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I Should’ve Been Able to Decide for Myself, but I Didn’t Want to Be Left Alone.” A Qualitative Interview Study of Clients’ Ethical Challenges and Norms Regarding Decision-Making in Gender-Affirming Medical Care

Bibliographic Data

ID11061872
AuthorsKarl Gerritse (0000-0001-8997-0596, Amsterdam UMC Location Vrije Universiteit Amsterdam, corresponding author), Casper Martens (0009-0006-2466-5770, Amsterdam UMC Location Vrije Universiteit Amsterdam), Marijke A Bremmer (0000-0002-0415-1127, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands), Baudewijntje P C Kreukels (0000-0002-9713-4835, Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands), Fijgje De Boer (0000-0003-4167-563X, Amsterdam UMC Location Vrije Universiteit Amsterdam), Bert C Molewijk (0000-0003-1944-9759, Amsterdam UMC Location Vrije Universiteit Amsterdam)
Year2024
Volume71
Issue7
Pages1757-1781
Publication date2024-06-06
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Homosexuality (JOURNAL)
Journal identifiersISSN: 0091-8369 • E-ISSN: 1540-3602
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/00918369.2023.2201972
PMID37097132
OpenAlexW4366984422
LanguageEN
Citations received1
References cited46

This qualitative study aimed to map and provide insight into the ethical challenges and norms of adult transgender and gender diverse (TGD) clients in gender-affirming medical care (GAMC). By doing so, we seek to make an empirical and constructive contribution to the dialogue on and moral inquiry into what good decision-making in GAMC should entail. We conducted 10 semi-structured interviews with adult Dutch TGD people who received GAMC. In our thematic analysis, we (1) included both ethical challenges and norms, (2) differentiated between explicit and implicit ethical challenges and norms, and (3) ascertained the specific context in which the latter emerged. We identified the following themes: (1) clients should be in the lead, (2) harm should be prevented, and (3) the decision-making process should be attuned to the individual client. These themes arose in the context of (1) a precarious client-clinician relationship and (2) distinct characteristics of GAMC. Our findings highlight divergent and dynamic decisional challenges and normative views-both within individual clients and among them. We conclude that there is no single ideal model of good decision-making in GAMC and argue that elucidating and jointly deliberating on decisional norms and challenges should be an inherent part of co-constructing good decision-making

Constructive · Context (archaeology · Empirical research · Epistemology · Ethical decision · Harm · Normative · Process (computing · Qualitative research · Social science · Sociology · Thematic analysis · Transgender · Computer Science · Feminist Epistemology and Gender Studies · LGBTQ Health, Identity, and Policy · Psychology · Reproductive Health and Technologies · Social Psychology

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Unique citing works1
Citations per year1
Citation span2026 - 2026 (1)
Citation velocitycurrent
Highly citedNo

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