Narratives of Regret: Resisting Cisnormative and Bionormative Biases in Fertility and Family Creation Counseling for Transgender Youth

2021 ◽  
Vol 14 (2) ◽  
pp. 157-179
Author(s):  
Beth A. Clark
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Hormone Therapy ◽  
Healthcare Providers ◽  
Healthy Development ◽  
Ethical Concerns ◽  
Transgender Youth ◽  
Trans Youth

Gender-affirming hormone therapy is increasingly available to support healthy development of transgender (trans) youth, but ethical concerns have been raised regarding fertility-related implications. In this article, I present data from an exploratory qualitative study of the decision-making experiences of trans youth, parents of trans youth, and healthcare providers serving trans youth related to fertility and family creation. I discuss how cisnormative and bionormative biases can impact care and contribute to ethically problematic narratives of regret. Finally, I offer recommendations to support ethically sound, gender-affirmative fertility and family creation counseling with transgender youth.

scholarly journals This Wasn’t a Split-Second Decision”: An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy

2021 ◽  
Author(s):  
Beth A. Clark ◽  
Alice Virani
Keyword(s):  
Decision Making ◽  
Hormone Therapy ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Best Interests ◽  
Legal Authority ◽  
Capacity To Consent ◽  
Decision Making Capacity ◽  
The Right ◽  
Trans Youth

AbstractInherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender (trans) youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent to hormone therapy and to address the normative question of whether there is ethical justification for granting trans youth the authority to consent to this care. Through qualitative content analysis of interviews with trans youth, parents, and healthcare providers, we found that trans youth demonstrated the understandings and abilities characteristic of the capacity to consent to hormone therapy and that they did consent to hormone therapy with positive outcomes. Employing deontological and consequentialist reasoning and drawing on a foundation of empirical evidence, human rights, and best interests we conclude that granting trans youth with decisional capacity both the right and the legal authority to consent to hormone therapy via the informed consent model of care is ethically justified.

scholarly journals Lack of autonomy in facility-based births makes women become absentees of maternity services in Somaliland fragile contexts - a qualitative study

2021 ◽  
Author(s):  
Jama Ali Egal ◽  
Amina Essa ◽  
Rahma Yusuf ◽  
Fadumo Osman ◽  
Marie Klingberg- Allvin ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Healthcare Providers ◽  
Medical Knowledge ◽  
Care Seeking ◽  
Place Of Birth ◽  
Maternity Services ◽  
Risk Pregnancy ◽  
Respectful Care

Abstract ObjectiveSomaliland has high levels of both maternal and infant mortality. This has been attributed, in part, to the fact that nearly 80% of births in the country take place at home, with women assisted by Traditional Birth Attendants (TBA) who have limited medical knowledge when it comes to obstetric complications. In this study we aim to capture multipara women’s decision-making when choosing the place of birth, illuminated by their experiences of maternity services in SomalilandDesignAn explorative qualitative approach using individual interviews conducted in Somaliland with 25 multiparous women who had experience of both a home and facility-based birth within the last three years.FindingsThe main finding of this study was the description of how valuable autonomy and respectful care were for Somaliland women. Respectful care and the cost of maternity services were vital parts of women’s autonomous decision-making when choosing a place of birth. Disrespectful care in maternity services made low-risk pregnancy women chose homebirth instead of a health facility birth. Women who had previous high-risk pregnancies that suggested they should be returnees to facility-based antenatal care, were still planning for a homebirth as their first choice.Key conclusionThis qualitative study was conducted in the fragile context of Somaliland and suggest a need to transform maternal and child health clinics into midwifery-led birthing centers that promote natural birth. It is further important to create new roles and responsibilities for TBAs that link them to the formal health system assuring timely health care seeking during pregnancy and in relation to delivery. There is a need to conduct a country-wide study on the availability and distribution of healthcare providers and to construct a long-term sustainable plan to assure quality and equal access to maternal health care in the country.

Conditions for shared decision making in the care of transgender youth in Canada

2020 ◽  
Author(s):  
Beth A Clark ◽  
Alice Virani ◽  
Sheila K Marshall ◽  
Elizabeth M Saewyc
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Hormone Therapy ◽  
Shared Decision Making ◽  
Theory Approach ◽  
Shared Decision ◽  
Open Communication ◽  
Decision Making Processes ◽  
Trans Youth

Abstract Information is lacking on the role shared decision making plays in the care of transgender (trans) youth. This qualitative, descriptive study explored how trans youth, parents and health care providers engaged or did not engage in shared decision-making practices around hormone therapy initiation and what conditions supported shared decision-making approaches in clinical practice. Semi-structured interviews were conducted with 47 participants in British Columbia, Canada, and analyzed using a constructivist grounded theory approach. While formal shared decision-making models were not used in practice, many participants described elements of such approaches when asked about their health care decision-making processes. Others described health care interactions that were not conducive to a shared decision-making approach. The key finding that emerged through this analysis was a set of five conditions for supporting shared decision making when making decisions surrounding initiation of hormone therapy with trans youth. Both supportive relationships and open communication were necessary among participants to support shared decision making. All parties needed to agree regarding what decisions were to be made and what role each person would play in the process. Finally, adequate time was needed for decision-making processes to unfold. When stakeholders meet these five conditions, a gender-affirming and culturally safer shared decision-making approach may be used to support decision making about gender-affirming care. Implications for clinical practice and future research are discussed.

scholarly journals Shared decision making in early knee osteoarthritis: A qualitative study of older adults and healthcare providers

2016 ◽  
Vol 24 ◽  
pp. S234-S235 ◽  
Author(s):  
A.J. Zbehlik ◽  
N.B. Riblet ◽  
M.E. Meinke ◽  
R.L. Pepin ◽  
R. Akkineni ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Qualitative Study ◽  
Knee Osteoarthritis ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Shared Decision

Hormone therapy decision-making processes: Transgender youth and parents

2020 ◽  
Vol 79 ◽  
pp. 136-147
Author(s):  
Beth A. Clark ◽  
Sheila K. Marshall ◽  
Elizabeth M. Saewyc
Keyword(s):  
Decision Making ◽  
Hormone Therapy ◽  
Transgender Youth ◽  
Therapy Decision ◽  
Decision Making Processes

What do new neuroscience discoveries in children mean for their open future?

2017 ◽  
Author(s):  
Cheryl D. Lew
Keyword(s):  
Decision Making ◽  
Moral Agency ◽  
Structural Changes ◽  
Fetal Life ◽  
Open Future ◽  
Ethical Concerns ◽  
Pediatric Ethics ◽  
Pediatric Decision Making ◽  
New Research ◽  
Pediatric Healthcare

Over the last decade, the number of neuroimaging and other neuroscience studies on the developing brain from fetal life through adolescence has increased exponentially. Children are viewed as particularly vulnerable members of our society and observations of significant neural structural changes associated with behavioral anomalies raise numerous ethical concerns around personal identity, free will, and the possibility of an open future. This chapter provides a review of recent research in the pediatric neuroscience literature, common pediatric decision-making, and social justice models, and discusses the implications of this research for the future of pediatric ethics thinking and policy. New research presents challenges to professional and pediatric bioethicist views of the moral future of children in pediatric healthcare and opportunities to examine anew notions of how to consider the developing moral agency of children.

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