care</topic><topic>Humans</topic><topic>Informed Consent</topic><topic>Medical Law</topic><topic>Morals</topic><topic>Philosophy</topic><topic>Philosophy of Biology</topic><topic>Philosophy of Medicine</topic><topic>Scientific Contribution</topic><topic>Theory of Medicine/Bioethics</topic><topic>Transgender Persons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gerritse, Karl</creatorcontrib><creatorcontrib>Hartman, Laura A.</creatorcontrib><creatorcontrib>Bremmer, Marijke A.</creatorcontrib><creatorcontrib>Kreukels, Baudewijntje P. C.</creatorcontrib><creatorcontrib>Molewijk, Bert C.</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Religion Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>Philosophy Collection</collection><collection>Philosophy Database</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Arts Premium Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Art, Design & Architecture Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Arts & Humanities Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Religion Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Visual Arts & Design</collection><collection>ProQuest One Religion & Philosophy</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest Digital Collections</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medicine, health care, and philosophy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gerritse, Karl</au><au>Hartman, Laura A.</au><au>Bremmer, Marijke A.</au><au>Kreukels, Baudewijntje P. C.</au><au>Molewijk, Bert C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications</atitle><jtitle>Medicine, health care, and philosophy</jtitle><stitle>Med Health Care and Philos</stitle><addtitle>Med Health Care Philos</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>24</volume><issue>4</issue><spage>687</spage><epage>699</epage><pages>687-699</pages><issn>1386-7423</issn><eissn>1572-8633</eissn><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.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>34008081</pmid><doi>10.1007/s11019-021-10023-6</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-7500-2164</orcidid><orcidid>https://orcid.org/0000-0002-0415-1127</orcidid><orcidid>https://orcid.org/0000-0002-9713-4835</orcidid><orcidid>https://orcid.org/0000-0003-1944-9759</orcidid><orcidid>https://orcid.org/0000-0001-8997-0596</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1386-7423 |
ispartof | Medicine, health care, and philosophy, 2021-12, Vol.24 (4), p.687-699 |
issn | 1386-7423 1572-8633 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8557156 |
source | Springer Nature; Art, Design & Architecture Collection |
subjects | Conceptual analysis Decision Making Delivery of Health Care Education Ethical Analysis Ethics Gender Health care Humans Informed Consent Medical Law Morals Philosophy Philosophy of Biology Philosophy of Medicine Scientific Contribution Theory of Medicine/Bioethics Transgender Persons |
title | Decision-making approaches in transgender healthcare: conceptual analysis and ethical implications |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-16T22%3A09%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Decision-making%20approaches%20in%20transgender%20healthcare:%20conceptual%20analysis%20and%20ethical%20implications&rft.jtitle=Medicine,%20health%20care,%20and%20philosophy&rft.au=Gerritse,%20Karl&rft.date=2021-12-01&rft.volume=24&rft.issue=4&rft.spage=687&rft.epage=699&rft.pages=687-699&rft.issn=1386-7423&rft.eissn=1572-8633&rft_id=info:doi/10.1007/s11019-021-10023-6&rft_dat=%3Cproquest_pubme%3E2528919100%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c474t-21fa7acd5ab383e259c25747a431123782f74ba8166e124558aa756f6fec89323%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2588813838&rft_id=info:pmid/34008081&rfr_iscdi=true |